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NHS dentistry: Reform must not be a final destination

The British Dental Association has said Scottish Government reforms to NHS dentistry fall short of the root and branch change required to make the service fit for the 2020s.

Following tense negotiations, a reformed payment system will be rolled out from 1 November 2023. This includes changes to the fees provided for many treatments and will see the number of items on the ‘menu’ at dental practices slimmed down – purportedly meant to make it less burdensome – to 45 codes down from around 400. The BDA had stressed that surging costs had left practices delivering some NHS care at a financial loss, particularly for items like dentures that require laboratory work. These items have seen significant increases in fee levels.

However, the professional body has stressed reforms offer no fundamental changes to the current model of care. The service is still predicated on a low margin/high volume system, without the appropriate targeting of resources for those in highest need. The BDA had been seeking a clean break towards a new patient-centred and prevention-focused model and say the package as it stands will do little to tackle deep oral health inequality across Scotland.

Dentist leaders have warned ministers not to view the current package as a “final destination.” There is uncertainty over whether these changes will be sufficient to halt the exodus of dentists from NHS services and restore access to millions.

The Scottish Parliament COVID Recovery Committee recently concluded its inquiry into the recovery of NHS dentistry, including a recommendation that the Scottish Government provide costings for – and consults on – different service model options, including those that it does not prefer, in partnership with the sector so that the opportunity is not missed to consider a full range of options for the future of service delivery.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said:

“We’ve secured some improvements, but the fundamentals of a broken system remain unchanged.

“The Scottish Government have stuck with a drill and fill model designed in the 20th century. They were unwilling to even start a conversation on making this service fit for the 21st.

“Ministers cannot pretend this is a final destination for NHS dentistry in Scotland. We struggle to see how these changes alone will close the oral health gap, end the access crisis or halt the exodus from the NHS.”