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No recovery without reform

We have warned MSPs that the pandemic has had an unparalleled impact on NHS dentistry, leaving the service facing an existential threat.

Speaking to the COVID 19 Recovery Committee Inquiry into NHS Dental Services, we have spelled out the facts, armed with data on the scale of the backlogs facing high street dentists.

As a result of the initial closure to routine care, and then facing exacting infection and prevention control guidelines that reduced patient throughput, lost capacity on the high street exceeds general medical practice and secondary care, resulting in backlogs that will take many years to clear.

Dentistry has lost over half of its capacity since lockdown, when comparing examinations delivered since March 2020 with typical levels pre-COVID. For face-to-face appointments at GPs, that figure is just over 30%. It is just over 6% for hospital outpatients and in terms of volume, inpatient care appears to have already recovered lost ground.

By any measure captured in official data, whether it is examinations or Statement of Dental Remuneration (SDR) activity claims, Scotland has lost more than a year's worth of NHS dentistry.

Ongoing access problems are fuelling backlogs, with patients presenting with higher levels of clinical need. Our survey shows over two thirds of dentists cite higher needs patients requiring more clinical time as a key issue on return to 'full' capacity. The only comparable problems are those concerning recruitment and retention of dentists.

David McColl chair of the Scottish Dental Practice Committee told the COVID 19 Recovery Committee Inquiry, recovery was impossible without reform.

"The low margin/high volume model the service works to is incompatible with working through the pandemic" he said, "and cannot form the basis for a meaningful or sustainable recovery."

This leaves the service at a crossroads, with a contract that is unfit for purpose, underfunded, overstretched, and facing the challenge of deep and widening oral health inequalities. We fear that an exodus of dentists from the NHS is already in motion. This shift is going unseen in official data, that counts heads rather than the amount of NHS work dentists carry out.

According to member feedback only 1 in 5 practices appear to have returned to pre-COVID-19 capacity. Hard limits on restoring capacity, and the existential threats to NHS dental services require a proportionate response from the Scottish Government.

In the final evidence session, the inquiry quizzed the Minister and the Chief Dental Officer.

The topics from widening oral health inequalities, to prevention and practice sustainability reflect many of the thousands of messages members have sent to MSPs.

The committee has now submitted a list of recommendations to the Scottish Government, pressing for clarity on reform and finance. Together, we are being heard.