They discussed the need for ongoing financial support for dental practices with the prospect of the removal of the multiplier pandemic support.
The Health Minister's letter to the profession on 23 September outlines how contract holders will receive temporary 'bridging' funding, following cessation of the multiplier, which operated at 1.3 for Q2. The bridging payments will be set at a rate of 1.2 for Q3, and just 1.1 for Q4 of FY 2022-23. These bridging payments will replace both the multiplier payment and the General Dental Practice Allowance (GDPA) legacy enhancement payment. SDPC subsequently resolved that the bridging payments are insufficient to sustain all the treatments currently available in the SDR.
Scottish Government had notified the profession of a 4.5% pay rise and contract uplift from 1 November 2022. However, this increase does not factor in escalating costs such as inflation, energy price hikes, increasing laboratory costs and higher staff wages. With RPI currently running at 12.3%, this year's award of 4.5% will not be sufficient for practices to afford a full range of treatments.
The reality is that denture repairs currently incur a lab fee of approximately £26.40, with a current Statement of Dental Remuneration (SDR) fee of £24.24, reducing to £22.22 in December. It is untenable to expect dentists to provide treatments at a loss and practitioners are concerned about breaching treatment regulations. To make matters worse many acrylic labs have now stopped providing NHS services. We have informed Mr Yousaf that an amendment to the regulations and terms of service would be needed to reflect this situation. Meanwhile our advice to members is to be mindful of and follow the current General Dental Services (2010) Regulations (Terms of Service for Dentists Paragraph 22).
We are very clear that there is no financial headroom for cross-subsidy between different elements of the SDR and the GDPA. In fact, if inflation continues into next year at current levels there will be more elements of the SDR that won't cover the growing costs.
There are a few options open to practice owners to maintain NHS dentistry provision; although for how long these options would help financial viability is unfathomable. One option is de-registration of non-attending patients on the lower levels of registration. Such patients currently have the same access to emergency care as those who attend regularly. Although this would reduce registration levels, it would also remove a considerable administration burden and a substantial amount of abuse from patients, both of which are a drain on staff and resources.
In his letter, the Cabinet Secretary suggested that greater support for expenses in the future could come about following an open book exercise. Apart from being commercially intrusive, this is a sledgehammer to crack a nut. Given there are very specific issues around items of service prices and costs of lab bills we recommend the government goes directly to dental labs for a list of charges and accept these figures as evidence. This direct approach would be far more efficient and accurate.
We will continue to press home to the government the very simple truths – that practice owners cannot afford to operate NHS dentistry at a loss. Given the current financial climate there will be inevitable pressures on some practices to consider handing back their NHS contracts if the contractual and remuneration prospects for next financial year continue in the same vein.