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What does payment reform mean for you?

It’s change, but not wholesale reform for Scotland as a new Determination I of the Statement of Dental Remuneration (SDR) lands.

Rolling out from 1 November, this is the result of tense negotiation with the Scottish Government. These were confidential in nature and further information can be found on scottishdental.org.

Much has changed, with the new Determination I, there are now just 45 items for general dentistry, purportedly to make it less burdensome. Orthodontic items have not been reviewed as part of this process and the item 32 items have been retained. The PCA (D) (2023)4 introduces the changes and lists the items and associated fees.

We stressed that surging costs have left practices delivering some NHS care at a financial loss, particularly for items like dentures that require laboratory work, and as a result these items come with significant increases in fee levels. 

The fees also incorporate the DDRB uplift of 6% on fee items and Capitation and Continuing Care payments. The pay award will be implemented with reform on 1 November and backdated payments will be made, including the value of ‘bridging’ payments from 1 April to 31 October 2023.

All items, unless stated otherwise, can be claimed for both adults and children where clinically appropriate. Patients who pay for their treatment will continue to pay 80% of the cost up to a maximum of £384 per course of treatment. 

The prior approval limit will also be increased to £600 for courses of treatment opened on or after 1 November 2023, a move the Scottish Government claim will provide for more clinical freedom.
We are told an FAQ for the new Determination I is in development. Questions about the new SDR should be emailed to [email protected]. Officials have promised that educational guides and webinars to support dental teams in using the new Determination I will also be available and will be published on Turas in early Autumn.

We have worked to secure improvements; however, these changes do not represent a break from an outdated model of care.

There is real uncertainty over whether reform will be sufficient to halt the exodus of dentists from the NHS, restore access to anything resembling ‘normal’, or narrow widening inequalities. Certainly, we pressed for movement towards a patient-centred and prevention-focused model.

The Scottish Parliament COVID Recovery Committee recently concluded its inquiry into the recovery of NHS dentistry. And MSPs have called on the Scottish Government to provide costings for – and consult on – different service model options, including those that it does not prefer, in partnership with the sector. Like us, they don’t want the opportunity to be missed to consider a full range of options for the future of NHS delivery.

Ministers must not view this package as a final destination for NHS dentistry in Scotland. 

“The Scottish Government have stuck with a drill and fill model designed in the 20th century says Scottish Dental Practice Committee Chair, David McColl who led negotiations. “They were unwilling to even start a conversation on making this service fit for the 21st.”

We will support our members during this transition, but we will continue to push for the change we need.