What are the practicalities of lobbying for change? David McColl and Kenny McDonald discuss what’s next on the agenda for improving dentistry in Scotland.
We’re fighting to keep dentistry at the heart of policymaking in Scotland.
“We remain the only dental association that any Scottish Government... will negotiate with”
So far we have achieved some hard-won successes. But our ultimate goal, to revolutionise dentistry through major structural change, cannot happen overnight.
However, it is within our grasp. We remain the only dental association that any Scottish government, present and future, will negotiate with. Progress at times can feel slow and arduous but we believe we will get there.
The cross-party support we have received ahead of today’s elections has made it clear that our concerns are being heard and shared by all parties.
The realities of achieving change within the system
Achieving real change through lobbying requires consistent commitment over time. It’s a complex process with weeks of meetings and reams of emails required, covering the broadest possible spectrum of essential issues. There is no one single binary decision, no single moment when we have convinced the machine of government of what must be done for dentistry.
We and our BDA colleagues receive dozens of emails each day from concerned fellow practitioners. We share your frustrations, but incremental improvements are the reality of success in our political system.
And even with success, we don’t stop. Because we know there is always more that can be done. Here’s just some of the areas in which we continue to lobby, even where we have already achieved real change and improvements:
Putting oral health on the agenda
We were proud to see
the impact of our campaigning on the manifestos of the parties ahead of today’s elections.
We’ve consistently made a strong case for dental health being essential to overall health and have been a clear and resounding voice at Holyrood throughout this crisis, keeping dentistry – public and private – on the agenda in Scotland.
If re-elected the SNP have promised to improve access to dentistry by abolishing all NHS dentistry charges over the course of the parliament. They have further promised to engage with the BDA to help shape a reformed funding arrangement so that NHS dentists are supported for the future. If the SNP forms the next government, this stands us in good stead to hold them to account on pledges made.
A fair outcome for dental students
calls to financially support dental students who were facing an extended period of study were heeded earlier this year.
When the lack of clinical contact last year meant that graduations were going to be deferred, we sent an open letter to Ministers calling for student support. The government responded with the announcement of a bursary of up to £6,750 for students at Aberdeen, Dundee and Glasgow dental schools.
We also secured subsequent confirmation from the government that the financial support would be offered to Aberdeen students on a pro-rata basis, and to students from the rest of the UK and to international students.
Deferring the tiered payment system
We welcomed the deferment of the new tiered payments system, which the government wanted to introduce back in January 2021.
This would have come at an ineffective and inappropriate time, with the amount of fallow time still required and Scotland facing tighter national restrictions. As a result of our negotiations, now a three-month rolling average is to be introduced in June/July instead.
Securing more sustainable support funding
We are currently lobbying for a new Covid support funding model.
“We have made it clear to the government that the current financial support arrangements are not fit for purpose.”
We have made it clear to the government that the current financial support arrangements are not fit for purpose and are causing problems for many dental professionals. This was particularly the case for pregnant dentists who were being financially disadvantaged by the Covid support funding model. The government agreed to review its
system for calculating maternity payments.
The new payment system will also apply to paternity and adoptive leave, and long-term sick leave. We continue to raise concerns about problems practices are facing in recruiting associates and locums, and to press for more sustainable funding support arrangements that will allow practices to plan their finances.
Support for ventilation upgrades
General practice is not the same as it was before COVID-19.
Measuring activity by item of service alone is simply not reflective of the level of activity taking place. We lobbied the government to conduct a survey of practices to ascertain the degree of ventilation and what is needed to bring existing systems up to code. This was welcomed, but dentists are still beholden to a cowboy culture where some are being quoted as much as £10,000 for new ventilation systems. Government should be leading on this.
What is now sorely needed is official guidance on what good ventilation looks like, a recommended contractors list and funding to support it. We will continue to push for this to ensure the safety and efficiency of dental practice in Scotland.
Improving access for the most vulnerable
“Restarting routine appointments for children is vital to avoid a tidal wave of serious, and more expensive, treatment.”
In some cases, dentists are being unfairly financially penalised for prioritising those most in need of care.
This is particularly true when it comes to young patients, many of whom have urgent dental problems following months of lockdown.
From July, dentists will be required to deliver at least 20% of baseline activity to continue to receive 85% of pre-Covid funding. Lots of work in practice does not have a fee attached – including COVID-19 screening, fallow time and treating children.
Restarting routine appointments for children is vital to avoid a tidal wave of children requiring serious, and more expensive, treatment. Dentists are seeing their young patients regardless, but the system disincentivises it.
Of the 12,500 patients in my (David McColl) practice, 2500 are children. If I treated only my young patients, this would equate to four months of work with no fee received. The incoming government needs to recognise the full range of activities taking place in practice to avoid the unintended consequence of reducing access to those who need it most.
General Dental Practice is not the same as it was before COVID-19. It is process driven now and the new processes are here to stay. Government policy and support needs to reflect this reality and regardless of the outcome of the elections, we will continue to work with our BDA colleagues to push on your behalf for the necessary changes to be made.
Chair, Scottish Dental Practice Committee
Vice Chair, Scottish Dental Practice Committee