Graham Smith, Chair of the Scottish PDS Committee, highlights the massive backlog of unmet dental need and the future capacity concerns.
The Public Dental Service in Scotland did a fantastic job setting up Urgent Dental Care Centres (UDCs) at short notice across the country to deal with the COVID-19 outbreak. However, our continued operation of the UDCs has come at a cost as the backlog of unmet dental care for our “core” patients has continued to grow. These patients include care home residents, children with additional needs and adults with disability.
This was clear from the PDS survey we conducted late last year. As one dentist starkly put it: “I would like to be doing my normal clinics, these patients are being neglected.”
Unmet dental need continues to grow
“It’s important that PDS capacity to serve the most vulnerable patient groups is not compromised.”
An example of this unmet need is the waiting times for paediatric extractions under general anaesthetic. We have long expressed deep concerns about lengthy waiting times, and the pain and distress this causes for children and their families. I have spoken with various PDS leads about this issue, and approximately 2,500 children are on these waiting lists. It could be many months before backlogs are cleared. We continue to highlight the severity of the situation to the Scottish Government, and to seek clarity on Boards’ plans to reduce waiting times.
The PDS also faces pressure to see unregistered emergency patients, and that PDS teams are now being utilised as vaccinators and in other roles across the wider NHS. We fully support these excellent efforts to respond to the current pandemic, and recognise the difficulties that these issues pose. However, it’s important that PDS capacity to serve the most vulnerable patient groups is not compromised going forward.
Concerns about funding and future capacity
Members will know that we had previously expressed concerns about the future of the PDS in Scotland and ongoing funding cuts. There was a 14% reduction in funding (in cash terms) between 2014/15 and 2018/19, and a 15% drop in the number of PDS posts during this period. That’s why, we
wrote to the Minister last summer to seek assurance that the budget would at least match the 2019/20 funding to ensure the PDS has sufficient capacity to meet patient demand.
“We’re very concerned about ongoing funding issues and possible staff shortages.”
We were relieved to see the Government subsequently confirm that the 2020/21 budget would match the 2019/20 figure. This has provided some much-needed reassurance. However, in our recent PDS survey, less than two thirds (65%) of PDS dentists said they planned to continue practising as a community dentist in the next 5 years. This is the lowest in the UK. Almost one third (32%) also intend to retire during this time. These figures raise significant concerns about the future capacity of the PDS.
We’re very concerned about ongoing funding issues and possible staff shortages. That’s why we wrote to the Minister again late last year to request
details of the Scottish Government’s medium and long-term plans for the PDS. I, and other BDA colleagues, have also met with the CDO to discuss your concerns. The discussion was constructive with the CDO recognising our concerns, and we will continue to push for solutions with the Scottish Government on behalf of the PDS.
Low morale during challenging times
Our recent BDA survey also highlighted a number of concerns relating to the morale of PDS dentists in Scotland. 2020 was a challenging year for us all and we see this reflected in the low morale reported by our colleagues in the service. If these issues of low morale are not tackled, then we may see considerable attrition from the service in the years to come.
- Over a third of PDS dentists in Scotland (35%) would not recommend a career as a community dentist
- 70% said their morale was lower than a year ago
- 57% of PDS dentists reported that their morale was either low or very low – the highest percentage for low morale in the UK
- Overall job satisfaction (65%) was the highest among UK countries, but PDS dentists in Scotland reported the largest reduction in job satisfaction in 2020
- While PDS dentists reported the highest job security in the UK (78%), only 41% (the lowest in the UK) said that their pay was fair
- Motivation appears to be particularly low among PDS dentists in Scotland, with colleagues having the lowest levels in the UK for various measures including never or rarely being enthusiastic about their job (16%).
The current crisis has shown how essential the PDS is, not just in an emergency, but also in our usual role of treating the most vulnerable and disadvantaged in our society. These and other groups will need the PDS more than ever once the pandemic subsides to treat the massive backlog of dental problems that have accumulated in the past year.
All of us who work in the PDS – along with GDPs and other colleagues who were redeployed to the UDCs – can be justly proud of the key role our service has played and continues to play in response to the pandemic. And I was heartened therefore to see our colleagues recognise their own achievements in the PDS survey: “I am proud of the PDS response which was almost seamless with the ceasing of dental treatment and UDC work began.” The BDA will continue to work hard on your behalf, because together we are stronger.
Chair, Scottish Public Dental Service Committee