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The four nations' wishes for 2023

As we enter the new year BDJ In Practicehas asked each of the four British Dental Association offices across the UK's nations to reflect on the past year's struggles and set wishes on how to improve the situation for 2023 and beyond.

Written by: Martin Woodrow, Caroline Seddon, Charlotte Waite, Tristen Kelso

Dentistry is facing tough times. We recognise that the challenges and needs of the profession are constantly shifting and adapting to the environment we operate in. We are working hard to represent the profession on workforce issues, push for contract reform and support members across all nations.

England

In England there is an undeniable growing shift from NHS to private provision. Although large numbers of NHS contracts have not yet been handed back, NHS delivery is down and dental plan providers are busier than ever, with many practices seeking to offer private capitation schemes to their existing patient base.

Disillusionment towards NHS dentistry is not a new trend.

Disillusionment towards NHS dentistry is not a new trend, however, given the current economic climate there is an urgent need for a long-term fix to the discredited Units of Dental Activity system and support for practices looking to shift the balance of care.

The pandemic left the legacy of a backlog in care, with no NHS availability in many parts of the country. This came at the same time as the workforce being squeezed by recruitment and retention issues. A deeper understanding of the workforce is necessary to pinpoint what changes need to be adopted to provide the support needed.

Five pledges to deliver better oral health in England in 2023 and beyond

Government needs to deliver:

  1. NHS contract reform to enable access for those in need of care and a preventative approach to oral healthcare.
  2. Fixing NHS pay systems for dentists and the wider healthcare workforce. The current Doctors and Dentists Review Body process does not work effectively, especially in the current high inflation environment. Wider disruption to healthcare caused by a troubled employment relations environment will impact on health and care.
  3. A workforce plan for dentistry. We need to work out what workforce we have and what we need to deliver the oral health required by the nation, and then action a future plan.
  4. On a prevention agenda. There were welcome signs in the Health and Care Act 2022 of ambition on fluoridation and other prevention measures, but public health appears to have slipped down the agenda again with the financial squeeze.
  5. A place for dentistry and oral health in integrated care systems. There are potential opportunities but also threats as the new systems kick in across England. Dentistry needs funding and a voice in these structures.

Wales

A great deal of debate has been carried out throughout 2022 around NHS access issues. Reports from the Community Health Councils across Wales identified that access for new patients is the worst in the UK, having a significant impact on oral health.

Many practices operating under the recent volumetrics of the GDS contract have been allocating additional resources to meet the new targets. However, the difficulty to retain associates and nurses prepared to work under contract reform conditions brings new levels of uncertainty and many practitioners still report great difficulties in achieving these targets.

We continue to impress the need to move away from target-driven dentistry upon the CDO, but health boards still subscribe to that target mindset. We need viable contract reforms that fairly remunerate practices, dentists and DCPS for the treatment provided. The Welsh Government must ensure annual uplifts to dentists' pay, keeping in pace with inflation. The latest DDRB uplift of 4.5% to NHS contracts is below half of the inflation rate, translating to pay cuts and a shortfall in practice income to cover expenses.

Five pledges to deliver better oral health in Wales in 2023 and beyond

Government needs to:

  1. Understand the scale of the service problems and to monitor the effectiveness of future remedies, Welsh Government needs to improve the collection and reporting of all relevant data and make the processes and full analysis publicly accountable. Currently lacking is accurate data showing either the demand side (numbers of patients who seek ongoing NHS care), or the supply side (the whole-time equivalent number of dentists providing the service).
  2. PCR should be collected centrally by the local health boards and restructured and simplified into a fee for a basic capitation charge that can be topped up. Currently PCR is a complicated tax, charged at the point of treatment delivery, that involves bureaucracy and costs for dental practices, and which acts as a deterrent to patients on lower incomes but not eligible for benefits.
  3. The Government must account for the changing demography of Wales and the future requirements of the population in planning the dental workforce of the future. Welsh Government must commission an evidence-based review of the dentist workforce ensuring the requirements for the future for all dentistry crafts will be fully met.
  4. The intervention programmes Designed to Smile and Gwên am Byth have demonstrated their efficacy and cost-effectiveness. Welsh Government should invest more funding and attract the workforce needed to ensure these community programmes thrive and reach their full potential.
  5. The increasing pressures put on the community dental services (CDSs) must be balanced with additional investment to offset the current loss of access for their core cohort of patients, including the most vulnerable patients.

Scotland

Dentistry in Scotland is at a crossroads. A balance will need to be struck between the priorities of the profession, government and the Scottish public. The Scottish National Party has promised to abolish all NHS dental patient charges over the course of this parliament and 'shape a reformed funding arrangement for NHS dentists, so they are supported for the future', however without exploring the impact of COVID-19 it will be impossible to understand the challenges faced by the whole system.

Although Scotland has much to be proud of in relation to oral health improvement measures, programmes were impacted by pandemic public health measures. All schemes focus on promoting and supporting oral health amongst the most at risk, but these have experienced reduced activity over the last few years.

The profession needs assurance that the future of NHS dentistry is a priority to the Scottish Government. In 2022, the Cabinet Secretary for Health and Social Care promised to meet the expectations for an administratively simpler and more clinically focused system with a reform programme. Alongside reform, dentistry requires an appropriate long-term funding model to attract and retain dentists. Having a stable workforce and suitable remuneration package will be the only way to ensure that the pledge for free dental treatment for all will be met.

Five pledges to deliver better oral health in Scotland in 2023 and beyond

Scottish Government needs to:

  1. Ensure NHS dentistry remains sustainable
  2. Address the backlog of unmet dental care needs
  3. Promote prevention to help tackle oral health inequalities
  4. Improve access for vulnerable groups
  5. Integrate oral health with wider public health priorities

Northern Ireland

In Northern Ireland we have found a dichotomy between dentists enjoying significant growth in private earnings and those for whom NHS dentistry is increasingly failing to generate sustainable returns. We have observed a failure on the part of the government to plan strategically for the future, making it increasingly difficult to recruit and retain associates willing to work in NHS committed practices.

While a Cost-of-Service investigation and direct engagement with the profession is necessary, we also aim to support private practitioners, particularly the transition from NHS to mixed/private earnings. We look to the government to establish a model of care that properly incentivises NHS care.

We also recognise that there is an immediate need for dental workforce reform. Urgent action is required on the long-awaited CDS Workforce Review; on dental nurse shortages; and in naming and addressing key obstacles to effective recruitment and retention and succession planning across all specialties.

Five pledges to deliver better oral health in Northern Ireland in 2023 and beyond

Northern Ireland Government needs to:

  1. Present a GDS contract that is attractive and financially viable to deliver
  2. Target better oral health for children and the older population, guided by an updated Oral Health Strategy for Northern Ireland
  3. Deliver a Dental Workforce Plan incorporating, 'a people-first approach'
  4. Get to grips with oral health inequalities
  5. Apply a strategic approach to dental reform

Looking ahead

In 2023 we will continue to press for intervention and action on the issues facing dentistry across the UK. The backlogs require urgent attention, dentistry must be made financially sustainable, workforce issues need to be reviewed, and oral health inequalities must be targeted with public health strategies.

We will continue to press for intervention and action on the issues facing dentistry across the UK.

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