Scotland: Fighting for dentistry

Phil Grigor, Director of BDA Scotland, takes stock of 2020’s successes and challenges and looks ahead to 2021.

This has been a manically busy year. But with Christmas and New Year around the corner, I think it’s a good time to step back and take stock of what we’ve achieved together. In 2020, we faced unprecedented challenges, but I’m proud to say that we also had some notable successes. Now as we look towards 2021, we plan to build on what we’ve achieved as we continue to fight for dentists and dentistry.

Securing financial support

Since the start of the pandemic, we have worked tirelessly to ensure that General Dental Practice remained viable. In March, we fought for and secured a revised funding package for NHS dentists, followed by an increase of 30% to the General Dental Practice Allowance (GPDA) and a 30% increase to the cap in the summer. This additional funding was welcomed, but it did not go far enough. And after our campaigning, extra funding was made available for Vocational Dental Practitioners (VDPs) and we continue to campaign for this group of young dentists.

Looking forward, we need a new long-term funding model for NHS dentistry. The Statement of Dental Remuneration is not fit for purpose. That’s why, our working group is currently considering options for a new funding model to present to the Scottish Government. This won’t happen overnight and there’s no silver bullet, but we are keen to contribute proactively and I’m pleased to say that next year will see a national consultation, followed by regulatory and legislative changes.

We also provided evidence of the stark financial situation facing mixed practices, and repeatedly raised concerns with government Ministers on the precarious position of wholly and partially private dental practices. However, the Scottish Government has refused to give any specific funding to private dentistry. This was the same across the UK, and was one of my single biggest sources of frustration and disappointment this year. We’ve supported private and mixed practices with advice and other services and we continue to prioritise the concerns of mixed and private dentists.

Influencing government policy

As more services began to resume, we challenged the government over out-of-date PPE that was being provided free of charge to dentists. We continue to raise concerns about the reliability of PPE supplies and low pass rates for face fitting, which recently led to NHS National Services Scotland (NSS) reaching out to dentists on the supply and face fitting of FFP3.

In November, we made it clear that with the transmission rate on the rise, it was not the time to expand the range of dental services or reintroduce the pre-COVID Statement of Dental Remuneration (SDR). I was pleased to see our actions result in a number of changes to the Government’s proposals. The transition period was extended from two to four months, practice-based rather than individual practitioner activity was included, and VT activity was removed.

However, I remain concerned that some practices may not be able to meet the prescribed activity levels due to extenuating circumstances. Expanding the range of treatments naturally carries the risk of increased patient demand and potentially untenable levels of stress within the profession. That’s why we continue to seek further resolutions from the government, with a particular focus on reducing fallow time.

Fighting for PDS and HDS

The current crisis has highlighted how essential the Public Dental Service (PDS) is, not just in an emergency, but also in its usual role of treating the most vulnerable in society. And it will be more important than ever, as we tackle the massive backlog of dental problems currently accumulating.

I’m pleased that we secured commitment from the government that the 2020/21 PDS budget would at least match the 2019/20 funding to ensure the PDS has sufficient capacity to meet patient demand. This was especially welcome following our previous concern about the future of the PDS in Scotland, with a 14% reduction in funding between 2014/15 and 2018/19, and a 15% drop in PDS posts during this period.

We’ve also requested details of the Scottish Government’s medium and long-term plans for both the PDS and Hospital Dental Service (HDS) and recently met with the Chief Dental Officer to discuss our concerns for these branches of dentistry. This discussion was constructive, and we look forward to continuing our work for both the PDS and HDS next year.

Tackling oral health inequalities

We will continue to highlight stark oral health inequalities in Scotland, which are likely to have widened considerably during the pandemic. Pre-pandemic data showed a continued long-term improvement in children’s oral health. However, children from the most deprived communities still experienced more than four times the level of tooth decay compared to those in the least deprived areas.

Patient attendance figures and oral cancer rates are also considerably worse in more deprived areas. We know that early detection of oral cancer is essential for improving survival chances and the drastic reduction in dental appointments since March has increased the risk that oral cancer cases will have gone undetected. The gap between Scotland's most and least deprived communities continues to grow, and requires a concerted effort to get low-income patients to attend their dentist.

We’ve long expressed our serious concerns about the lengthy waiting times for paediatric extractions under general anaesthetic, with children in some Boards waiting up to 40 weeks. The pandemic has exacerbated this situation, causing further pain and distress for children and their families. We will continue to highlight this issue to the Scottish Government and to NHS Boards in the coming year.

Looking ahead

These are just some of the key issues we have campaigned on this year. In 2021, we’ll continue to be your voice and represent dentistry effectively at the highest level. Indeed, we are already working with representatives from across the political spectrum in the run up to the Scottish Parliament elections next May, to ensure oral health and dentistry issues are robustly represented.

Next year, we’ll continue to campaign on your behalf, dedicating ourselves to making progress on the issues that matter to you and working hard for all of dentists and dentistry. Because, as this year has shown better than any other, together we are stronger.

Phil Grigor
Director of BDA Scotland