Scotland: Where next on reform?
13 February 2023
NHS dentistry in Scotland is at a pivotal moment, as the Scottish Dental Practice Committee (SDPC) enters a process of formal engagement with Scottish Government, covering fee allocation for the revised Determination 1 of the Statement of Dental Remuneration.
We recently wrote to the Cabinet Secretary for Health and Social Care, Humza Yousaf, calling for interim financial support to continue, until this reformed payment system is fully implemented. Last week we got a response and the 'bridging payment' - originally due to lapse on 1 April 2023 – which uprated NHS fees by 1.1, will continue to October 2023.
Humza Yousaf wrote "I am keen to work closely with your sectoral representative body (BDA Scotland) to consider the appropriate level of fees and negotiate an agreeable outcome to ensure that the government is able to offer you assurance on sustaining your dental businesses to deliver high quality NHS dentistry to your patients and that this is reflective of the public purse."
Less than 24 hours later and Scottish Parliament were debating our issues, with MSPs from across the political spectrum joining us in calling on the Scottish Government to deliver meaningful reform to NHS dentistry by the autumn.
With dental practices facing spiralling costs, many echoed our call that the NHS's traditional high volume/low margin model is now unsustainable, and that real change must be in place by 31 October.
We have stressed this extension cannot simply delay the inevitable. "The Scottish Government made the right call by not prematurely pulling the plug on vital support" said SDPC Chair David McColl. "The question is now whether come October we'll have the reforms needed to give this service a future. Failure to do so will take us from crisis to collapse."
The service has not returned to anything resembling business as usual. Recent data has indicated claims submitted by NHS dentists for dental work are 43% down on 2019 levels and suggest a growing exodus from the NHS workforce.
Moving forward towards the payment reform negotiations, we are conducting a timings study to establish an evidence base on the time and costs involved in completing various clinical treatments. This will help to establish the labour costs of these treatments, and those incurring laboratory fees will also be captured.
This study will replicate, and update, the 1999 Heathrow Timings Study and its predecessor studies. This is based on the refining of expert clinician opinion through a survey and discussion group to establish consensus on timings for each treatment. An initial pilot study has been undertaken in Scotland. This evidence base will support the progress of payment reform negotiations.
We want to know the views of the profession are heard. A short survey remains live. We want to know what the ongoing uncertainty means for our members at this crossroad for NHS dental services in Scotland.
We will continue to work on your behalf to ensure that the future of NHS dentistry and its financial stability is a priority to the Scottish Government and will continue to press for much needed reform.