Following ‘tense negotiations’ between the Scottish government and the dental sector, dentists providing NHS dental services are set to receive increased fees under a new payment structure – one the British Dental Association says fails to address fundamental problems.

The Scottish government reforms come as part of its Oral Health Improvement Plan, with ministers stating that the new payment structure will help dental teams provide enhanced NHS care and treatment.

According to the government, the changes will see patients’ specific oral health needs prioritised and improve the focus on patient-centred care including preventative gum disease treatment.

However, patients required to pay NHS charges are likely to see an increase in costs – though the roughly 40% of patients currently receiving free NHS care and treatment will continue to do so.

Earlier this year, the Scottish parliament’s COVID-19 Recovery Committee launched a survey of dentists as part of its “snapshot inquiry” into NHS dental services recovery from the pandemic.

At the start of July, the committee convener wrote to Scotland’s Minister for Public Health and Women’s Health, Jenni Minto, to highlight the key issues raised as the pandemic ‘significantly impacted’ dental service provision.

These included patient backlogs and continuing concerns that ‘a full recovery will not be possible without reforms’, reflecting perspectives gathered by the committee from professional bodies and dentists.

The inquiry said it had heard a clear call from dentists and professional bodies for “root and branch” reform to the service model, moving away from the “outdated” disease-centred model.

Announcing the new system, Ms Minto said NHS dentistry teams and patients will benefit from the changes:

“This new NHS offer improves the system for both dental teams and patients and is the first step in the process to make the services available on the NHS reflect the changing oral health needs of the population. It also reaffirms our commitment to the sector and to all NHS patients in Scotland.

“We are confident that the modernised system, with increased clinical freedom for dentists, will provide longer-term sustainability to the sector and encourage dentists to continue to provide NHS care.

“All patients will continue to receive free NHS dental examinations and I want to reassure those who are exempt from NHS dental charges – including children and young people under 26, and those on certain benefits – they will continue to receive free care and treatment. People on a low income are also eligible for support, details of which can be found on NHS Inform. 

“I’d like to take this opportunity to thank all NHS dental teams for their continued engagement and commitment to NHS dentistry. Increased costs for energy and the cost-of-living crisis still pose challenges for them but we will continue to work together to ensure the best quality of care is available.”

Additionally, the government says by reducing the number of different fees from over 700 to 45, it will streamline payments, cut bureaucracy, and give dentists greater authority over the treatments offered.

However, dentists says the reformed system does not offer the fundamental change called for in the inquiry and the British Dental Association (BDA) says the profession has warned ministers not to view this as a “final destination”.

Meanwhile, a medical and dental legal support body has shared that its members experienced worse mental health and wellbeing over the last year than at the height of the pandemic.

Advanced or unchanged?

The representative body for dentistry added that uncertainty remains around whether these changes will be able to halt the exodus of dentists from NHS services and restore access to care across Scotland.

Earlier this year, founder and CEO of Scotland’s biggest dental group told healthandcare.scot that a shortage of dentists in the NHS results from the ability to offer more advanced treatments privately. Mr Hall said that the government must work with dentists to overcome the challenges facing NHS dentistry.

The Scottish parliament’s health committee also recommended in its letter to Ms Minto that the government develops costings for – and consults on – different service model options, including those that it does not prefer, in partnership with the sector so that the opportunity is not missed to consider a full range of options for the future of service delivery.

While the BDA echoes this sentiment of focusing on patient-centred and preventative care, the organisation says the changes to come do not go far enough.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said:

“We’ve secured some improvements, but the fundamentals of a broken system remain unchanged.

“The Scottish government have stuck with a drill and fill model designed in the 20th century. They were unwilling to even start a conversation on making this service fit for the 21st.

“Ministers cannot pretend this is a final destination for NHS dentistry in Scotland. We struggle to see how these changes alone will close the oral health gap, end the access crisis or halt the exodus from the NHS.”

Although the new system includes an additional £10m to support the delivery of laboratory-based treatment like dentures, the BDA says the service model fails to appropriately target resources for those in highest need.

Due to be rolled out from November 2023, the system considered “modernised” by the government will – according to the BDA – do little to tackle deep oral health inequality across Scotland.

Read more: Scotland's doctors and dentists ‘trying not to lose hope’; Can Scotland make health fairer?; College: Preserve GPs to preserve the NHS; Junior doctor strikes on pause; Auditor General: Difficult choices for Scotland's NHS

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