Event: LDC Conference Scottish Dentistry: Where next?
Date: 27 May 2021
Panel: Tom Ferris, David Notman, Alan Whittet, David McPherson, Lindsay Milton
Analysis: By The SDA on 28 May 2021
The SDA welcomed the Local Dental Committees initiative to engage with the profession, Practitioner Services Division, and the Chief Dental Officer for Scotland. We were delighted to have many members at the event, and we continue to welcome their feedback and comments.
We would encourage our colleagues who missed the event to re watch it at their earliest convenience.
This event continues the discussion we started with The SDA Summit on 16 March 2021.
The main question at this event was, Scottish Dentistry: Where next?
The speakers were knowledgeable on The Statement of Dental Remuneration (Division, 2020) and how Covid Support Payments (CSP) work but there is a massive lack in the knowledge of all the issues to the current funding model and these issues are having a wider impact to dental practice on an individual level.
David Notman highlighted the support measures in place, and we acknowledge this. The COVID support for other sectors like hospitality has not been as generous and for that we are grateful. The SDA’s position is that Scottish NHS Dentistry is a complicated contractor-based healthcare system with independent and corporate dental practice arrangements. Similar NHS contractors on other contracts have been afforded 100% sustainability whilst dentistry was on 80% of twelve-month average Items of Service payments, which recently was increased to 85%. For transparency, we acknowledge the maintenance of 100% Continuing Care and Capitation payments and the generous 30% increase in General Dental Practice Allowance.
Hospital and Public Dental health colleagues’ salaries were all maintained at 100%. The view of The SDA is that this is potentially unfair. General Dental Services in Primary Care provide care to more patients and must support their entire dental team.
We noted that Alan Whittet was quick to assert that dental practice owners were emailing too many enquiries compared to Optometry. We believe this to be true however not a negative as it was portrayed. The SDA believes whilst Optometry and General Dental Services are administered by the same Practitioner Services Division, we are two quite different, complex, and distinct systems. The SDA would take the view that dentistry is more complicated but not more important than other public health care sectors. At the start of the pandemic, any of our conscientious and understandably concerned dental practice owners can be forgiven for taking to any means they deem necessary to get the answers that they required. This included contacting Practitioner Services Division, the Chief Dental Officer for Scotland and even their Local Members of Parliament and Members of Scottish Parliament. To assert that they were wrong to voice their concerns is tantamount to censorship and patently lacks understanding. Not to mention the growing concern that the closure of all our businesses may have been an unlawful directive.
85% of GDPs average items of service is a 15% pay decrease. David Notman implied that the profession could simply work harder to top up the payments to the normal 100%. The SDA believe that just now that is not possible, fair, or attainable.
These reasons are:
- 2m Social distancing requirements in any public space limits waiting room capacity.
- Fallow time.
- Additional cleaning measures and standard operating procedures.
- Time to put on and remove enhanced personal protective equipment.
- Additional administrative tasks like triage.
- Voluntary reduced patient throughput.
The Statement of Dental Remuneration and GDS Contract has been progressively eroded over successive governments and was due to change under the Oral Health Improvement Plan (OHIP) first published 24 January 2018 (Government, 2018), now abandoned. Low cost, high patient volume, multi claim treatment can be perceived as beneficial from a quality-price, ratio perspective. We believe without adequate longitudinal studies demonstrating the clinical effectiveness of this we strongly believe this is a short-sighted view of dental public health.
Additionally, on a clinical level and not mentioning the business aspect, with higher patient demands, expectations, and dentolegal claims, the profession is under extraordinary levels of stress with burnout and early retirement set to rise. This does not include the additional stresses and health concerns experienced by everyone during the COVID-19 pandemic.
A pre COVID-19 NHS dentist would see an average of 30 patients a day. There is no capacity, will or necessity to accommodate this model now. It is clear from our members that they are all extremely uncomfortable returning to this model for all the reasons stated above.
March 2021 there was supposed to be a 20% minimum target or activity level to maintain the COVID Support Payment. This was delayed as we all know due to the second wave which we all believe was the correct decision.
The SDA would like to caution any dental practice that is not meeting 20% currently as that target achievable in a safe manner. The panel acknowledged that some practices could have very valid reasons for not and we would invite them to come forward and get in touch with us. We need to hear from you.
Tom Ferris said to remain cautious about the ventilation issues and recall the washer disinfector/LDU situation of past which would also be unlikely to be back dated if any support is forthcoming.
The SDA has been in contact with several dental practices who are genuinely struggling to make ends meet. They are of the view that the NHS cannot or will not support their businesses. This has arisen for a variety of reasons for example maternity/paternity/adoptive/sickness leave and associates moving practice and new practice set ups without previous 12 month history. Again, The SDA needs to hear from you so please get in touch.
Practices wanting to relinquish NHS commitments to favour private options are becoming more and more common, not least to relieve themselves of over regulation and accompanying administrative burden.
The SDA is of the view that practices are doing what they need to do to survive, and we will support them in this. Their main goals are to provide for their patients, their staff, and their families.
Dentists and Practice Owners being accused of being greedy is not acceptable. That is not a brush anyone should be tarred with. The Scottish Government, Chief Dental Officer, LDCs, SDPC, and PSD have had over a year to contend with the activity calculations and ventilation issue. We believe they are currently benefiting from reduced administration costs as a result of implementing the current payment scheme.
Delegates of the LDC Conference and our members have brought forward issues within the workforce and recruitment, which need addressed.
Newly qualified dentists are leaving salaried Vocational Training and are asked to take positions where they do not know what their payment calculation is until months after their appointment. The SDA position is that this is unacceptable. Newly qualified graduates and former VTs need support and security. Dental practice owners need transparency and foresight of financials for them to plan their business and for their patients.
The Scottish Government and PSD seem bewildered that our members and colleagues need clarity on what associates are going to be paid before the undertake contractor duties for thousands of patients. The SDA is supportive of all dental practices and newly qualified dentists who want to know these answers.
Salaried hospital and public dental service colleagues can move positions freely with certainty of their salary. The discrepancy within the GDS is unacceptable and will be raised by The SDA.
There is a plethora of options to consider dealing with this issue. For example, a simple pay scale dependant on experience and list size could easily have been implemented to negate the impotence that the present system has caused.
Our members have been in contact and have said that this is affecting all dentists. Some associates are unhappy in their current post or need to move for personal reasons feel trapped. Many saying that they cannot move to another NHS practice without taking a “gamble” on their financial situation. And as mentioned previously about retiring associates, principals and those on maternity, paternity, adoptive and sickness leave.
For as long as the support payments are here in their current form, the NHS will see this continued spiral of decay. The workforce will continue to be eroded and the pressures on the current workforce will increase more than they already were.
Our members get in touch every day expressing their views and opinions and we encourage everyone to come forward with their views and ideas.
Our main aims are to:
- Give you a voice.
- Have your say.
- Be heard.
(And for it to mean something) We want the best for:
- Our patients.
- Our staff and teams.
- Our families.
(And value for the taxpayer)
The SDA is confident that:
- The previous system was not the best.
- We all need to speak up now about the next one.
- We are stronger and louder together.
(Please join the cause and get involved)
With best wishes to all dental teams across Scotland.
Interim Committee of volunteers happy to be superseded by the best and brightest Scotland has to offer.
The SDA Pledge:
We want one voice for all our dental colleagues in Scotland!
We want you to reshape the future of Scottish NHS Dental Services!
Once we reach a critical membership mass, we will hold elections to appoint likeminded, enthusiastic dental colleagues to take control of Scotland’s Dental Future!
Division, P. S., 2020. Statement of Dental Remuneration no 148. [Online]
Available at: https://www.scottishdental.org/wp-content/uploads/2020/11/Amendment-No-148-FINAL-03nov2020.pdf
Scottish Government, W., 2018. Oral Health Improvement Plan. [Online]
Available at: https://www.gov.scot/publications/oral-health-improvement-plan/#:~:text=Oral%20health%20improvement%20plan%201%20Preventive%20Care%20Pathway.,recognise%20that%20the%20population%20of%20Scotland%20is%20ageing%2C