NHS dentistry in Scotland faces cutbacks as payments reduced

The move has sparked anger from practitioners who are struggling with the spiralling costs of staff, energy bills, and materials. Charges for laboratory work – such as making and fixing dentures – have soared by around 50 per cent in recent months.

Dental leaders warned that the level of service provided on the NHS will have to be drastically cut back, with many already making plans to go fully private or to restrict NHS dental checks to children only.

Analysis: Statistics mask the reality of a shrinking NHS dental service 

Dr Brendan Murphy, a partner in eight dental practices, including four in Glasgow, and a member of the Scottish Dental Association (SDA) – founded during the pandemic to push for reform of the sector – said: “I’ll be in discussions with my business partner about making one of our practices fully private for adults – if not instantly, in the next few months.

“The others will be cutting NHS sessions so that it will be delivering a very basic service and that’ll mean mostly emergencies, pain relief, dressings, repairing things.

“We won’t be able to repair dentures though, because the lab bills are now higher than the fees being awarded, so if you’ve got false teeth and you break them, then you’re in trouble unless you’ve got the money to pay privately.

“As of Friday there will be people who run mixed [NHS and private] practices looking at it quite frantically and making plans.”

Read more: What's happened to NHS dentistry? 

David McColl, a dentist based in Govanhill – one of Scotland’s most deprived communities – who chairs the Scottish Dental Practice Committee for the British Dental Association (BDA) said the Scottish Government must “stop pretending everything is available” and be honest with the public that they cannot afford to fund pre-Covid levels of NHS dentistry.

He said: “If someone comes into me with a broken denture next week, I’m going to have to say I can’t afford to provide this because the Government aren’t paying enough to cover it.

"They’ve got their heads in the sand pretending everything is going to be OK.”

Govanhill dentist David McColl says the Scottish Government has its head in the sand over limits to funding pre-Covid levels of treatments (Image: Newsquest)

Covid infection control measures were eased in April as part of the NHS remobilisation to increase the number of patients who could be seen in dental surgeries.

Dentists were also temporarily reimbursed at a rate of £1.70 per £1 of NHS work completed in a bid to tackle treatment backlogs.

After a spike in activity, however, this was cut to £1.30 from July, with the latest statistics from Public Health Scotland showing a drop-off in treatment claims.

Dentists argue that rampant inflation means that even the 1.3 rate makes it unaffordable to carry out complex courses of treatment on the NHS, such as for patients requiring multiple fillings and crowns.

The number of NHS dental treatment claims paid in July remained 40 per cent below pre-pandemic levels.

From Saturday the payment rate will be reduced to 1.2, then 1.1 from January, with no uplift from April.

NHS dental treatment claims increased in April when the 1.7 multiplier took effect, but fell back again in July when the rate reduced to 1.3. Activity in July was 40% below the pre-pandemic average (Source: Public Health Scotland) (Image: jj)

Dr Murphy said he expects to see “a cull of existing NHS practices”, especially in the Highlands and rural areas where surgeries are more likely to be owned by a single dental partner, along with widening oral health inequalities.

He said: “There will be large pockets of affluent, suburban Scotland that survive without huge impacts on their health, but in inner city areas where people can’t afford to go private, they’re going to have real problems.”

In his letter to dentists, Mr Yousaf said he is “keen to understand in more detail the pressure practices are under” and would be asking practices which provide NHS services to “participate in an ‘open books’ exercise” and share their accounts with the Government.

Read more: Dentists 'cannot afford' to provide NHS treatment

Mr Yousaf said this “will allow the Scottish Government to understand the impact of business costs on NHS practice” as well as informing future pay award recommendations.

This is likely to be controversial with the profession who, as independent contractors like GPs, are not required to routinely disclose details of their businesses’ income and expenditure.

Mr McColl branded the request a “red herring”, noting that there had been four previous “open book”exercises in the past, and that the most recently available accounts for 2021/22 pre-dated current levels of inflation and covered a period when patient turnover was restricted by Covid.

Mr Yousaf’s letter adds that the Government is also “working at pace on appropriate payment reform”, with an updated set of payments due to be introduced from April.

It is understood that this will be modelled on the existing Statement of Dental Remuneration (SDR), where dentists are paid a fixed fee per item – such as a filling or extraction – carried out on the NHS.

However, the list of treatments is expected to shrink from around 600 to 50.

“Basically it amounts to no new model at all – they’re just taking the current model and shortening it,” said Mr McColl.

Both the SDA and the BDA want to see the fee-per-item model scrapped.

The BDA backs a GP-style funding model where practices would be paid a global sum guaranteeing that they provide specific services, while the SDA has proposed a system that would see dentists spend 60% of their week on a salaried basis providing NHS care.

Read more: Pensioner flies to Spain for dental treatment amid delays 

Mr McColl said he anticipates that the coming months will see an increasing number of practices adopt payment plans – where patients pay a monthly fee in exchange for a fixed number of check ups and teeth cleaning appointments per year – while those who cannot pay privately face “indefinite waiting lists” until NHS fees change.

The Scottish Government said NHS dental activity from May to July this year averaged 70% of pre-pandemic levels.

Mr Yousaf said: “The ‘multiplier’ was introduced as a short-term measure to address the low activity levels in NHS dentistry and public health restrictions.

"While the dental sector is now performing well and public health restrictions are less severe for dentistry than previously, we now face the cost-of-living crisis.

"So I am offering the sector continued support for a temporary recovery period into next year to help tackle the threat high dental inflation, increasing lab fees and rising energy costs pose to dental teams.

“During Covid-19 we responded quickly to provide significant additional support – over £150 million to date – to maintain the capacity and capability of the sector.

"This includes permanently increased examination fees because we appreciate the pressure that teams are under.”