IS there any way back for NHS dentistry?

For decades the vast majority of practices have paid their bills by combining a high volume of NHS care (typically around 30 patients per dentist per day), topped up with more lucrative private treatments and cosmetic dental work.

Even before Covid the model was fraying, but the enormous treatment backlogs accumulated during the pandemic have driven it to breaking point.

Stricter rules, enforced much longer on the NHS, curtailed the number and types of treatment available while private dentistry resumed everything from fillings to crowns in summer 2020.

Baffled patients wondered why their practices were suddenly telling them that previously routine procedures were unavailable on the NHS – but up for grabs privately.

Those who could afford it, paid; those who could not, waited. By April to June this year, teeth extractions on the NHS – a sign of decay – were up 26% on pre-pandemic levels.

It is impossible to know exactly how many patients have switched to private dentistry. The number of people registered with an "NHS dentist" exceeds 95%, but given that most practices are mixed the reality for many is that NHS care amounts to a basic examination with added extras like a scale and polish or a (reasonably quick) filling only available privately.

With inflation soaring, the bottom line for dentists is that what they are being reimbursed now for NHS work simply does not cover their costs.

Patients are becoming the casualties in a tug of war between a profession that wants either more money or, better still, a complete overhaul of how dentists are paid, and a Scottish Government that wants dentists to "open their books". A hint, perhaps, that it might like to find evidence of a few rogue profiteers as an excuse to shut down calls for additional funds?

The independent contractor model entitles dentists (and GPs, and pharmacists) to autonomy in how they run their businesses, but there is also an argument that this lack of transparency deters investment.

The interim payments between now and April have been dubbed a "sticking plaster on a gaping wound". For a genuine NHS dental service to survive - and thrive - a complete change in approach is needed.

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Dentists warn of cutbacks to NHS service as funding reduced