Dentist 'exodus' warning as eight in 10 plan to cut NHS work

Statistics up to the end of October last year, based on dental claims, show that NHS activity remains around 30 per cent lower than pre-pandemic levels despite the lifting of Covid-related infection control measures from April 2022.

READ MORE: NHS dentistry in Scotland facing cutbacks as payments reduce

According to an online survey British Dental Association (BDA), 83% of dentists in Scotland expect to cut the amount of NHS work they do in the year ahead.

The share of practice income which comes from private dentistry has already increased substantially.

Of the 526 dentists to responded to the survey, 41 said that more than half their income came from non-NHS work pre-pandemic compared to 107 now.

Dental claims (when dentists lodge a claim to be reimbursed for a completed course of NHS dental treatment) have remained at a similar level since Covid restrictions ended (Image: PHS)

There are also fears of an exodus from the profession, with 34% of respondents saying they plan to change career or seek early retirement over the coming year.

It comes as NHS Education for Scotland data indicates that the number of high street dentists in Scotland has fallen by 8% during the pandemic, from 3,038 in March 2020 to 2,791 in September 2022.

Only one in five dentists said their practice had returned to pre-Covid levels of capacity, with most blaming recruitment and retention problems or an increase in the number of patients requiring complex dental care which takes longer to complete.

Since April 2022, the Scottish Government has reimbursed dentists using a multiplier system which initially paid practices £1.70 for every £1 of NHS work claimed.

This has gradually reduced to a rate of £1.10 which dentists said was far too low to offset the effect of inflation on materials, utility bills, and staffing costs - pushing practices to rely more and more on private dental work.

READ MORE: Statistics mask the reality of a shrinking NHS dental service 

The £1.10 multiplier, which had been due to expire in April, has been extended until October, but dental leaders are calling for an overhaul of the payments system to ensure that NHS dentistry remains sustainable.

David McColl, chair of the BDA's Scottish Dental Practice Committee, said: “The majority of dentists have pared down their NHS work, and many more are set to follow.

"It’s an exodus that’s going untracked by government but is the inevitable result of working to a broken system.

“NHS dentistry’s survival requires rapid action, with meaningful reform and sustainable funding."

The BDA argues that the scale of the shift to the private sector is going undetected in official Scottish Government statistics because no attempt has ever been made to count the NHS dental workforce on a whole-time equivalent basis that measures what proportion of time is spent on NHS work, compared to private dentistry.

Given that most dental practices are mixed, providing both NHS and private care, this lack of data makes workforce planning "effectively impossible", said the BDA.

READ MORE: What's happened to NHS dentistry? 

Alex Cole-Hamilton, leader of the Scottish LibDems - who have backed funding reform for dentistry - said the survey's findings were a "devastating insight into the plight of Scottish dentists and their patients".

He added: “Dentists are stopping offering NHS services because of the low rates they receive for NHS work and the barriers thrown in their way by Scottish Government ministers.

“Liberal Democrat research recently revealed that one in five of those who cannot get a dentist appointment decide to turn to unlicensed alternatives or perform dental work on themselves.

"That is a grotesque failure on the part of SNP ministers."

Scottish Labour MSP Paul Sweeney, a member of Holyrood's health committee, said: dental services "have gone into freefall", adding: “Without action now to support dentists, we face a two-tier dental service with only who can afford treatment receiving it."

Rhoda Grant, a Scottish Labour MSP for the Highlands and Islands, said she had been contacted by constituents who had to travel to Glasgow for dental treatment. 

She said: "Dentistry isn’t just at risk of a crisis, it is in crisis.  People throughout the Highlands and Islands are struggling to be seen by any dentist, NHS or private. 

"I’ve had many constituents write in to me asking for help and being told that they have to travel miles to Glasgow to be seen by the nearest available dentist. 

"This is not on.  Dentistry is not just about ensuring oral healthcare for everyone, it is integral to overall health."

The Scottish Government has previously said it is working with dentists to deliver payments system reform, and has written to practices asking them to to participate in an "open books" exercise - sharing their accounts - to help officials "understand the impact of business costs on NHS practice" and to help inform future pay awards.

The BDA described the move as "commercially intrusive".

A Scottish Government spokesman said: “Officials Statistics from Public Health Scotland show over 1.6 million NHS examination appointments were completed between April and October with an average of more than 300,000 courses of treatment per month, meaning we are set for over 3.5 million contacts in the 2022/23 financial year. This constitutes an increase of 40 per cent in NHS dental activity compared with 2021-22.

“The longer-term trend shows an increase of 23% in dentists providing NHS dental services for the period 2007 to 2022.

“We note the results of this survey and understand the concerns expressed by respondents and continue to work apace on payments reform that will comprise a new, modernised system that will provide NHS dental teams with greater clinical discretion, and transparency for NHS patients.”