GG&C LDC Political Update

12 October 2021

We as the Local Dental Committee (LDC) link closely with the Scottish Dental Practice Committee (SDPC). Some of our LDC committee members are also elected national representatives. SDPC recently met with the Chief Dental Officer (CDO) and Scottish Government (SG) and have relayed worrying news back to the LDC. It is our understanding that Scottish Government plan to end Covid Financial Support Measures completely and return GDS to a full dependency on the SDR. 

Scottish Government are concerned that a minority of practices are providing a low level of NHS activity and offering treatment on a private basis whilst taking covid support payments. This situation is of course an untenable use of public funding, yet instead of signalling an intention to cease funding to these practices, Scottish Government wish to return the entire GDS to a funding model based on the SDR with the cessation of covid support payments.
 In our view, Scottish Government have not been proactive enough in recognising all of the activity within primary care GDS and still focus on measurement of activity based on an outdated SDR. It is our view that they need to work harder to understand and measure all activity in an accurate manner. The CDO has stated on many occasions that the SDR is unfit for purpose. It is both SDPC and the LDC’s view that a model of care under the SDR at the present time makes NHS GDS non-viable and in-sustainable.

What we know:

  • The SDR will essentially remain as it is save for a few minor tweaks to examination fees, including a fee for child examinations.
  • No official date has been announced although PMS SDR updates are rumoured for 1st December 2021.
  • Neither the ‘new model of care’ or the promised ‘interim model of care’ is any further forward.
    • No meaningful consultation has taken place over the past 16 months. 
    • This is despite many years of OHIP prior to Covid with very few of its stated objectives achieved.
    • This is despite promised ‘conversations with the profession’ during the 19 months of the pandemic so far, which have yet to take place. 
    • It is our view that CDO and SG failed to capitalise on the opportunity provided by Covid FSM to trial models of care.
  • There is not yet any commitment to provide PPE beyond the end of the financial year. 

The LDC has very serious concerns about a number of aspects as described below:

Concerns for child dental health 
The equality gap for children will continue to widen so long as the SDR and a dependency on IoS continues. If the above SG plan goes ahead, practices will once again be forced to churn out IoS treatments to remain financially viable. We were promised a focus on prevention but are once again being forced to focus on restorative dentistry. SG are forcing a choice between financial sustainability and caring for children, an impossible choice that will result in dentists leaving NHS practice.

Concerns for unregistered patients
In most circumstances, taking on unregistered NHS patients will disadvantage existing patients where capacity remains stretched. Further to this, the remuneration for any activity new patients generate is loss-making when compared to the IoS generated on reliable returning patients. Also, the risk of taking on a patient that becomes a sporadic attender under SG’s ‘life-long registration’ policy has been made all too clear throughout the pandemic. It must be made crystal clear that it is SG/CDO policies that have forced an NHS access crisis, not any perceived greed or ill-intent on the part of dentists. A return to the SDR will not allow practices to financially plan and increase capacity to see new patients.

Concerns for recruitment
The extension to VT, Brexit, SG’s disregard for year 1 associates, the absurd approach to vaccination funding, and the complete inflexibility in the PSD Covid FSM calculation method, have all combined to create the largest recruitment crisis Scottish dentistry has ever seen. Practices can’t recruit dentists. Dentists can’t recruit nurses. Unbelievably, SG’s solution to reducing the pressure on an already overstretched workforce was to widely advertise the removal of NHS dentistry charges to patients!

Concern about Morale 
The promise of throwing the SDR in the bin was the light at the end of the tunnel for NHS dentists struggling through the pandemic. Now, the idea of returning to the treadmill of  the SDR will be the tipping point that pushes dentists into private practice or out of the profession altogether. 

It is the position of GG&C Local Dental Committee that continuing with the SDR fee-per-item model would be fundamentally dangerous for patients and dental team members. Patients deserve better. Dental teams deserve better. 

In order to better represent your views, SDPC are looking for:

  • Your views on the proposed ending of Covid support funding, and returning to the pre-Covid payment model.
  • Real examples of private/plan conversion/uptake rates (we can anonymise if preferable)
  • Your view on what you consider is the appropriate of  % level of activity under current restrictions should be.
  • Your view on what % would be achievable in your practice if AGP restrictions were eased.
  • Your examples of recruitment difficulties. 

You can provide these by reply to this email and we will pass them on. Please continue to support us as we support you,

Josephine Weir, Chair
David McColl, Deputy Chair
Simon Kidd, Dental Secretary