NHS dental backlog ‘impossible to clear’, warns senior practitioner

CLEARING the backlog of NHS dental treatment built up during the pandemic is “fundamentally impossible”, a dental leader has warned.

Douglas Thain, chair of the Scottish Dental Association (SDA), said it was unclear whether new funding arrangements will do enough to stem early retirements and an exodus of dentists into private-only practices after the pandemic.

It comes as taxpayer-funded Covid support grants which have been in place in Scotland since 2020 to prop up dental practice incomes end from April 1.

They are set to be replaced by a temporary “multiplier” payment model which will see dentists reimbursed 170 pence for every £1-worth of treatment carried out on the NHS.

ANALYSIS: Covid has exposed the dyfunction at the centre of NHS dentistry 

The Scottish Government hopes that this will incentivise an increase in NHS activity at a time of record waiting list backlogs for dental care.

However, Mr Thain said practices could still struggle financially.

He said: “If we do a check up on someone that needs half a dozen fillings, the way our appointment books are that’s going to be three or four months probably before they’re completed and we won’t see any of that money until that course of treatment is completed.

“So you’ve got this crisis of ‘how are we going to pay the staff over April, May, June?’.

“Do you go further into debt and borrow, or do you draw a line under the NHS and say you’ve got to go private?

“Practices can survive on 20% of the number of patients that they need as an NHS practice.”

HeraldScotland: NHS dental activity remains well below pre-pandemic levelsNHS dental activity remains well below pre-pandemic levels

Under Covid support grants, dentists were reimbursed 85 per cent of their pre-pandemic NHS income for doing 20% of their pre-pandemic NHS activity, to account for infection control measures which cut patient turnover.

Mr Thain, who co-owns a dental practice in Cumbernauld, was speaking to the Herald ahead of the SDA’s first in-person conference due to be held today at the headquarters of the Royal College of Physicians Edinburgh.

The SDA, which has around 800 members, was established in 2020 to push for more radical reform to how the sector is organised.

It comes amid mounting concerns over widening oral health inequalities and spiralling backlogs.

The number of patients being seen on the NHS is running at around half compared to pre-pandemic levels, and growing numbers are signing up to private dental plans instead to get routine check ups or quicker treatment.

READ MORE: ‘This will be the end of NHS dentistry’ – Warning of exodus amid pay row with Government 

Ongoing requirements for PPE and physical distancing mean that fewer patients can be seen and many dentists fear their practices will become financially unviable unless they substantially increase their share of private work or pull out of NHS provision altogether.

Mr Thain said: “The Government says it wants to reform – but we’ve got to clear the backlog first.

“They don’t seem to grasp that clearing the backlog is fundamentally impossible with fewer dentists working fewer hours. Private income is definitely where a lot of dentists are heading, sadly.

“I think the reality is that the NHS is going to have to be much more of a core service: simple fillings, simple acrylic dentures, pain relief and prevention.

“Prevention is the big thing. We’ve got to strip out some of the stuff that just makes no financial sense and spend more time on the more needy patients.”

HeraldScotland: More than 70% of children from the least deprived areas have seen a dentist on the NHS over the past two years, compared to around 55% of those from the most deprived areasMore than 70% of children from the least deprived areas have seen a dentist on the NHS over the past two years, compared to around 55% of those from the most deprived areas

Mr Thain added that a salaried model could enable dentists to spend more time on each NHS patient and could work since “most dentists have a take-home income in the same bracket”.

The total number of dentists working in the NHS in Scotland has increased, from around 2,650 in 2007 to 3,703 in 2021, but critics say this has not kept pace with demand given that most dentists also divide their time between NHS and private practice.

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Mr Thain said his own practice had lost three dentists over the course of the pandemic – one to a mainly private practice in Linlithgow, one who returned to Ireland, and one to training as an oral surgeon for the NHS.

“The pace NHS dentistry worked at before – five minute, 10 minute appointments – made it impossible to provide the level of care we wanted,” said Mr Thain.

“It’s not necessarily about more money – it’s just an acceptance that doing 30 patients-worth of fillings every day is not good practice. You want to do far less work but see far more return for the patient.”

Public Health Minister Maree Todd said record sums have been invested in NHS dentistry and the revised payment model from April “means dentists could earn more than they do now”. An advisory group will also evaluate long-term reform of the sector.

Chief Dental Officer Tom Ferris said: “We’re confident that these revised arrangements are a step in the right direction to improving access, by linking financial support to seeing patients.”

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