The uncertainty introduced with the new Oral Health Improvement Plan and a struggle to find suitable candidates to fill positions in dental practices is creating a crisis in Scottish dentistry, Robert Donald says.
According to the latest press interview given by the Scottish Government, the new Oral Health Improvement Plan (OHIP) is going to ‘change dentistry for the next generation’ and will be based on ‘evolution and not revolution’.
I am sure by now, that many of my colleagues have read the document and have taken their own view of the plan. Whilst there are some positive initiatives, the proposals that still seem to be causing the greatest anxiety and confusion amongst my GDP colleagues are around the status of the six-monthly dental examination and the suggestion that scales and polishes will be phased out.
One thing however, is abundantly clear – there is insufficient detail given about the proposals and the timescales for implementation within the document. Also, the proposed ‘biannual newsletters’ updating dentists on progress of the plan are just totally inadequate. Until more detail is forthcoming, many of my colleagues will continue to interpret this vagueness in a fairly negative way and assume the worst. Who can blame them? Particularly against the backdrop of a 30% fall in income over the last five years and with no mention anywhere in the document about how this funding shortfall will be addressed any time soon.
This lack of detail has backfired spectacularly and is causing major uncertainty, particularly amongst dental practice owners. Uncertainty is the last thing you need when you are trying to figure out if your business is going to be viable and sustainable in the future. The outpouring of angst in the various dental social media groups has also highlighted the negative impact the plan is having on their morale and outlook.
Scottish Government’s supposedly reassuring message of ‘evolution not revolution’ doesn’t seem to have reached practices like the Monifieth Dental Health clinic in Dundee. According to the report in the Dundee Courier in April, the practice owner informed his patients and the press that the OHIP was going to be implemented in July!
Like many Scottish GDPs, he has interpreted the ‘detail-light’ improvement plan as a threat to his business and his NHS patients’ care. In the article, he ‘raised gum disease fears for his patients following a Scottish Government shake up’ and stated that it ‘appears likely that practices in more affluent areas, such as Monifieth, will have its funding cut in order to pay for increased funding in deprived areas’. He also stated that this will ‘significantly impact’ on the level of service he can offer to his NHS patients, who he said will be ‘penalised’ by being refused a six-month NHS check-up.
He further stated that after ‘careful consideration of the proposed changes’ he could no longer guarantee continuing to provide NHS dental treatment will be the best option for his patients.
His local MSP also waded into the debate at the suggestion of reduced access to NHS dental care and called on the Health Secretary to ‘guarantee NHS Tayside patients will not have to go private or face gum disease.’
The dental workforce
Having spoken to many colleagues over the last few weeks, what is apparent is that even though there is little detail contained in the document itself, large numbers of GDPs have already decided that they are not only negative about the plan, but also negative about the outlook for their future in NHS dentistry.
Unfortunately, this cloud of uncertainty hanging over Scottish dentistry is not just about the implementation of the Scottish Government’s OHIP. The popular Dundee-based Sunday Post also raised the issue of access to NHS dental care following the Brexit referendum. The article published around about the same time as the OHIP article in the Dundee Courier highlighted that ‘Dentists across the country are reporting how the uncertainty created by the 2016 vote to leave the EU is leaving them struggling to fill vacancies’. A lack of home-grown applicants means one in 10 of Scotland’s dentists are from the EU and fears are growing that many are turning their back on working here. According to the article: ‘The number of registered NHS dentists dropped between 2016 and 2017, the first fall in five years and bucking a wider increasing trend for decades.’
A UK-wide BDA survey last year revealed 58% of NHS dentists were considering leaving the profession within the next five years, with a third of members over the age of 55 looking to take early retirement. According to NHS Scotland figures, there were 3,647 dentists in Scotland as of September 2017, down from 3,670 the previous September. Around 400 of those come from Europe. The fall in dentists was the first drop in numbers for five years, and only the second drop in the last 18 years. A number of Scottish politicians also stated their concerns. Labour health spokesman Anas Sarwar, a former NHS dentist, added: ‘From speaking to dentists, including those who own or run practices, there is real concern over this issue – both in rural Scotland and in urban areas. The potential of losing them, or at least struggling to replace them, is something we should all be concerned about.’
One Scottish-based dentist, who runs dental practices in Dingwall, Huntly, Inverurie, and Kyle of Lochalsh currently has four vacancies and is concerned about how he is going to fill them. In more than two decades as a dentist, he stated, he has never seen a recruitment crisis like this.
‘When we can’t get local candidates, we are forced to look further afield and that is both in the EU and beyond,’ he explained. ‘Since the Brexit vote the interest from EU-trained candidates in vacancies has just fallen away. Our problems are made worse by the changes in the visa rules, which now make it impossible for us to get people from outside of the EU.’
Whilst we have this double whammy of uncertainty hanging over NHS dentistry, some things remain all too certain. Scottish GDPs are set to maintain their unenviable position at the bottom of the UK league table when it comes to morale, motivation and earnings.
The opinions and views expressed here are personal to the author and do not reflect the policy of any organisation with which he is associated.