With £2 billion promised to the NHS, Robert Donald explains where this money is most needed in dentistry.
NHS Scotland’s 70th birthday has come and gone. We have been told a birthday bonus of £2 billion has been set aside and Scotland now has a new Cabinet Secretary for Health and Sport in post to decide on how to invest it.
Scotland’s Oral Health Improvement Plan (OHIP), published nine months ago, sets out big aspirations, but still provides little detail on how to pay for them. The promise of extra scope for investment should offer, in theory, a significant opportunity to secure the necessary resources required for implementation.
Meeting the needs of an ageing population and reducing oral health inequalities in Scotland are vital goals. However, we are yet to see any meaningful detail on the plans, timescales or resources to achieve them, or indeed any tangible commitment to maintain the financial viability of high street practices during a period of profound change. Is it any wonder that Scottish dentists are highly sceptical of the Scottish Government’s funding intentions when they haven’t even confirmed if and when they will implement this year’s Doctors and Dentists Review Body (DDRB) pay award?
We know that the Department of Health (DH) in England has confirmed that the award is not going to be backdated to April. Surprisingly, and for the first time, many of the DDRB recommendations are being staged. DH England is delaying implementation until October ostensibly to cut costs. As yet there is no news from the other three national governments on their approach to the pay award.
We know the introduction of an Oral Health Risk Assessment for adults to help improve prevention will take time to develop, pilot and implement. Ministers must ensure that sufficient resources are available to dental practices to introduce these assessments.
Unfortunately, instead of needed investment, a focus on 24-month recall intervals feels like nothing more than a cynical bid to spread a steady state budget too thinly.
Oral cancer rates in Scotland are the highest in the UK – incidence rates are more than 50% higher than in England. There are also stark inequalities within Scotland – for example, someone in Glasgow is almost 2.5 times more likely to be diagnosed with oral cancer than someone in Grampian. I know from personal experience that the risk-based approach to determining the recall interval doesn’t apply to oral cancer. I recently referred two patients that were subsequently confirmed as having oral cancer who did not fit in with any of the recognised risk factors. Also, the Human Papillomavirus (HPV) is a recognised risk factor for the soaring incidence of oropharyngeal cancer and is very difficult to pick up. Sexual activity with someone who already has HPV is the most common way of acquiring it. It can therefore be difficult to assess risk factors for it based on a medical health questionnaire.
When oral cancer rates are surging – and early detection is key, the last thing you do is increase the recall interval. Scottish Government has to urgently rethink its tactic about using the English based ‘NICE’ guidance on dental recall intervals. This issue is not just about improving oral health – it’s about saving lives.
Likewise an approach to scale and polish treatments looks like nothing more than another Government cost cutting exercise. This procedure is an important part of encouraging good oral hygiene and Government policy should not be concocted on the back of one research study. The expansion of Childsmile to include older children is good news, as this will help to maintain the good habits learned through the programme, but again all of these pledges need to be paid for.
We have a commitment to adopt a proportionate approach to disciplinary procedures, including increased local resolution by NHS boards. The Scottish Government will provide assistance with administrative tasks, but hasn’t given any indication of whether additional money will be made available, nor information about timescales. We need appropriate funding at local level.
There is therefore an opportunity with a new health minister to shape how the OHIP is put into practice. Scottish dentists deserve to see the detail. Prevention could reap huge dividends for Scottish patients and taxpayers, but the Scottish Government needs to show it is prepared to make an effective investment in oral health and ditch the approach of ‘robbing Peter to pay Paul’.
Meanwhile, the GDC took a trip up to Scotland in June to ‘press the flesh’ with some of its stakeholders and also hold one of its council meetings in Edinburgh. According to the latest key performance indicators (KPIs) on its fitness to practise (FTP) procedures, nine out of the 22 KPIs were seriously in the red. For example, only 13% of cases received by the GDC had a case examiner decision within six months of receipt, against a target of 75%. Statistics like that are very difficult to defend and this serious underperformance is just one of the reasons why many Scottish dentists still believe the GDC is not fit for purpose.
This just adds to the spiralling stress levels amongst my dental colleagues. Everyone knows you are more likely to make mistakes when you are stressed. For now, the GDC has acknowledged its poor FTP performance, and has said it is committed to making substantial improvements by the end of this year.
Underfunding certainly isn’t a defence that it can use for its fitness to practise failings. With a substantial reserve of £28.2 million as of March this year, it does seem somewhat bizarre that there is no leeway on the high cost of the annual retention fee that registrants have to pay. At least the GMC, for all its faults, is beginning to speak out more forcibly to support its registrants who work in pressured and stressed environments. The GDC should take note and be fair and even-handed to its own registrants. It should acknowledge the concerns about whether our dental health service, on its 70th birthday, is fully shouldering its responsibility, not only to our patients but also to those of us who deliver dental care in stretched and under resourced environments.
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.