With Margie Taylor announcing her retirement as CDO, Phil McCafferty looks back through her tenure.

In June our chief dental officer, Margie Taylor, announced she is to retire at the end of this year.

Margie Taylor took up the post as CDO for Scotland in May 2007, having been appointed in the twilight of the Labour-Liberal Democrat coalition. This had been a period of relative positivity in the dental profession, having seen significant financial initiatives introduced in the previous two years, addressing decades of underinvestment in NHS dentistry.

One of the first strategies introduced by her new political overseers, the first SNP Government of Alex Salmond, was the concept of lifelong registration for NHS dental patients. This cynical manoeuvre was designed to ‘solve’ the festering issue of access to dentistry. It was a masterclass in political chicanery and sent a message out to the profession that this Government wasn’t afraid to play dirty.

The fleeting optimism of the previous two years was thus extinguished overnight, compounded by events sweeping across from north America, as the threat of a global financial crisis began to take hold.

The credit crunch begins to bite

Although the financial markets began to take a battering, for a short period it felt as if dentistry would somehow ride it through. I remember relaying this sentiment to my accountant, and I recall his melancholy rejoinder that it would eventually hit us as hard as anyone. ‘They’re flooding the market with dentists as well’, he said, ‘They can drive down the cost now…and everyone thinks you’re all loaded anyway, so you won’t get any sympathy from the public’.

Undeterred, I remember the euphoria at the announcement in 2008 from the first SNP Cabinet Secretary for Health and Wellbeing, Nicola Sturgeon, of a new and substantial package of capital funding for primary care premises modernisation, with specific targeting for ‘high street dentistry’. This was in response to the crippling burden imposed with regard to decontamination requirements; a situation not created by the current CDO, but one she inherited. Unfortunately, it was left to the discretion of local NHS boards as to how this money would be spent. Some boards utilised it wisely. Others, notably Greater Glasgow and Clyde, frittered it away on grandiose ill-advised projects in the salaried dental service, much to the anger of high street GDPs there.

Not content with such extravagance, in 2009 the Government embarked on the biggest white elephant project of them all – Aberdeen Dental School. The set-up cost was a mere snip at £18 million!

By 2010 there was a new Conservative-Liberal Democrat Government in town and UK-wide austerity was now the order of the day. A health care budget freeze was decreed, and any talk of fee rises was declared to be strictly off the agenda. The mantra was: ‘We’re all in this together’, unless you were a politician of course. This policy of austerity was reinforced by the announcement in 2012 of a pay cap in the NHS at 1%, a concept that of course has no meaning to high street dentists or their staff, whose expenses are dictated by the vagaries the market. All it meant was, once the Government had gone through the charade of an annual analysis by the so-called independent DDRB, the fees would go up by somewhere in the region of 1%, irrespective of the evidence presented to it by the BDA and others.

Later that year the Government started raiding our pensions too, to pay for their own and their predecessors’ mismanaging of the economy. First through higher contributions, then by imposing a new, and less favourable pension scheme on us. The fact that our pension funds were not in deficit was of no interest to them.

This year saw the announcement of the Oral Health Improvement Plan. It went down like a damp squib and I suspect this may have been a factor in the CDO’s decision to call it a day.

I bear no personal ill-will towards the departing CDO, and I wish her a long, happy and healthy retirement, but I suspect if she is honest she would admit there are many aspects of her 11 years that she will find a source of frustration. I do not blame her for the turmoil the profession has gone though, but although the role is one of a professional adviser to Government, and therefore expected to be politically neutral, I feel she has been used by politicians to deliver policy not necessarily in the interests of the profession or the public.

Cooking the books

Over the last 11 years there has been a gradual erosion in the funding available for general dental practices – figures from ISD Scotland show a small percentage rise every year in the total fees paid to high street dentistry as a whole. However, there has been a massive rise in the number of dentists over that period. The cake is essentially being cut in to more pieces, each of them smaller than before. Coupled with the inexorable rise in the running costs for practices, the net impact is there for all of us to see. Financial hardship, diminishing morale, a reduction in quality of output and mounting stress. None of that is good for patient care.

The position of CDO is, regrettably, a somewhat poisoned chalice in times of austerity, and I think whoever inherits the role would be wise to keep that in mind. However, the new CDO needs to remember the role should primarily be focused on public dental health, rather than spin doctoring. Above all, they need to remember that the profession needs to be kept onside, particularly if dentistry is to be retained within an NHS context. Ignore that at their peril.

For more information, Phil McCafferty can be contacted through Dentistry Scotland. Responses to the article should be emailed to the editor, seb.evans@fmc.co.uk.