“Practices which can, will go fully private, and practices which can’t, will go bust.”
That is the warning from a Scottish dentist who sees a “perfect storm” for the health service.
From Friday, the way the NHS pays dentists for treatments is reverting back to its pre-pandemic system – something those in the industry have said is no longer fit for purpose.
The Scottish Dental Association has said a significant number of its members are being forced to turn to private patients to balance the books and that is one of the major reasons so many are struggling to see a dentist.
Dentists in Scotland say on top of a broken payment system the NHS service is facing a shortage of staff amid its recovery from Covid-19. They have warned this could cause irrevocable damage to the industry.
For the last 30 years, the Statement of Dental Remuneration or SDR has set out the treatments available under NHS contracts, the conditions of providing them and how much the health service will pay.
“It is an outdated document which our own chief dental officer Tom Ferris has gone on record as saying is no longer fit for purpose,” Dr Robbie Parr, a dentist based in Fife, told STV News.
“In order to make a decent living and keep the practice going based on NHS income alone, dentists have traditionally had to carry out a lot of work very fast: lots of checkups with a scale and polish, and lots of fillings crammed back to back.
“The SDR rewards drilling and filling, not modern, evidence based preventative dentistry. Working within the confines of the SDR it is often impossible to provide treatment which is up to a modern standard, and where it is possible this involves incurring a financial loss.”
The leader of the Scottish Dental Association agrees.
Dr Douglas Thain has been a dentist since 1999 and believes it is becoming harder than ever to attract new recruits into the profession
“The numbers of graduates that have no intention of coming into NHS general practice in the first place is astonishing,” Dr Thain said.
“The number of associate jobs on offer right now is unprecedented. Practice owners will suffer because they can’t find dentists, therefore patients will suffer because there is a shortage of dentists.
“I keep coming back to it the Government doesn’t seem to have grasped yet that they have to make an offer to dentists to make it an attractive career once again.”
Dr Parr also believes there are misconceptions around how much dentists earn.
“We use the term NHS dentist – but we aren’t directly employed, we are self employed contractors, we are paid by item of service.
“There’s an old stereotype of greedy dentists bleeding the NHS dry, but funnily enough it’s actually the other way around.”
That is because the SDR document is incredibly complicated for professionals to follow to the letter, meaning something as minor as a spelling error can lead to any payments associated with the treatment being taken back.
There can also be a demand that the clinician pays back any money paid to them for the same treatment over a period of time – regardless if there was an error on those occasions or not.
Dr Parr said: “Imagine if your employer docked you potentially tens of thousands of pounds due to a minor clerical error despite you doing an absolutely perfect job?”
Those in the industry believe that the combination of a lack of new recruits, an outdated payment system and the recovery from Covid will ultimately have an impact on the availability of NHS dentistry and in the end, lead to worse patient care.
“Many are simply leaving the NHS, with those left behind gradually reducing their commitment,” said Dr Parr.
“This is why NHS dental appointments are in such short supply and unless something is done this will only get worse.
“Most likely is a dilution of NHS high street services, you’ll see fewer and fewer NHS appointments and then you’ll be at a point where practices which can go private, will do and those that are maybe in a more deprived area, will potentially go bust.”
The Scottish Government has been asked to comment.