The SDPO group currently represents 469 dental practice owners across Scotland. The teams within these practices provide care to approximately 3.5 million patients and make a substantial contribution to public oral health nationwide.
A key remit of the group is to promote change for the betterment of dental services in Scotland. We believe that practices across Scotland and in all communities should be able to offer modern and high-quality oral healthcare consistent with that of other highly developed nations. We also wish to promote the role of dental teams in improving public health and we believe there is potential for this role to be enhanced.
Our members currently have grave concern about the sustainability of general dental services and the public health consequences if dental practices fail or withdraw from the NHS in the aftermath of the pandemic. Before the pandemic, NHS dentistry was becoming increasingly unsustainable in general practice. Our members were frustrated by compromises to patient care inherent in the NHS model of working, and remuneration of NHS treatment failed to reflect the cost of delivering high quality care.
In May 2010, the Scottish Government published its document, ‘Healthcare quality strategy for NHS Scotland’ and this included several laudable statements of intent. We believe that in general dental services, these goals have yet to be achieved and opportunities to improve public oral health have been missed. Below are some of the Scottish Government (SG) statements together with SDPO observations.
SG: The ultimate aim of our Quality Strategy is to deliver the highest quality healthcare services to people in Scotland and through this to ensure that NHSScotland is recognised by the people of Scotland as amongst the best in the world.
SDPO: Our members are of the opinion that general dental services have not been sufficiently resourced to allow the delivery of the highest quality healthcare to the people of Scotland.
SG: Success will mean that, for the first time. People in Scotland will have:
- an assurance that NHSScotland services will be further improved in the light of what people tell us about their experiences and outcomes;
- a guarantee that their NHS Board will prioritise quality in its agenda, including the use of a new early warning system.
SDPO: Ten year since the publication of the document, yet in dentistry there does not appear to have been any significant revision in the delivery of the NHS dental services to promote quality. There is little or no evidence that The Scottish Government has reacted to the concerns of the profession over this period and the increasing financial pressure on the NHS dental providers is not consistent with a focus on quality of care. Dental practices need to be adequately resourced to enable them to effectively perform their public health role.
SG: We want confidence for people working in and with NHSScotland that they are doing what they came into the NHS to do, are valued and are key in delivering the ambition to make NHSScotland a world leader. We want a shared national pride in our NHS and a recognition that it is the very best it can be.
SDPO: Our members and our colleagues working in NHSScotland do not feel that they have ever been valued by the Scottish Government. Numerous surveys have shown dentists working in National Health Services have low morale. These surveys have also highlighted the high incidence of depression among general dental practitioners. The current system does not afford NHS dentists the time or resources to treat patients as effectively and completely as they would like.
SG: We are all aware of the challenges in delivering reliable and responsive high-quality healthcare, and in improving people’s health. These include increased public expectations, changes in lifestyles, demographic change, an ageing population, new opportunities from developments in technology and information, and the current economic climate which brings with it significant financial constraints. The Quality Strategy provides the basis for us all to focus our combined efforts on what is required to address these current and future challenges, and to ensure high quality healthcare for ourselves and for generations to come.
SDPO: Our members understand the financial pressures on government, and that this will be more acute after the pandemic. As dentistry becomes more advanced there is a broad consensus that many treatments will lie outside what a current National health Dental services system can support.
However, good oral health is a key contributor to good general health. Numerous studies show that poor oral health and tooth loss is associated with a range of systemic conditions. Perhaps for adult patients NHS spending should focus on a range of core treatments which enables clinicians to secure and maintain oral health. These treatments should be funded such that they can be delivered to a high standard, in accordance with the government strategy document previously referenced. Discussion around the content of a core range of treatments would be required, but we would suggest that this includes protection of the integrity of the reduced dental arch, excluding implants.
It is also worth noting that dentists are highly trained and highly skilled healthcare professionals who enjoy a unique position in that they have regular contact with many of their patients. Our profession is in an excellent position to support the government in achieving objectives outlined in its document ‘Healthcare quality strategy for NHS Scotland’. We are well placed to promote smoking cessation, diet improvement and exercise to large numbers of individuals who may rarely visit a doctor. In conclusion we believe that a new model for the delivery of national health general dental services should be developed with close cooperation between the government and the key stakeholders.
The new model should focus on quality and effectiveness and the potential of our profession to sustain and enhance its contribution to overall public health. As the representative body of the majority of dental practice owners in the country, SDPO wishes to work with the government to achieve these goals. Patients, dental teams, and Scottish government all stand to benefit if an effective and sustainable model is developed.