Patients in four health boards are facing the closure or tendering of salaried dental practices in a bid to cut costs to the NHS payroll.
But the British Dental Association fears the move will hit care for patients with special needs, such as handicapped children, dementia sufferers or recovering drug addicts whose teeth can be rotted by the high sugar content of methadone. These patients often require sedation. Salaried dentists, who are paid directly by the NHS rather than being partners in their own dental practice, were parachuted into various areas around 2005 to deal with a crisis in local access which was forcing patients to go private or travel long distances for NHS dental care.
Although they can carry out routine procedures, they also specialise in providing dental treatments to patients with complex clinical needs who cannot be seen by normal high street dentists. BDA Scotland's Salaried Dentists' Committee has raised concerns about the future of care for such patients amid plans to axe or tender out a number salaried clinics. It is understood that the Eyemouth Dental Surgery in NHS Borders will close in June with the transfer of 1400 patients to an independent practice. Patients requiring specialist care will have to travel 23 miles to Coldstream.
In NHS Dumfries and Galloway, three salaried dental practices - in Dumfries, Lochmaben and Newton Stewart - will close, with patients transferred to independent practices. The salaried dental clinics in Lochside and Sanquhar will be taken over by independent dentists. Specialist services will be provided in Dumfries.
In NHS Ayrshire and Arran, three salaried dental practices - in Arran, Dalmellington and Patna - will be put out to tender for independent practitioners, but patients requiring specialist treatment will have to travel to Ayr. People in NHS Orkney face the same upheaval as salaried practices at Earl Place and the Station Centre are transferred to an independent practitioner, forcing patients with special needs to go to the mainland.
NHS dental care will still be provided for routine patients in all the health board areas, but the BDA is worried about the impact for vulnerable patients. Pat Kilpatrick, director of BDA Scotland, said: "The worry about some of these is that if there's no longer any special needs service, these patients will have to travel significant distances. If you're in Patna and you've got a child with cerebral palsy ... you've got to go to the salaried service in Ayr.
"There's also a question over whether some of these practices will be financially viable. If a practice was viable there would have been an independent practitioner in it already."
Graham Smith, deputy chairman of the Scottish Salaried Dentist Committee, said centralising specialist services would increase dental health inequalities. He said: "Treatment of special care patients, of the disadvantaged, of the poor, of high [tooth decay] children, of families facing social isolation, of offenders, of the frail or housebound elderly, of those with substance abuse issues and of individuals with complex or chaotic lifestyles, is best achieved through integrated care which is 'embedded' within care for the rest of the community."
A spokeswoman for the Scottish Government said: "There is absolutely no evidence in the claim that vulnerable groups of patients will be disadvantaged by any proposed changes to local dental services.
"In fact our new Public Dental Service protects the rights of such groups of patients to have access to care in a suitable location.
"While the configuration of dental services whether independent contractor or salaried services is a matter for NHS Boards, we understand some boards are in the early stages of reviewing the balance of services they provide."