Coronavirus Scotland: NHS dentistry facing crisis

One senior figure told The Herald there was a pressing need for changes to the emergency funding model put in place to support practices and said the NHS risked haemorrhaging staff to the private sector or other countries.

Dentists warned previously that waiting times were going to “shoot through the roof” because of a virus-related cap on patient numbers, and that six-monthly check ups were unlikely to return.

READ MORE: Dentists in Scotland allowed to operate under lockdown

The latest fears come after Universities Scotland, which represents the country’s higher education institutions, confirmed clinical training had been “severely limited” due to the risk of Covid spreading via aerosol transmission.

“All applicants who interviewed for September 2021 entry will still receive a final decision on their interview by 20th May 2021 but any offers made this year will be for a deferred start date of September 2022,” a spokesman said.

“Our sympathies go out to these incoming students who, like so many people, are having their life plans severely disrupted.”

It was announced last week that dental students had not been able to gain sufficient clinical experience as a result of the pandemic.

Students being forced to repeat their final year are to be given a bursary by the Scottish Government.

Graduation for students at the dental school in Aberdeen has been put back until the winter, while counterparts in Glasgow and Edinburgh will not complete their studies until next summer.

Scottish Public Health Minister Mairi Gougeon previously said those affected would be eligible for a bursary equal to the level of their student loans and totalling between £4,750 and £6,750.

Deputy First Minister John Swinney.

They can also apply for other types of support. David McColl, chairman of the Scottish Dental Practice Committee, said: “The decision to make existing dental students repeat a year and defer entry to first year at dental school until September 2022 will mean an additional, albeit temporary, squeeze on NHS dentistry on top of other significant pressures but it’s unavoidable.

“No-one could have foreseen this pandemic and, short of increasing capacity at dental schools, which is logistically challenging and really a longer-term measure, there’s not a lot we can do about it.

“In terms of ensuring safe training and clinical environments, I cannot see any way forward [other than to make students repeat a year and defer entry for those who would normally start their university courses in September 2021].

“The Scottish Government have at least been brave in saying this is what we are going to have to do.”

Delaying this year’s graduations is likely to add to fears over rapidly mounting  pressure on NHS dentistry north of the border.

READ MORE: Dentists' leaders warn of 'private only' system

The Herald reported previously that waiting times were likely to surge amid tough new caps on patient numbers aimed at making practices Covid-secure.

There are also fears “two-tier” access to dental care will continue as some invest in powerful ventilation systems that will enable them to see far more private patients per day, driving those who can afford it to pay for quicker treatment.

Routine dental services such as fillings, scaling and root canal were re-started last November.

It was announced last month that treatments would continue despite fresh lockdown restrictions.

However, social distancing and infection control arrangements mean dental practices have only a limited number of appointments.

They are restricted to 10 patients and five aerosol generating procedures (AGPs) per day per surgery.

So if a practice has two surgeries, this is doubled. Dentists also need to ensure social distancing is maintained in waiting and reception areas, with all processes subject to the availability of personal protective equipment (PPE).

There are fears dental staff could be lost to the private sector or other countries.

In addition, a one-hour “fallow period” from the time the drill stops must be observed so particles released into the air can settle.

Only then can the treatment room be cleaned. Mr McColl previously told The Herald that Covid-related pressures could usher in the end of routine check-ups, something which the profession had already been debating pre-pandemic.

He said deferred entry and the loss of a year’s cohort of graduates would add to the strain, echoing the British Dental Association (BDA) which had warned that the lack of new students could create longer term problems for the NHS workforce.

Mr McColl, whose practice is in Glasgow’s Govanhill area, also stressed that the latest developments had highlighted other serious concerns.

“Ventilation is a huge issue,” he said. “In my own practice I’ve spent thousands of pounds already to reduce fallow time between patients.

READ MORE: Scottish dentists ‘turning away’ NHS patients

“But we need additional guidelines. We need the Scottish Government to map out what we as dentists have to do in terms of ventilation requirements.”

Mr McColl said funding was another source of worry. “NHS dentists operate on a contracted basis,” he explained.

“As a practitioner and as a business owner, I have to finance my business.

“What dentists need now is a sustainable finance package so we can go forward.

“The current funding model – in which dentists are required to show that they are meeting 20 per cent of their average pre-pandemic NHS activity in order to receive 85% of NHS funding, or less, if activity falls below 20% - needs to be revised.

“The current funding model is an emergency measure but there’s no provision within it for a new associate dentist who might want to come and work in any practice.

David McColl has a practice in Govanhill, Glasgow.

“Because they have no earnings history, they do not know how much they will earn.

“It means you cannot attract new associate dentists to the practice because they don’t know how much money they’re going to make.

“The fear then is that they’re lost to the NHS and work entirely within the private sector - or even leave the country.”

Mr McColl added: “The need to ventilate within dental practices, social distancing in the practice, PPE availability and so on are going to be with us - and affecting the number of NHS patients we can see - for longer than people think.

“We need urgent action to address issues such as ventilation and funding.”

READ MORE: Dentists' anger amid 'ludicrous' funding row - and warning NHS model 'is finished'

Addressing the issue of postponed graduations and deferred entry to courses, Deputy First Minister John Swinney said during yesterday’s coronavirus briefing that he was “confident there will be the ability for new dental students to be able to secure places and to be able to take forward their dental training”.

Mr Swinney described the decision to extend the training of current students as “inevitable and pragmatic”, adding that he would be discussing the situation with the BDA and dental schools.

Chief Dental Officer Tom Ferris said: “The government is continuing to provide an unprecedented amount of financial support to ensure the continuity of NHS dental services. We are making exceptional payments to the value of £12 million per month to support NHS dental incomes.

“As well as deploying the Scottish Government budget for NHS dental services, we are investing an additional £2.75 million a month. On top of this is the supply of free PPE to dental practices to allow them to provide safe dental care.

“Dentists have been receiving a guaranteed income of 80 per cent of gross fees during the pandemic, which has been increased to 85% from 1 November. A pay award for GDPs of 2.8%, backdated to April, was paid in December. Dentists will also be among frontline workers to benefit from the one-off £500 bonus announced by the First Minister.

“Issues concerning ventilation and financial support are discussed regularly with Mr Mc Coll and the Scottish Dental Practice Committee, most recently on Thursday.”