Fees for NHS dental treatment in Scotland are set to increase from November - but dental leaders warn that the changes fall short of the "root and branch" reform needed to reverse widening oral health inequalities.

The revised payment system has been finalised following months of "tense negotiations" between the Scottish Government and Scotland-based representatives for the British Dental Association (BDA).

The changes mean that the 60% of patients who are required to contribute towards the cost of NHS dental treatment will see prices increase from November 1 2023.

It means that an adult patient receiving single surface filling will pay £12.72 instead of £8.80 now, while the cost to the patient of a single tooth extraction appointment will increase from £14.76 to £28.84.

Patients getting a basic acrylic denture created with one to three teeth will be charged £117.04, compared to £69.84 now.

Eligible patients are required to cover 80% of the cost of any NHS dental care they receive up to a maximum of £384, while the Government pays the remaining 20% from the public purse.

ANALYSIS: It's do or die for NHS dentistry - so what's the outlook? 

Only patients under 26, pregnant women, and mothers who are breastfeeding are automatically entitled to free NHS dental care, although people on low incomes can apply for support.

The fees which dentists can charge for NHS work are fixed and set out in a nationally agreed document known as the Statement of Dental Remuneration (SDR), which also lists the types of dental treatment available on the NHS.

The Herald: NHS dental activity in Scotland is still well below pre-pandemic levelsNHS dental activity in Scotland is still well below pre-pandemic levels (Image: PHS)

The hike in fees comes after dental leaders warned that the existing rates were too low and meant that practices were now delivering some NHS care at a financial loss, particularly in relation to items which required lab work such as making or repairing dentures.

Most dental practices are mixed - providing both NHS and private dentistry under the same roof - and many have responded to current pressures by cutting back on NHS work, providing some procedures on a private-only basis, and closing lists to new NHS patients.

READ MORE: Dentist 'exodus' warning as eight in 10 plan to cut back on NHS work

There have been reports of patients travelling hundreds of miles to access NHS dentistry, and overall NHS activity remains around a third lower than it was pre-pandemic.

It comes as separate figures show significant increases in the costs of private dental treatment in Scotland over the past year.

Along with the increase in fees, the Scottish Government said the number of items on the SDR will be "streamlined" from more than 700 to 45 in order to cut bureaucracy and give dentists "greater authority over the treatments offered".

It follows criticism that the SDR had become overly complicated and unwieldy, and claims that some patients were seeking cosmetic work such as teeth whitening on the NHS.

The Herald: David McCollDavid McColl (Image: Newsquest)

David McColl, chair of the BDA's Scottish Dental Practice Committee said: “We’ve secured some improvements, but the fundamentals of a broken system remain unchanged.

“The Scottish Government have stuck with a drill and fill model designed in the 20th century.

"They were unwilling to even start a conversation on making this service fit for the 21st.

“Ministers cannot pretend this is a final destination for NHS dentistry in Scotland.

"We struggle to see how these changes alone will close the oral health gap, end the access crisis or halt the exodus from the NHS.”

READ MORE: Statistics mask reality of a shrinking NHS dental service 

At present, NHS dentistry has three income streams.

Practices receive a capitation fee of £1.30 per patient, per month, reducing to 26 pence per patient per month if a patient has not been seen for three years.

They also get "direct reimbursement" from the Government to cover rent and business rates on their premises.

Finally, there is the fee-per-item payments system - the fixed sum dentists receive for work, such a tooth extraction or a filling.

Dentists can only claim for this work once a full course of treatment has been completed, which may take months for patients requiring multiple fillings, extractions or other interventions.

Dental leaders including the BDA, Scottish Dental Association, and Scottish Dental Practice Owners group had been pushing for the fee-per-item model to be scrapped in favour of a GP-style funding model, also known as "full capitation", which would have seen them reimbursed at a much higher annual sum per patient.

They argued that this was the only way that dental practices could afford to devote the time needed to NHS dentistry in order to clear treatment backlogs.

This was not supported by Scottish Government advisors, who feared that it would disincentivise dentists to work and "lead to a reduction in NHS treatment". 

The Herald:

Scottish Labour's health spokeswoman, Jackie Baillie, said the payment reform plans "fall far short of the mark" and "risk forcing more and more dentists into the arms of private practice".

She added: “The very existence of NHS dentistry is in doubt on the SNP’s watch.

“The government must listen to dentists and implement proper pay reform before access to dentistry becomes even worse.”

Public Health Minister Jenni Minto said: “We are confident that the modernised system, with increased clinical freedom for dentists, will provide longer-term sustainability to the sector and encourage dentists to continue to provide NHS care.

“All patients will continue to receive free NHS dental examinations and I want to reassure those who are exempt from NHS dental charges – including children and young people under 26, and those on certain benefits – they will continue to receive free care and treatment.”