This article appears as part of the Inside the NHS newsletter.

Will 2024 be the year when NHS dentistry turns a corner? The Scottish Government hopes so – many dentists, and dental patients, remain more sceptical.

Ministers have pinned their hopes on a revised payment system which took effect on November 1 2023, increasing the charges on the NHS for a number of common procedures from fillings to root canals.

That means patients eligible to contribute to the cost of NHS treatment (basically anyone over 26 who isn't pregnant, breastfeeding, or on a low income) pays more, while dental practices are also reimbursed at a higher rate by the Government.

The argument is that this should make it more financially viable for dentists to provide these treatments on the NHS, making it easier for patients to be seen and treated without being pushed towards private dental care instead.

The new system also means that most patients with a track record of good oral health will now have been switched to annual, instead of six-monthly, check-ups – something already adopted in England and Wales. The idea is to free up dentists' time to prioritise patients who really need to be seen.

Decay

Days before Christmas, a report by the Nuffield Trust – a respected health think tank – said NHS dentistry in England was in "a clear trajectory of decline" and that "full, universal access to NHS dentistry has probably gone for good" as a result of factors including a real terms fall in funding for NHS dentistry (down by around £525 million in 2021/22 compared to 2014/15).

Professor Grant McIntyre, Dean of the Faculty of Dental Surgery at the Royal College of Surgeons of Edinburgh, said the concerns outlined in the report were shared by dental professionals across the UK, including in Scotland.

However, he added that the "recent overhaul of the NHS dentistry payment system in Scotland is a positive step that could be emulated by other UK nations", adding that "its new focus on prevention rather than reactive treatment compensates dentists for both aspects, addressing the mounting waiting list challenges within the NHS and enhancing access to dental care".

That’s the optimistic viewpoint: that Scotland may be setting a blueprint for NHS dental recovery.

The more pessimistic among the profession consider it a sticking plaster that goes nowhere near providing the level of reform necessary to retain NHS dental care in any meaningful sense.

A return to pre-pandemic levels of NHS activity is still miles off.

The most recent available data for Scotland, published in August 2023, shows that dentists submitted a total of 1.99 million claims for NHS treatment between January and June 2023. This compared to 2.85m over the same six month period in 2019 – indicating a 30% reduction in NHS work.

The Herald: The most recent data in Scotland shows a 30% reduction in NHS work between 2019 and 2023The most recent data in Scotland shows a 30% reduction in NHS work between 2019 and 2023 (Image: Newsquest)

Some of that 30% drop in NHS activity will have been offset by patients paying for treatment privately instead, but many who cannot afford to do so will simply be going without as they languish on NHS waiting lists.

It might be a grim sign of the nation's deteriorating oral health that one of the few procedures to see an increase in NHS dental claims between 2019 and 2023 were tooth extractions, up from 277,000 to 289,000.

Read more:

Trends

The earliest indication we will have of how well Scotland's new dental system is functioning will come on February 20 when Public Health Scotland publishes its first 'NHS Dental Data Monitoring Report'.

This will provide information on the volume of clinical activity being carried out on the NHS in high street dental practices; what practices are being paid; and how access to NHS dental care varies in different health board areas and by deprivation. 

Something else that patients deserve to know is how trends vary depending on who owns the practice.

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My own dental practice, based in Lanarkshire, is owned by one of the largest UK chains and recently hiked the cost of a scale and polish (offered only on a private basis) to £63. Yet another practice, just 10 minutes away and owned independently by its two dental partners, continues to include a routine scale and polish on the NHS as part of their check-up.

Given that 13% of all dental practices in the UK are already owned by just four corporate groups and the trend towards acquisition and consolidation accelerating, patients look set to face less and less choice.