The British Dental Association Scotland has warned the Scottish Government it must improve communication, and carefully manage patient expectations, as it issued instructions today to Health Boards on delivering free NHS dental care to 18-25 year olds, just one full working day before the policy takes effect on Tuesday.
The instructions are unlikely to reach practices until next week.
The policy was a centrepiece of the SNP’s May election bid, and plans to abolish dental charges for this age group were introduced over two months ago. Today’s communication is the first formal instruction on how practices should implement the policy.
Many practices will simply be unable to introduce the required changes at such short notice. The eleventh-hour timing has all but ruled out the possibility of delivering necessary staff training for the new arrangements, and the opportunity and introduce appropriate practice management systems.
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BDA Scotland has also expressed deep concern over the absence of clear messaging to manage patient expectations. Practices are continuing to operate at low capacity owing to ongoing COVID restrictions, with no capacity to cater for an anticipated spike in demand.
Analysis of Freedom of Information requests made by the BDA indicate over 4 million appointments have been lost since the first lockdown in Scotland, when compared to pre COVID levels, with just 25% of the usual volumes of dentistry delivered. As of April 2021 the service was delivering less than half the courses of treatment it offered in a given month before the pandemic. 
Scotland already operates free NHS dental check-ups. Official data from before the pandemic indicated Scotland had 25% higher adult participation rates compared to England, which hints at the scale of demand suppression effects of charges, which the BDA believe are the wrong way to fund NHS dentistry. The Business Assessment Document for the new policy states that additional costs may arise due to increased Item of Service treatments, but this is “not quantifiable”.
While BDA representatives discussed the change briefly with the Cabinet Secretary in June, at which it stressed the need for clear public messaging, the Scottish Government has acknowledged that no formal public or business consultation on this policy has been undertaken.
David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “It beggars belief that practices have been given a single working day to prepare for seismic change in how dentistry is delivered in Scotland.
“The rollout of free dentistry will inevitably increase patient expectations and heap more pressure on dental teams who are already struggling to address a colossal backlog.
“Ministers risk creating demand for care that simply cannot be met, and must communicate clearly what is and isn’t available. Failure to do so will only leave hard-pressed colleagues bearing the brunt of patients’ frustrations.
“The Scottish Government hasn’t fully understood the operation of dental practice throughout this pandemic.
“We need better communication and appropriate investment. This is not the way to implement a landmark policy.”
Number of Courses of Treatment (COT), by payment month and year by General Dental Services in Scotland; January 2019 to April 2021
|Average COT per month pre-COVID||360,778||41,701||402,479|
|Likely COT in absence of COVID||5,050,893||583,811||5,634,704|
|Actual COT in pandemic period||1,295,579||150,194||1,445,773|
|Estimated missed COT||3,755,314||433,617||4,188,931|
|Missed COT as % of potential activity||74.35%||74.27%||74.34%|