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.

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. [1]

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

Year

Payment Month Adults Children Total
2019 January 409,711 45,356 455,067
February 345,344 42,399 387,743
March 373,208 45,734 418,942
April 332,881 39,698 372,579
May 398,419 44,687 443,106
June 344,762 39,352 384,114
July 336,899 39,862 376,761
August 375,654 42,489 418,143
September 348,147 40,137 388,284
October 382,284 45,104 427,388
November 387,979 44,275 432,254
December 261,065 28,247 289,312
2020 January 412,508 45,302 457,810
February 342,032 41,169 383,201
March 187,518 20,306 207,824
April 10,185 1,658 11,843
May 7,138 917 8,055
June 13,879 1,799 15,678
July 82,570 8,936 91,506
August 79,878 8,344 88,222
September 91,817 9,067 100,884
October 108,665 10,061 118,726
November 116,334 13,543 129,877
December 98,183 11,140 109,323
2021 January 126,103 17,069 143,172
February 112,968 14,275 127,243
March 107,217 13,163 120,380
April 153,124 19,916 173,040
2019 COT 4,296,353 497,340 4,793,693
2020 COT 1,550,707 172,242 1,722,949
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%
Adults Children Total