David McColl reflects on the plans to reopen dental practices in Scotland and the challenges facing dentists.
Dental practices in Scotland can start seeing NHS patients again on Monday 22 June. This was confirmed today by the First Minister who also clarified what the next phase of easing lockdown restrictions in Scotland will look like.
While practices will be relieved to finally have a confirmed date in which they can return to face-to-face care, it arrives after weeks of waiting for clear guidance and a firm response. During this time the disparate approach to reopening practices has led to widespread confusion and frustration for dental teams across the country. Here I wish to respond to your concerns and outline the current situation on reopening dental practices in Scotland.
Who is reopening and when?
The confirmation that NHS and mixed practices can reopen on Monday 22 June should come as a great relief. However, it also comes several weeks after wholly private practices were allowed to reopen. While the disparity has annoyed many in the service, the Scottish Government has repeated its view that the cautious approach for NHS and mixed practices is in line with the national phased approach to easing lockdown.
The CDO’s letter of 8 June and the subsequent Scottish Government Memorandum provided advice on how best to prepare for re-opening, including:
- The Scottish Dental Clinical Effectiveness Programme (SDCEP) guidance for reopening dental practices – recently updated following feedback from BDA Scottish committee members and other stakeholders
- Advice on working with your local NHS Boards to have your preparations signed off to begin seeing patients.
Wholly private practices, which comprise 23 out of the roughly 1,000 Scottish practices, have been open for some weeks now. The National Clinical Director and CDO issued a joint letter to private practices on 1 June and Healthcare Improvement Scotland (which is responsible for inspecting private practices) issued guidance on reopening on the same day. The guidance stresses the importance of patient and staff safety, and of not contributing to an increase in the ‘R’ number.
Yesterday, we pressed the CDO to extend to Key Worker status to dentists and their teams once they reopen. The CDO has written to the Scottish Government about securing this change. Officials have advised that local authorities are responsible for granting Key Worker status. We hope to receive clarity on this by the end of the week.
What financial support can you expect?
The Scottish Government has issued an interim Statement of Dental Remuneration (SDR) which practices should use on reopening. This revised SDR is to record activity only. There will be no patient charges for the time being.
Unfortunately, we were given little opportunity to comment on the draft SDR, and there are elements in it that we do not agree with. For example, the Scottish Government predicts that there will only be a low number of denture repairs once practices reopen and practices should therefore fund the lab bills. We think there will be a significant number and have made clear expecting dentists to foot the bill from COVID-19 support funding is unacceptable.
We have urged the Scottish Government to work with us in putting together the next version. As we move towards the next phase of reopening, it’s important dentists’ voices are heard on what should be included and what items could and should carry a fee.
The NHS financial support package that we helped to secure will remain in place during the initial phased reopening. However, we are concerned that costs will increase when practices start paying unfurloughed staff, but their income will remain largely unchanged as they will only be able to see a limited number of patients. We will continue to make the case for adequate financial support to ensure dental practices remain viable.
As we look towards Phases 3 and 4 of the return to practice, we will not be returning to a fee per item model as currently exists within the SDR and a new model will be required. The Scottish Government accepts this and has been working on something and we expect them to share it with us soon.
We have told the Scottish Government that some practices have indicated that they cannot afford to reopen. In response, the government has urged practices to be patient during Phase 2. Their view is that the current funding model is adequate but that it cannot support the loss of non-NHS income. However, members have been in touch with us to say otherwise.
The funding model is 80% of gross Item of Service, and when allowances and Capitation and Continuing Care payments are considered the actual overall funding support is 90%. We made the point that as we enter Phase 2 we will be doing exactly the same as GMP’s who are being funded at 100% with additional allowances. The Scottish Government have acknowledged this discrepancy and we will continue to push for change.
The CDO has previously advised that dentists in mixed practices should discuss with their local NHS Boards what patients they can see, and what treatments they can provide. However, there is still widespread confusion and we have urged the Scottish Government to clarify the position of mixed NHS-private practices.
We have highlighted the sustainability challenges facing mixed practices during Phases 2 and 3 with the current level of support. We are chasing the Cabinet Secretary for Finance again for a response on funding for mixed practices.
How can you get hold of PPE?
NSS National Procurement is working with NHS Boards across Scotland to deliver PPE for onward distribution (by Boards) to all dental practices. Allocation to NHS Boards will be based on the number of practices in each Board area. National Procurement recently distributed more than 3 million individual items of PPE to dental practices – these supplies were delivered to all 14 territorial boards for onward distribution to all dental practices throughout Scotland.
While we welcome this initiative, we are concerned that these supplies will only allow practices to see around 10 patients a day. We will monitor the situation and report back to the Scottish Government on how well these arrangements are working, and whether practices are receiving the appropriate PPE to fully protect dental teams and their patients.
We asked the Scottish Government about the evidence around the use of aerosol generating procedures (AGPs). They advised that dentists must continue to follow the advice given by Health Protection Scotland regarding AGPs and PPE, and that this will continue into Phases 3 and 4.
The Scottish Government considers us to be the main stakeholders that they wish to negotiate with. We will continue to do everything we can to ensure dental practices are well prepared to reopen safely, and are able to survive this extremely difficult time. Our patients need us more than ever. The Scottish Government must help us to ensure we are there for them. To find out about developments as they happen, see our live updates page.
Chair, Scottish Dental Practice Committee