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Scotland: Real contract reform negotiations needed now

Blog Author Josephine Weir

Blog Date 19/04/2022

We're calling for meaningful and long overdue contract reform negotiations with the Scottish Government as the profession faces an uncertain future.


We have been waiting on reform for ten years now. Although there is a sense of returning to normality, we are not out the other side of the pandemic and can wait no longer. Without agreed reform we cannot effectively plan our dental business model and are left sinking in a swamp of last-minute guidance and changes.


"We need long term contract reform negotiations now, and certainty about our future."

We have repeated our call for the multiplier that was introduced earlier this month to remain in place until long-term contract reform can be agreed. Reviewing it every three months simply does not allow practices to plan appropriately and we suspect that the Scottish Government will look to reduce it at the earliest opportunity. With many staff self-isolating, and patients cancelling appointments, now is not the time to end Covid support payments and return to the Statement of Dental Remuneration (SDR).


The SDR has become a treadmill, unsuitable for modern dentistry and with no real remuneration for the additional activity that takes place in a dental practice looking after patients. It does not consider the number of patients needing care with dementia, complex medical histories and requiring assisted communication.


Even before the pandemic, dentistry had changed in many areas including delivery, materials, laboratory costs, patient expectations, education and training. The SDR model only remunerates dentists by seeing as many patients as possible in order to allocate a fee-generating income. We are left wondering what kind of care we are delivering. We need long term contract reform negotiations now, and certainty about our future.


Drip feeding guidance  

As a practice owner, I look to the Government for clear, concise guidance. However, information has been drip-fed and poorly timed, causing additional stress. Often, I don't hear about changes that are happening until a Primary Care Administration publication is sent out, which leaves no time to talk to our team at the practice.


New guidance takes planning, communication, training and time to put in place. Updates often come to us on a Friday, despite guarantees this would no longer happen. This makes them hard to implement. Staff look to us to reassure them, but when there is scarcely time to deal with new things, it creates a culture of worry and upset. The system is dysfunctional.


NHS Dentistry in peril 

We are deeply disappointed that an interim funding model hasn't been developed over the past two years, despite numerous opportunities to do so. Members of the SDPC have always been available to share our experience and knowledge of NHS dentistry with the Government but have not been consulted.


"We need to have constructive negotiations and communication together with appropriate financial measures."

It is the Government's policy that dentistry in Scotland will be free at the point of delivery in the future, but it is impossible to know how we will achieve this when it is completely unaffordable. Colleagues cannot sustain practices on current fees (many of which are absurdly low) and are put in a position of supplying NHS treatments at a loss. Due to this many are understandably walking away from NHS care.


We now have a three-month enhancement, which is encouraging a return to the SDR treadmill, but what happens next? We have yet to receive any reassurance from the Chief Dental Officer (CDO) of what lies ahead. We need to have constructive negotiations and communication together with appropriate financial measures. The instability we are facing now, has never been worse.


Young dentists feeling the pinch

There are major difficulties in recruiting associates and other staff, which is making it harder to treat sufficient levels of patients to generate enough income. The current financial plan is not working for young associates and dentists. For example, a young dentist on a VT scheme would get paid £32k which the Government pledged to maintain as students became associates during the pandemic. What students weren't made aware of is the mandate that as they become an associate, 45-55% of this payment from the Government must go to the practice, where it has been assigned to help cover practice staff and running costs.


This has caused understandable bitterness and has meant in order to pay mortgages or make ends meet young dentists have taken extra jobs, for example as delivery drivers, to top up their income. Young professionals are no longer keen to work in the NHS, but want to look at further training in Invisalign, facial aesthetics, composite bonding or non-dental services. because that is the only way they can make a sustainable living.


Staffing problems are systemic 

Once they reach their 50s a lot of dentists are now choosing to leave the profession. With pensions available from 55 and stress levels high, it is hard to argue a reason for staying. This has created a gap in dentists available to care for NHS patients. There is simply too much stress and not enough money to make it work in NHS dentistry.


The exodus of dentists aged over 50, combined with the reluctance of younger dentists to work within the NHS, has created a colossal backlog. We are faced with a mass of NHS patients who need our help, but we don't have enough workforce to deal with it.


Looking ahead

We will be attending the Scottish LDC Conference in Stirling soon, where the Cabinet Secretary, CDO and Deputy CDO will be speaking and holding a Q&A session. We will be making it clear that we need an interim model of remuneration that will keep dentistry in the NHS.


I will continue to champion the voice of dentistry and want to work constructively with the Government to create a model of care that works for all. By doing this, I hope to be a part of making delivery of NHS dental care better for the next generation of dental teams and our patients.



Josephine Weir

Practice Owner and Vice Chair of the BDA SDPC