Why is it so hard to get an NHS Dentist in Scotland?

This question seems to come up around once an hour in a dental practice at the moment (circa October 2021). The honest answer is a bit long and involves us going back in time. So to understand, we need to travel back to March 2020.

Of course, most people remember March 2020 as when the pandemic started. It was a scary time for so many people and businesses. Nothing had ever disrupted so many people’s livelihood. It seemed like the world stood still and nobody really knew what to do.
When it came to dentistry, there was a special issue. Covid passes through the air and on surfaces. In surgery, we use a lot of drills and hand pieces that produce aerosols (small bubbles of air) that linger in the environment for an extended period of time. When covid hit it was identified and taken by authorities that Aerosols were very good at transmitting covid and Aerosol generating procedures (AGP) in particular should be stopped in the community.

A typical dental practice will have at least 2 hand pieces that cause aerosols. As such there is a very high number of procedures that are classified as AGPs including fillings, crowns, scale and polish, root treatment and some surgical procedures etc. In other words, most dentistry. So we had to shut. It. Down.

To get back into the surgeries, we needed enhanced PPE, especially FFP3 mask. These masks make you sound and look a bit like Darth Vader (as if we weren’t scary enough). To wear an FFP3 mask we need to get ‘face fitted’ which in March 2020 meant finding a specialist- there weren’t many. On top of our new fancy masks, we were mandated to introduce new PPE such as surgical gowns and increase our cleaning protocols. We bleached every surface in the surgery every time someone even looked at it. I am keeping things light, but we really did introduce new cleaning processes to ensure that we could minimise the risk of transferring covid.
When we were waiting for the all clear, we spent a lot of time on the phone. We did online and telephone consultation to help with emergencies. A lot of antibiotics were prescribed. At this time Dental Hubs were set up which were in designated NHS clinics to do simple extractions and get some patients out of acute pain.

In the summer of 2020 we were told (at rather short notice) that we were to reopen regularly. We learned at the same time as the rest of the country. Face to face, in our surgery, we were informed by a patient. The official word from the government and chief dental officer (the big boss) didn’t come for a couple more days.

We were only allowed to see patients for antibiotics and to drain abscess, strictly no AGPs. We were told to only attempt extractions if they were easy because if the tooth snapped we would have to do an AGP, which was not allowed. Fast-forward a few weeks, and now we are allowed to do simple fillings and normal check-ups. We were given permission to use one of our drills, but not the main one we use for most procedures.
In addition to those restrictions, we were limited to between 8-10 patients a day. To give you an idea of what we used to see in our NHS practice pre lockdown, most dentists would see between 20-30 patients a day, with many easily seeing more than 30 per dental chair. So a 3 surgery practice may see 90-100 patients per day – so it was a big change to then be put down to 10.

Without going through every single restriction change (because that would take ages, and is a bit boring) eventually we were allowed to carry out AGP treatments with our new fancy PPE. We were restricted to a maximum of 12 patients per day with a maximum of 5 AGP’s.

During the reopening of dentistry, the cost of PPE and other materials had increased significantly. Some people may be able to remember the procurement of PPE across the NHS as a whole and to the greater public. The demand completely outstripped supply and for most PPE we saw a massive price increase. For example a box of gloves jumped from £3.50 to £24. We even heard of a practice having to spend £50.

As for payment, the NHS changed the way surgeries get paid. We were given a reduced package based on the preceding 12 months. A lot of dental practices were in dire straits, especially if they had any dentist or previously, it meant a massive reduction in income. In fact several practices had to let go of staff because even with furlough they couldn’t afford to run the practices with new associated costs while also paying their staff.

Almost finished now! So, now we still have restrictions. Our contracts have changed to explain that they will only get paid if they see a specific number of NHS patients. If the practice sees more than that specific number of patients they will not get paid any extra and as such the practice will lose money for any patient seen above the quota.

In the last few weeks, extra rules have been added which allows free treatment for patients under the age of 26 years old. The amount going to practices sadly doesn’t cover the extra treatment expected to be delivered. Sadly the financial situation has been a massive factor over the past year. Add this to the restricted numbers (they have improved since the start but still significantly less than before). The result being that getting into a dentist has become very hard.

Currently, practices are limiting the number of NHS patients being seen due to all the reasons above. The remainder of the time has been allocated to private treatment. This allows the practice to offer all treatments (the NHS limits what treatment can be offered) and except for the patient numbers there are significantly fewer restrictions.

There is no clear end in sight. If the NHS decides to drop the covid package to dentists, which will have to occur eventually, there is likely to be more change, and it is possible that getting NHS treatment may be even more difficult.

We all hope that the situation starts to improve, however for the foreseeable future, getting an NHS dentist will continue to be difficult. As the treatment need increases the pool to access dentistry will continue to grow, sadly we cannot give any tips to get into any practice for NHS treatment as each surgery will have a different policy. We would advise if you need treatment, please contact your local practice to get seen.

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