The Scottish Government

« Previous | Contents | Next »

Listen

Modernising NHS Dental Services in Scotland: Analysis of Responses

CHAPTER 4: CHANGES TO THE SYSTEM: GENERAL COMMENTS

The consultation stated:

A number of factors have led to a growing momentum for change in the way dental services are delivered to meet the needs of a modern Scotland:

• Continued and growing problems of service availability and access leading to major public and patient concerns

• The changing demography of Scotland with the consequent impact on healthcare services

• Growing dissatisfaction within the dental profession with the current framework

• The changing nature of the dental profession - more women, more career breaks, more dentists retiring early

• A lack of incentive in the GDS contract for promoting dental health

• Concerns about aspects of private dental services (e.g. lack of information; regulation of standards) as outlined in the recent Office of Fair Trading report

An effort to reform dental services must inevitably consider the balance between the requirement for change and the extent to which existing systems have been effective in meeting the needs of the public and dental health professionals. No change is possible without some degree of risk to the stability created within the existing framework.

The consultation paper set the scene for a consideration of future change by outlining current concerns about the dental service framework and delivery. Around one-third of respondents provided further commentary on what they saw as the problematic issues which needed to be addressed. These comments are summarised here.

General

The current system was criticised by a few respondents in relatively strong terms, as " archaic and ineffective" (Dent 1), " a disgrace" which required to be " scrapped as soon as possible" (Dent 78), and clearly not impacting on oral disease amongst much of Scotland's populace (Pat Rep 11). Several dentists bemoaned the loss of NHS dentists to England or the private sector with a few respondents highlighting their perception of dentistry becoming increasingly detached from the NHS (Dent 78, Dent 79).

Access to NHS Dentistry

Most commentary focused on issues of difficulties with access to NHS dentistry, with members of the public comprising the largest respondent group on this topic. Whilst several responses remarked generally on access problems, some respondents specified geographical areas where they perceived there to be current difficulties. Most frequently mentioned were Highland (e.g. Pub 4, Bod 17, Pat Rep 2, Pat Rep 4); Borders (e.g. Pub 10, Pub 23, Bod 26); Fife (Prof Rep 25, Bod 6, Prof Rep 1); with other areas such as "NE Scotland", Argyll and Clyde, Dumfries and Galloway, Nairn and Thurso receiving individual mentions in this regard.

Lack of Support for NHS Dentists

Many dentists and a few NHS Boards highlighted the mounting tension between increased bureaucratic workloads and responsibilities on NHS dentists, set against what they saw as a lack of adequate financial and other support. One respondent commented:

" General Practitioners manage and run their own practices: they are the Chief Executive, Director of HR, IT, Finance, purchasing and procurement and safety officer all rolled into one. Along with treating patients of course! All this work is done with little recognition from the government" (Dent 15)

Several others pointed to the increased public expectations of dentists and new requirements of practitioners to handle issues of health and safety, cross-infection and training (e.g. Dent 17, Dent 37). Such demands were seen by some to be bureaucratic and time consuming to administer, with simplification needed if dentists are to be encouraged to stay under a NHS system in future (Bod 11).

Some dentists remarked on what they saw as their increasing financial vulnerability under an NHS system (e.g. Dent 37, Dent 47, Dent 65).

Lack of Appropriate Incentives

Several respondents commented on the lack of alignment between strategic goals for dentistry and current NHS dental financial incentives (Dent 13, Dent 23, Dent 63). Again, a tension was highlighted, this time between the General Dental Service Regulations and a holistic patient-centred dental care system (Educ 3). The GDS was seen as no longer in tune with the realities and complexities involved in the delivery of modern dentistry (Bod 15) with a perception expressed that the delivery of preventative dentistry needed to rely at times on dentists' social consciences (Bod 10).

« Previous | Contents | Next »