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Saturday, July 20, 2024

NHS Dentistry in The Highlands is in Crisis

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Steve Chisholm, Alba Candidate for Caithness, Sutherland & Easter Ross calls on the Scottish Government to take urgent action to aid recruitment and retention of Dentists for NHS Highland. 

NHS dentistry in Scotland is burdened by myriad challenges that hinder service delivery and negatively impact patient care.

The implications are far-reaching, affecting both urban centres and the remotest areas of the country with the Scottish Highlands one of the worst affected areas.

The root of the problem is multifaceted, involving workforce shortages, funding constraints, an aging population, and systemic inefficiencies. 

One of the most pressing issues is the acute shortage of dental professionals.

There simply aren’t enough dentists, dental nurses, and other essential dental care workers.

The situation is especially challenging in the Scottish Highland’s rural and remote communities where other issues, such as a lack of housing and constraints to other public services make recruitment and retention difficult.

This shortage has led to prolonged waiting times and diminished access to necessary care. 

The General Dental Council (GDC) bears significant responsibility for this shortage due to its limited offering of overseas registration exams.

Though they have recently opted to abolish the exam, allowing unrestricted entry, this measure is ill-considered and counterproductive given that over half of the candidates previously presented failed the exam.

A more sensible approach would be to increase the number of exam slots, thus enabling an influx of highly competent overseas professionals.

Sadly, even when experienced professionals are identified who want to work for the NHS in Scotland they face additional hurdles, such as mandatory self-funded courses, even for the highly experienced, and “Golden Hello” rules which are administered is such a way as to exclude certain professionals willing to relocate to a Highland practice.

Why is it that mandatory training is only needed for those either new to or who have been outwith NHS practice for 1 year, but the “Golden Hello” is only payable to those who are either new to or have been outwith NHS practice for more than 5 years.

A consistent approach should be applied here as the situation is preventing experienced and highly competent dentists from relocating to the Highlands.

Funding and budget constraints have severely strained the NHS dental services in Scotland.

Dentistry remains the only segment of the health service where patients must pay at the point of need and treatment is often severely rationed.

This rationing leads to many essential services being unavailable, a situation that starkly contrasts with the principle of free healthcare at the point of need.

Integration with general healthcare remains inadequate, making it challenging to provide holistic care for patients with complex medical histories and is a significant oversight given the integral role of oral health in overall well-being. 

The aging population in Scotland adds another layer of complexity to the dental crisis.

Older patients often have more complex dental needs that require specialised care and resources. Facilities like the health sciences building in Inverness, which functions as a mini dental hospital, showcase the potential for addressing these needs.

Expanding this facility into a full-fledged dental hospital and creating a graduate school of dentistry in association with the University of the Highlands and Islands (UHI) could significantly improve service delivery, especially with the involvement of experienced General Dental Practitioners (GDPs).

They could and would gladly mentor new undergraduates and continue to support post graduation.

This initiative could also help retain graduates in the Highlands, offering a sustainable solution to the workforce issue.

Experience elsewhere shows that graduates often choose to settle close to their Alma Mater. 

Oral health inequalities are stark across Scotland, with deprived areas experiencing higher rates of dental decay and gum disease.

This disparity highlights the need for more robust public health initiatives and education aimed at preventive care.

Currently, the emphasis on preventive measures is insufficient, leading to a high incidence of preventable dental problems.

Dentists are not adequately incentivised to focus on prevention, despite its potential to reduce the long-term burden on the NHS significantly. 

The impact of the COVID-19 pandemic cannot be overlooked.

The pandemic disrupted routine dental services, creating backlogs and necessitating additional infection control measures that have further stretched already limited resources.

During the pandemic, the Scottish Government prevented dentists from working despite meeting the highest cross-infection control standards.

Meanwhile, their European colleagues continued to operate safely.

This prolonged suspension of services saved the Scottish Government a considerable amount of money, which has not been reinvested into NHS dental provision. 

Technological advancements in dentistry require substantial investment in new equipment and training.

However, budget constraints make it difficult for NHS practices to afford these technologies, contributing to the emergence of a two-tier system where only private practices can offer state-of-the-art care. 

Regulatory and administrative burdens further complicate the landscape. Increasingly stringent requirements and excessive paperwork detract from clinical time, affecting the efficiency and morale of dental professionals.

The regulatory environment is perceived as toxic, with unrealistic expectations and inadequate remuneration.

The Scottish Government’s approach, spearheaded by a Chief Dental Officer with little practical experience in running an NHS practice, has also been criticised for its lack of engagement and understanding of the profession. 

Addressing these challenges demands a multifaceted approach.

Increased funding is crucial, as is strategic workforce planning and the development of robust public health initiatives.

Better integration with the broader healthcare system is essential, and experienced dentists, rather than politicians, should lead these efforts. 

The future of dental health in Scotland and resolution of the Highland’s dental crisis hinges on swift, decisive action and a commitment to overhaul a system that is clearly failing. 

Alba calls on the Scottish Government to take urgent action to: 

• Restore the overseas registration examinations and increase their availability 

• Harmonise both the need for mandatory training and the eligibility for a Golden Hello payment to 1 year outwith NHS practice 

• Increase funding to clear the Covid-19 backlog using savings arising from the enforced closure of dental practices during the pandemic 

• Support the early establishment of a graduate school of dentistry at the life sciences centre in Inverness 

• Increase the level of funding provided for preventive dental services recognising this as an investment in oral health which will be self-financing in the longer term 

• Simplify the administrative and regulatory burden on dentists so that more time can be spent on the actual delivery of dental care services

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