Scottish
dentistry

The Big Picture

Is the profession in the next few years heading into the perfect storm of increased regulation, increased running costs and increased competition accompanied by a steady reduction in income from reduced GDS allowances and a struggling economy? Is there a silver lining ?

An overview of Dentistry Practice in Scotland is, at first sight, encouraging;

1. As at March 2012 there were 3,115 registered General Dental Practitioners, – independent and salaried contracted to provide NHS dental services in Scotland; a record level.
2. 75% of adults and 87% of children were registered with a practice in 2012 and access to NHS dental services is at its highest ever level following several years of significant investment by the Scottish Government particularly in areas where there has previously been insufficient dental services to meet demand.
3. In 2011/2012 there were more than 4 million courses of treatment provided; approx 88% for adults and 12% for children. Data on the extent of private dental care is limited but the 2009 Scottish Health Survey suggested it was around 17% of the total provision.
4. There are approximately 1,000 registered dental practices in Scotland. Only a very small proportion of these (less than 10%) are operated by corporate chains
5. The value of the UK dental market was estimated by the Office of Fair Trading 2010 Report at £7.2bn. The value of the Scottish dental market in 2014 will be close to £1bn; a very substantial market by any measure.
6. Bob Kilpatrick, the British Dental Association’s Scottish Director says “We are quite fortunate in Scotland because the Scottish Government is deeply committed to NHS dentistry. It has invested significant amounts of money in promoting access which is now generally very good.

So everything in the dental garden in Scotland is rosy! Not quite; drill down a little deeper and some serious challenges to dental businesses will be exposed. But alongside the challenges there are also opportunities in a fast changing market place.

Three major challenges:

1. Financial and Economic Pressures
   According to the NHS Information Centre Report (28.10.2012) dentists in Scotland have seen a much bigger drop in earnings compared with other parts of the UK. Self-employed dentists suffered an average of 7.6% reductions in taxable income during the period, and practice owners 11%. This is the fourth year in succession that dental earnings have fallen. This, together with continuing rising costs and an increasing burden of non-clinical demands has serious implications for the sustainability of many dental practices in Scotland. NHS dentistry faces an outlook of continued funding cuts, possible modification and removal of some GDS allowances, rising practice expenses resulting in decreasing earnings. An additional concern is the fall in the numbers of people having treatment because of the economic climate. The jaws of rising costs and falling income bite hard!
2. Increasing Regulatory Requirements
   Hamlet’s comment about “a sea of troubles” is very apt in this connection; regulatory requirements seem to come in wave after wave.
   • Disability Discrimination Legislation
     Only about 10% of dental premises in Scotland are purpose built and the majority of these are new NHS facilities. The vast majority of practices are accommodated in converted residential property (55%) or converted commercial premises (30%), such as shops or offices. Meeting the requirements of DDA legislation in these older converted premises is often difficult, usually expensive and the end result at best a compromise. For patients with mobility issues this is more than just regulation; it is an essential requirement.
   • Building Regulations
     As part of the government’s drive to reduce carbon emissions, new building regulations require improvements in energy efficiency where extension or expansion of existing buildings is proposed. These requirements could range from new heating systems to insulation, lighting or double glazing and will add significantly to building, refurbishment or extension costs.
   • Decontamination and Infection Control Procedures
     All practices were required to be compliant and fully functional in terms of decontamination facilities by December 2012. Fulfilling the regulations, particularly in older, converted premises can be a complex, challenging and expensive process and may require alterations or extension to existing premises as well as the purchase of costly equipment. And then detailed and accurate records must be kept with the associated training and staff time. The on-going costs of maintaining the decontamination facility are significant.
   • Practice Inspections
     With effect from January 2013 every practice is subject to inspection covering Health Board, Vocational Training and National Standards for Dental Services. Given that the check list alone runs to 46 pages, the amount of staff time required to prepare and manage the inspection process is substantial and the costs of compliance considerable.
3. Increasing Competition
   • As of 28 March 2013 the General Dental Council decided to permit direct access to dental hygienists and therapists – one of the biggest changes in dentistry for a long time. Patients can now seek treatment from a hygienist or therapist without seeing a dentist first. Therapists can already do 70% of the procedures that dentists do and may seek to do more. The risk for dental practitioners is both in the potentially increased competition to provide services but more acutely, in a cheaper proposition – an attractive proposition for a cash strapped NHS.
   • The Government’s Dental Action Plan of 2005 has significantly increased the number of dentists recruited and setting up new practices through a system of grants and allowances. In addition, the number of qualified dental graduates has increased significantly over the last few years to the extent that the Dental Workforce Report predicts a surplus. The ambitious ones are likely to build their own practices with which it may prove hard for older practices in outdated premises to compete. The B.D.A has already expressed concerns that some practices are now short of work, even to the extent of offering a cash incentive to encourage patients to register with them. The elephant in the room at Practice Meetings is this – is the profession in the next few years heading into the perfect storm of increased regulation, increased running costs and increased competition accompanied by a steady reduction in income from reduced GDS allowances and a struggling economy?

The Future

But the clouds you so much dread could have a silver lining. Listen to dentist Charlie Crummey of Family Dental Care, “Dentistry, in a technical and clinical sense, has progressed enormously over the last 20 – 30 years, but the standard of premises…has not moved much beyond two rooms over the corner shop. This project (the new 10 surgery premises at Prestonpans) takes dentistry out of the corner shop into the 21st Century. When we go shopping or to a concert we expect a very high standard of facilities – why should dental patients not expect the same.”

Top quality, modern premises can address many of the issues of the perfect storm prediction. Dentists coming together to share high quality premises and facilities can reduce running costs with shared services (laboratory, LDU, reception, staff, IT, etc), meet all regulatory standards with ease, improve efficiency of operation and attract many new patients for whom quality premises equal quality dentistry.

Time for a radical rethink?