what will happen after GP commissioning takes over the current process, shortly. The dentist is paid a certain UDA (unit of dental activity) even to make a referral. Apart from this, in order to
keep up with the ı8-week RTT (referral to treatment)require- ment, NHS trusts have to spend a lot of money clearing the current huge hospital waiting lists, which may mean out- of-hours operations in NHS hospitals or treatment at ISTCs (independent sector treatment centres). At the time of publi- cation, data of costs involved in such treatments were not available to the author. In general, there is an air of
uncertainty over the future of NHS dentistry and how it can be funded as well as being able to provide high standards of care with ever-increasing healthcare expenses. It appears that the actual cost of providing a service delivering high-quality treatment is not consistent with the scale of fees set within SDR. The use of this scale has to be debated and appropriate changes made. It makes clinical and economic sense to give a serious consid- eration by the policy makers in Scotland as to how the services can be restructured to achieve efficiency. The author has made consid-
erable efforts to discuss this issue and obtain advice from a variety of professional and Scottish Government bodies. SDPB (Scottish Dental Prac-
tice Board) has revised the SDR via a core working group on a cost-neutral basis, which is still with Scottish ministers. SDPC (Scottish Dental Prac-
tice Committee) had taken a view that revision of SDR is not possible, unless a negotia- tion of item of service fees is considered. The reluctance of the board to consider an appropriate revision forced a unanimous withdrawal of SDPC from the core working group. In particular, the committee had concerns with the Scottish Government’s attempts to achieve unreason- able cost neutrality as this
failed to address properly the costing of the item of service fees, in particular more costly items such as extractions4. The service provided by
NHS dental contractors is taxpayer funded and they are duty bound to provide high quality care. They are under constant scrutiny especially with regards to their claims. We are in an era where
the NHS is downsizing its expensive secondary sector and encouraging as much work as possible to be carried out locally. Unlike GMPs, who are paid a salary, the dentists are self-employed and, if more work has to be moved to primary care setting, then appropriate change is necessary to achieve efficiency. Let us not forget if the
government or the NHS is trying to protect diminishing resources, there is mileage in spending where outcomes are not simply better but less expensive. Will the policy makers take
necessary action to help resolve the situation?
Disclaimer: While the author has made every effort to state the facts, readers are requested to take a measured approach in arriving at any conclusions. More extensive study of the regulations is needed, which is beyond the scope of this article.
Acknowledgments: The author is grateful for the advice and input given by Ms Fiona Angus, senior policy advisor at the British Dental Association (Scotland).
REFERENCES:
1. ISD Cost book 2012
www.isd
scotland.org/Health-Topics/ Finance/Publications/2012-11- 27/2012-11-27-Costs-Report.pdf 2. Statement of Dental Remunera- tion
www.psd.scot.nhs.uk/ professionals/dental/Amendment- no-122-to-the-SDR_000.pdf 3. MEE Oral Surgery Review 2010
www.mee.nhs.uk/PDF/os%20 review.pdf
4. Personal Communication Senior Policy Advisor, British Dental Association Scotland.
Scottish Dental magazine 67
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