Oral Health Improvement PlanThe Oral Health Improvement Plan has been launched by the Scottish Government to provide a framework for improving the oral health of the next generation.

The launch of this document started with an initial consultation in September 2016 and Shona Robison, Secretary for Health and Sport, claims the Government has engaged with a wide range of professionals and members of the public.

The Oral Health Improvement Plan has been broken down into the eight following sections.

Focus on prevention

The Oral Health Improvement Plan starts its focus on prevention by recognising that water fluoridation could have a positive impact on children’s oral health, however it is impractical to implement.

The Government will change payments to dentists for the Childsmile scheme and introduce a system of monitoring to ensure that all dental practices provide preventive treatment for children.

An Oral Health Risk Assessment (OHRA), which will include a comprehensive clinical examination and a discussion about lifestyle choices (eg diet, alcohol consumption etc) will be introduced for adults.

Patients will now be seen according to their OHRA results, meaning they may be recommended to visit the dentist once every 24 months.

Scaling and polish will be removed under the NHS and a more clinically-proven programme of periodontal care introduced.

Reducing oral health inequalities

A three-year Community Challenge Fund will be introduced to allow organisations to bid for funding to work in deprived communities.

GDS funding will be changed to better reflect the socio-economic status of patients registered to the practice.

Meeting the needs of an ageing population

The Scottish Government predicts that the number of people aged over 65 will increase by 53% by 2039 and has therefore decided to introduce arrangements to accredited GDPs to provide care in care homes.

Alongside this the Government will also be developing an accreditation scheme for GDPs.

Once there are enough GDPs with the necessary accreditation, the Government has said it will introduce new arrangements for people who are cared for in their own home.

More services on the high street

The Government is promising to work with NHS boards to ensure there is adequate availability to high street dental services.

A new system of accreditation will recognise GDPs with enhanced skills, enabling them to offer services that would otherwise have to be provided in a hospital environment.

Improving information for patients

Dental practices will be required to display Government’s NHS oral health information on self-care, treatments available, costs and services along with this being clearly communicated by the dentist.

The items of service payments to GDPs will be streamlined by the Scottish Government.

Quality assurance and improvement

Each NHS board will have a director of dentistry, so that there is one single professional source of advice and accountability.

A working group will be set up by the CDO, Margie Taylor, which will publish a pathway to support dental practitioners locally and, when necessary, ensure NHS boards can use disciplinary procedures rather than pass issues on to the GDC.

Workforce

There has been a 46% increase in the number of dentists in Scotland working under the NHS, from 2,474 in March 2007 to 3,613 in March 2017.

The Scottish Government will establish a Dental Workforce Planning Forum, which will make recommendations to the CDO about workforce requirements, morale and issues affecting the dental team.

There will also be programmes developed to help promote working in rural areas of Scotland.

An EU dentist’s network will be established for after Brexit, providing an opportunity for dentists from the EU to engage with the CDO.

A short-life working group will be set up to look at the possibility of providing out of hours NHS dental care. The group will report back to the CDO with recommendations on this.

The Scottish Government, along with NHS boards and NES, will work to ensure protected learning time for dental practice staff. It will also look to widen and improve access to dental education in Scotland.

Finance

The Scottish Government has admitted that introducing the Oral Health Improvement Plan will require additional investment and ‘a realignment of certain existing funding streams’.

The Government says it will continue to retain a mix of item of service, capitation and continuing care payments going forward, but the balance of payments will change.

In summary there will be:

  • A new system of capitation payments to support preventive care and treatment in children and young adults, supported by monitoring
  • A new system of enhanced continuing care payments to support the introduction of Oral Health Risk Assessments for adult patients
  • A simplified set of item of service payments for restorative care and treatment
  • Changes to the General Dental Practice Allowance to incentivise general dental practices with patients from more deprived communities
  • Changes to the reimbursement of rental costs to ensure that payments are based on an appropriate size of practice and taking into consideration its location
  • A new NHS commitment criteria
  • A single quality-based practice allowance, which reflects the unique circumstances faced in both remote and rural areas and deprived communities.

Patient charges will become a lot more straightforward as the number of treatments dentists can offer become more streamlined.

Conclusion

The Government admits that this is an ambitious programme of work, but has pushed on to establish a number of short-life working groups to take it forward.

The CDO will also help to produce a bi-annual newsletter to provide an update on progress towards implementation. Along with this there will be a number of roadshow events to discuss the implementation arrangements.