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NHS registration increase for Scotland
9th Apr 2009
Scottish, BDA
The registration period for NHS patients in Scotland has increased to four years – with a view to an eventual move to lifelong registration – in a startling move by the government.
The increase, which came into effect on 1 April 2009, comes as the result of an agreement reached between the Scottish Government Health Directorates (SGHD) and the Scottish Dental Practice Committee (SDPC) arm of the British Dental Association.
It follows a chain of events that culminated in SDPC committee members being asked to vote on the matter by secret ballot on 3 March. Members were given just 12 hours to consider the proposal; the majority being informed by email at 9pm and asked to respond by 9am the following morning (4 March).
The decision was reached with a narrow margin of nine votes ‘for' and seven ‘against', although not all members voted.
An immediate change to continuous registration – initially suggested to commence from 1 April – was rejected by the SDPC in February. Following further discussion, the SDPC was asked to vote on this amended proposal, giving more time to discuss the issue of moving to continuous registration by April 2010.
The way the vote was handled has drawn criticism for the tight timescales, secrecy, and lack of discussion involved, and has lead to the resignation of SDPC member, Margaret Willis.
Both the SDPC and SGHD have decided not to publicise the decision with the media and dental press themselves. The BDA wrote to LDCs and posted a message on its website rather than issuing a press release.
Many dentists will have been informed of the change by the Government, rather than their representative body. One area in particular – Grampian – does not even have an LDC.
The fact that continuous registration is still part of the proposal has raised fears that the SDPC has set a dangerous precedent for its continued discussion with SGHD. The letter sent to dentists from the Scottish Government goes as far as to describe the changes as one part of a ‘two-stage process' that will ultimately lead to continuous registration.
The Scottish Government maintains that this will benefit the most vulnerable members of society who are currently less likely to attend regularly.
Colin Crawford, chair of the SDPC, said: ‘The Scottish Government's timescale for reaching a decision on changes to registration was extremely tight. The profession's view on the measure had to be gleaned solely from its elected representatives over a period of only two days.
‘A proposal for the immediate introduction of continuous registration was unanimously rejected by SDPC as we did not believe practitioners would wish to see such an arrangement.
‘Given the tight timeframe for a decision from the profession and the alternative of continuous registration in April 2009, the BDA reluctantly accepted a one-year extension as an interim measure. This acceptance was based on a vote of the members of the BDA's Scottish Dental Practice Committee, the elected body that represents general dental practitioners across Scotland.
‘Because of the short timeframe for reaching a decision, this vote was taken by canvassing committee members personally by telephone over a 36-hour period.
‘We have stressed to the Scottish Government this is not a long-term solution to the problems many Scots face accessing dental care. Importantly, though, it will allow thorough consideration to be given as to how dental registration should work in the longer term. That discussion will need to consider how best to ensure patients are seeing dentists at appropriate intervals and take full account of encouraging a high standard of preventive care. The current system does that by providing registration for those who attend within the time intervals recommended by the National Institute for Clinical Excellence – between three months and two years for adult patients. It is important that the time is taken to properly consult dentists and patients on such a fundamental change and that this discussion is taken forward in a constructive way.
‘The British Dental Association informed dentists across Scotland of this change directly immediately that the change was finalised, providing information via the BDA's website and writing to Local Dental Committees.'
The changes mean that all patients currently registered with the NHS can go up to 48 months (four years) without attending before being taken off the list. No patient registrations, therefore, will lapse between now and March 2010.
NHS registrations – already extended by the present Scottish Government – were due to begin lapsing this month. If the move to continuous registration that the SGHD is aiming for in 2010 goes ahead, it will mean no more automatic lapses in patient registration ever.
Dentists' right to de-register their patients is not affected.
Remuneration for patients who have not attended for more than three years will be cut to 20% from April 2010 – there will be no change to existing capitation and continuing care payments during 2009/2010.
Author
Guy Hiscott
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