Sir, the majority of dental practices in Scotland are mixed NHS-private practices. A recent survey from BDA Scotland revealed that 52% of largely/exclusively NHS practices and 86% of mixed practices predicted a relative reduction in NHS work during the next year because of the COVID-19 pandemic's impact on the provision of NHS dental services.1 There is a possibility that dentistry in Scotland will move towards a two-tier system with reduced access for NHS patients. During question time on 12 August 2020, the First Minister of Scotland said: 'There is not, and there should not be seen to be, a two-tier system of oral healthcare. If dental practices are ready to do so, they can provide aerosol-generating procedures on patients with urgent dental problems from 17 August. We have 75 urgent dental care centres throughout Scotland, to which patients continue to be referred.'2
Since then, there has been a number of complaints about GDPs in Scotland who may be misinforming patients about the range of NHS services available following lockdown or coercing patients into undertaking private treatment. Some of these complaints were also sent to the Scottish government. On 14 September 2020, the Chief Dental Officer for Scotland wrote to the Directors of Dentistry with suggestions on how to deal with this type of complaint.3
On 12 October 2020, it was announced that NHS dental contractors in Scotland would, from 1 November 2020, be able to provide a full range of treatments to all NHS patients within dental practices.4 The BDA has concerns that expanding the range of treatments will increase patient demand which may encourage a 'two-tier' dental system.5
In the interests of patient safety, only a fraction of the number of patients can be treated compared to pre-COVID levels. To avoid confusion, it is essential that the Scottish government provides regular and timely information to inform the public and dental professionals about changes to primary dental care services.
References
British Dental Association Scotland. Open letter to Joe FitzPatrick MSP on mixed practices. 6 August 2020. Available at: https://bda.org/advice/Coronavirus/Documents/Scotland-David-McColl-letter-on-mixed-practices-06-08-2020.pdf (accessed October 2020).
Scottish Government. First Minister's Question Time on NHS Dental Services. 12 August 2020. Available at: https://www.theyworkforyou.com/sp/?id=2020-08-12.18.0 (accessed October 2020).
Scottish Government. CDO(2020)14: Letter to Directors of Dentistry. 14 September 2020. Available at: https://www.sehd.scot.nhs.uk/cmo/CDO(2020)14.pdf (accessed October 2020).
Scottish Government. CDO(2020)15: NHS dental remobilisation. 12 October 2020. Available at: https://www.sehd.scot.nhs.uk/cmo/CDO(2020)15.pdf (accessed October 2020).
British Dental Association. Scotland: Concerns about remobilisation. 14 October 2020. Available at: https://bda.org/news-centre/latest-news-articles/scotland-concerns-about-remobilisation (accessed October 2020).
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Yeung, C. Two-tier dental system. Br Dent J 229, 568 (2020). https://doi.org/10.1038/s41415-020-2359-z
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DOI: https://doi.org/10.1038/s41415-020-2359-z