NHS dental payment reform: equality impact assessment

Background

The publication of the Oral Health Improvement Plan in 2018 made the commitment to undertake a wider reform of NHS dentistry, and in particular address concerns highlighted by the sector to prioritise payment reform, for an administratively simpler and more clinically-focused payment system.

At present there are a number of access challenges across Scotland for patients attempting to access NHS dental treatment. The Government has therefore brought forward at pace a new suite of fees intended to incentivise NHS care and treatment, and sustain NHS dental services as a national service in Scotland. Payment reform affirms the Government’s commitment to sustaining and improving patient access to NHS dental services, in line with the First Minister’s Policy Prospectus.

The new payment system will also offer dentists greater flexibility in treating patients, with the opportunity to use modern dentistry care and treatment. For example, patients will benefit from treatment items being brought in line with current best practice guidance, particularly around periodontal treatment.

The resulting payment reform comprises a high-trust, low bureaucracy model comprising 45 items for payment (compared with over 700 items presently). While the number of items has been reduced significantly the actual care and treatment that may be offered to NHS patients will be enhanced. The new system will therefore be much easier for patients to understand, the NHS offer can now be presented in summary to patients.

At present, those patients who are not eligible for free NHS dental care and treatment pay 80% of the fee cost of the treatment they receive, up to a maximum of £384 per course of treatment. Payment reform comprises new higher fees to sustain the provision of NHS dentistry. This means for some patients they may have to pay more for their NHS treatment than at present.

Those only requiring preventative treatments, such as oral health advice, will typically see a smaller increase in charges than those requiring more complex restorative procedures. We have had to increase fees for restorative treatments more significantly to reflect their current market cost and protect these treatments for NHS patients.

Whilst costs to certain NHS patients have increased, these need to be set against the equivalent costs in private dentistry. Patients unable to access NHS dentistry and requiring private treatment typically pay between 6 and 10 times the NHS cost. NHS fees and the resultant patient charge remain significantly below the cost of private care for the equivalent treatment. In preserving universal NHS dental care all patients benefit.

Around 40% of people in Scotland are exempt from NHS charges – including under 26s’ and those on certain benefits – and these people will continue to receive free NHS dental care and treatment.