Oral health improvement plan

Reducing Oral Health Inequalities

The oral health of the population has improved dramatically, though there is still significant adverse impact from poor oral health amongst those living in the most disadvantaged communities.

Community Development

The First Minister’s Programme for Government 2017 acknowledged the importance of empowering communities to change behaviours in order to build a fairer society. ^[10] It is vital that going forward we ensure community-level interventions form a significant part of the overall approach to addressing oral health inequality.

Whilst the role of the dentist and the wider dental team is vital in treating and preventing dental disease; dental treatment and clinical prevention alone will not eliminate oral health inequality. We believe that the key to improving oral health in our most disadvantaged communities lies within the communities themselves.

There is good evidence that community engagement can improve health and wellbeing and is a recognised means of engaging the ‘hard-to-reach’ groups. This was a view shared by members of the public during the focus groups where it was noted that:

“Education and information sharing should be specifically targeted at individuals and groups most at risk such as those who do not attend regularly for check-ups, communities in low income areas and particularly those people who either smoked or drank heavily.” ^[11]

We know that there is good work being carried out by third sector organisations across the country, supporting people with long term health conditions. Our approach to improving oral health will seek to learn from this work.

Community Challenge Fund

We intend to introduce a Community Challenge Fund to allow organisations to bid for funding to work in deprived communities and support people to change their oral health behaviours.

This fund will initially be a three-year test of change programme and represents our first step in a significant journey to reduce oral health inequality. We will invite a range of partners, including third sector organisations, to help formulate the approach and agree appropriate outcomes.

Action 7: The Scottish Government will introduce a new three-year Community Challenge Fund for Oral Health Improvement. We will host an event with our partners to help develop the key components of the fund.

Deprivation Payments to Dental Practices

We need to ensure dentists and dental practices continue to provide care to patients in areas of greatest oral health need such as those areas with a high degree of deprivation.

Many payments and allowances at present do not reflect the socio-economic status of patients registered in the practice. To tackle oral health inequality the funding of NHS General Dental Services ( GDS) needs to better reflect the different challenges in oral health outcomes between areas of social deprivation and relative affluence.

Action 8: The Scottish Government will ensure that payments for practice-based allowances reflect the social deprivation status of the patients in the practice.

Priority Groups

Since the publication of the previous Dental Action Plan ^[12] in 2005, significant progress has been made in terms of oral health improvement for those population groups which need additional support such as children and older people. Our ‘Caring for Smiles’, ‘Mouth Matter’s and ‘Smile4life’ programmes have been well received by a wide range of health, social care, local authority, justice and third sector partners.

There are many elements common to these programmes and the Childsmile programme. We must therefore ensure we maximise the effectiveness of all programmes and develop common educational opportunities and partnership working wherever possible.

Action 9: The Scottish Government will establish a single working group to provide a strategic oversight to all national oral health improvement programmes and ensure we maximise our oral health improvement effort.

The mainstay of delivery of NHS dental services for priority group patients, such as people with a disability and those who are homeless, is the PDS. This service will continue to remain at the forefront in the delivery of future dental care to priority groups. The largest group of primary care dentists, however, work in General Dental Services ( GDS) as independent contractors in a ‘high-street’ setting. Wherever possible, people in our priority groups should receive their dental care in practices close to where they live, for example within a ‘shared care’ arrangement with the PDS providing more complex treatments.

Action 10: The Scottish Government will ensure the PDS actively pursue shared care arrangements with local ‘high-street’ dental practices.