Oral health improvement plan

Workforce

There has been a substantial increase in the NHS dental workforce in Scotland since the publication of the previous Dental Action Plan, ^[20] with a 46% increase in the number of dentists in the workforce, from 2,474 in March 2007, to 3,613 in March 2017. ^[21]

This is an excellent platform. We want our dental workforce however, to adapt and respond to the challenges of the future. This Plan is helping us shape how NHS dentistry and oral health improvement is taken forward, including an increasing emphasis on prevention for all life stages and in particular for older people in care settings.

Skill Mix and Direct Access to Dental Care Professionals ( DCPs)

We want to ensure that dental teams make best use of dentist and DCP skills to deliver the key actions included within this plan. The CDO is currently taking forward a body of work to explore the practicalities and benefit to the patient of introducing direct access to DCPs, particularly for older people cared for at home.

Action 28: The Scottish Government will establish a Dental Workforce Planning Forum chaired by the CDO to provide regular workforce planning across the dental team.

The Forum will make suitable recommendations to the CDO on workforce requirements, composition of the workforce, morale of the workforce and the issues that affect dentists and members of the dental team working in remote and rural areas. The Forum will also be able to commission intelligence reports.

Remote and Rural Areas

Despite the increase of the dental workforce, some remote and rural areas still experience difficulty in recruiting and retaining practitioners in their areas. We need to maximise recruitment in remote and rural areas by encouraging practitioners already in the area to become trainers for new graduates, including allowing them to recruit ahead of other areas in Scotland. We have recently reviewed the recruitment and retention allowance and will continue to keep it under review to ensure there are adequate incentives to work in remote and rural areas.

Action 29: The Scottish Government will develop programmes for promoting working in remote and rural areas.

EU Citizens (Brexit)

The First Minister continues to send a strong message about the impact Brexit will have on public services, ^[22] a message shared by the Chief Executive of NHS Scotland in a letter of 7 June 2017 to NHS Chief Executives emphasising the valuable skills and experience EU citizens bring to the health service. ^[23] Future workforce planning in NHS dentistry will take cognisance of the positive contribution made by EU citizens in providing NHS dentistry in Scotland.

Action 30: The Scottish Government will establish an EU dentist’s network which will provide the opportunity for dentists from the EU to engage with the CDO on issues which are a consequence of Brexit.

Out of Hours Care

Over the past ten years local NHS Boards have established a range of out of hours (OoH) NHS dental services. Whilst there is consistency for the public across Scotland in terms of accessing OoH services, namely through NHS 24 and the 111 telephone number, the models of OoH care at the point of service delivery differ from area to area.

Some NHS Boards operate a rota system that includes all GDPs in their areas, while others pay sessional fees to a group of dentists. We are aware that there are strengths and weaknesses in both models of care. The rota system recognises that all GDPs have a terms of service requirement to provide OoH care to their registered patients, while a sessional system of care acknowledges the efficiencies of relying on a smaller number of dedicated professionals.

At present the area where the patient’s dental practice is situated determines where the patient will be directed by NHS 24 to access an OoH service. This can cause significant problems when a patient is currently residing in another NHS Board area from where they are registered with a dentist. Registration is often linked to where the patient may work or a previous home address.

Action 31: The Scottish Government will commission a short-life working group to look at models of OoH NHS dental care and the patient’s OoH care journey. This group will report to the CDO with recommendations on how OoH care should be taken forward in the future.

General Dental Practitioner Fellowship Programme

It is important that dental teams feel competent to deliver care. In the future continuing professional development should be available across Scotland for all members of the team.

Additionally we see all GDPs taking on a clearer leadership role within the team to ensure that the dental team can deliver a wider, more complex range of NHS dental care for their patients. It is important that GDPs are able to undertake more strategic leadership roles for the profession with NHS Boards and will require on-going training and skills to allow this to happen. We see this programme as underpinning our proposals around providing more services in the high street.

Action 32: The Scottish Government will commission NES to develop a General Dental Practitioner Fellowship Programme to enhance clinical skills, develop quality improvement skills and support remote and rural working.

Protected Learning Time

We also want to ensure that our skilled workforce continues to be trained to the highest standard, with opportunities available for the dental team to take time out from clinical practice to allow practice staff to address their own learning and professional development needs. The principle of protected learning time is widely accepted in general medical practice.

The consultation asked respondents whether protected learning time should be rolled out for GDPs and practice staff. This question received overwhelming support with 77% of respondents agreeing with the proposal.

We will therefore work with NHS Boards to support the introduction of protected learning time for practice-based dental teams. In taking this forward we will consider the issues raised by the dental team during the consultation exercise that protected learning time should be adequately funded and remunerated. We will provide further details of how this will work in practice following our work with NHS Boards.

Action 33: The Scottish Government will work in partnership with NHS Boards and NES to ensure protected learning time for practice staff.

Occupational Health

At present there are no consistent occupational health advice and guidance services for GDPs and the dental team, including support staff. Going forward we want to ensure that all members of the dental team have access to an occupational health service to help support them to keep well, both physically and mentally.

Action 34: The Scottish Government will introduce an occupational health service for GDPs, members of the dental team and other practice staff.

Widening Access to University

The report ‘Social inequalities in oral health: from evidence to action’ highlights the widening socio-economic gap and the impact this will have on oral health inequalities. ^[24] We believe that having a dental workforce which reflects the rich diversity of the Scottish population will help us to deliver substantial improvements in the oral health of the population.

The First Minister’s programme for Government 2017 committed to “drive forward the recommendations of the Commission on Widening Access’s Report ‘Blueprint for Fairness’, so that every child, no matter their background or circumstances, has an equal chance of going to university by 2030.” ^[25]

We want to ensure that the opportunity to apply to study dentistry is open equally to everyone who has the ability to become a dentist.

Action 35: The Scottish Government will work with the Scottish Funding Council and the universities to widen and improve access to dental education in Scotland.