Doctors' and Dentists' Remuneration - 2025-2026 pay round: Scottish Government's written evidence

H. Specific Staff Groups – Pay, Terms and Conditions

General Medical Practitioners (GMPs)

Introduction

115. This section provides information relating to general practice (independent contractor GMPs) and the delivery of contracted services through the NHS Boards. This section also provides additional background to developments with the GMS arrangements in Scotland, and the implementation of the new contract in 2018.

Background

116. The majority of GMPs working to provide primary medical services in Scotland are independent contractors, self-employed or partnerships running their own GP practices.

117. The General Practice – GP practice list sizes was published on 19 December 2023. As of 1 October 2023, there were 897 GP practices^[26] in Scotland and 83.5% were on the national General Medical Services contract. The number of practices in Scotland has decreased by 9.8% from 994 practices in 2013, reflecting a trend towards larger practices with more GPs serving a larger number of patients. GMPs operating under Section 17C or 2C arrangements provide services based on locally agreed contracts, and any uplift in investment for these arrangements is a local matter for the Health Board.

118. As of 1 October 2023:

• 749 practices operated under the General Medical Services Contract;
• 89 practices operated under the 17C contract; and
• 59 practices operated under the 2C contract^[27].

Figure 4: General Practice Contract Types, 2013 -2023; as at 1 October

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Source: National Primary Care Clinician Database (NPCCD)

119. The average (or mean) size of a Scottish GP practice in terms of numbers of registered patients was 6649 in 2023^[28], however there was considerable variation, ranging from under 200 patients for practices in remote locations or practices which addressed specific health needs of patients (e.g. those with challenging behaviours or homelessness), to practices of over 20,000 patients in densely populated urban areas.

Pay and Contractual Uplift 2024/25

120. For 2024/25 the Scottish Government implemented the DDRB recommendation to uplift GP pay net of expenses by 6.5%. In total the Scottish Government uplifted the GP contract by £59.6 million. This also included a 5.5% uplift to practice staff expenses, and a 6% uplift to wider practice expenses. This also included £7.6 million funding to cover population growth in 2023/24.

121. The contractual uplift was applied consistently across all general practices.

Investment in General Practice

122. In 2022/23 the sum of NHS Scotland non-dispensing payments made to 910 General Practices was £1.013 billion^[29]. Investment had increased by £23.6 million (2.4%) when compared to 2021/22 .

• £846.3 million was paid to General Medical Services (GMS) contracted practices run by GPs^[30];
• £119.1 million was paid to locally negotiated contracted practices (17C) run by GPs^[31]; and
• £47.6 million was paid to NHS Board run practices (2C^)[32].

Figure 3 - Types Of General Practices And Their Total Payment^[33]

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alt Total Payment by type of General Practice from 2014/15 to 2022/23.

This line chart shows the Total Payment made in each of the last nine years, broken down by type of practice.

123. Of the £1.013.billion paid in 2022/23, the Global Sum was the largest payment amounting to £712.8 million paid to 910 General Practices. Moreover, payments for Directed Enhanced Services decreased by £10.8 million (-20.3%) to £42.3 million in 2022/23, largely due to the reduction in COVID-19 vaccination services provided by General Practices.

124. In addition to the £1.013 billion, £20.3 million was paid to 83 General Practices for dispensing services in 2022/23.

Vacancy, Turnover and Attrition Rates

125. According to the General Practice Workforce Survey Scotland 2023^[34], 42.3% of GP Practices reported that they had vacant GP sessions from April 2022 to March 2023, in comparison with 37% of practices in 2022^[35]. The overall vacancy rate was 12.1. The vacancy rate varied by NHS Board. Discounting the Island Boards rates which are subject to volatility due to small numbers, the vacancy rate ranged from 7.1 in Ayrshire and Arran, to 16 in Dumfries and Galloway.

126. Vacancy rate is defined as the number of vacant weekly GP sessions over the year, divided by the sum of vacant sessions over the year and weekly sessional commitment of GPs in post in March 2023. This definition differs from the vacancy rates reported elsewhere in NES’s workforce statistics and may tend to overestimate vacancy rates, particularly in smaller boards. Extra caution is therefore advised when referring to the vacancy rates published here^[36].

Board	% of Practices with Vacancies	Vacant GP Sessions	Contracted GP Sessions	Vacancy Rate
Ayrshire & Arran	33.30%	140.8	1839.4	7.1
Borders	34.80%	64.7	660.4	8.9
Dumfries & Galloway	34.40%	138.8	731.3	16
Fife	60.40%	261	1709.4	13.2
Forth Valley	34.00%	130.5	1424.5	8.4
Grampian	63.80%	517.7	2801.1	15.6
Greater Glasgow & Clyde	30.40%	608.5	6001	9.2
Highland	30.40%	297	2392.5	11
Lanarkshire	38.80%	351.1	2436.5	12.6
Lothian	58.50%	655.7	5086.2	11.4
Orkney	57.10%	166.9	241.2	40.9
Shetland	55.60%	111.8	137.7	44.8
Tayside	54.10%	354.4	2185.4	14
Western Isles	66.70%	84.9	180.3	32
Total	42.30%	3813	27826.9	12.1

127. Table 6 presents estimated numbers of GP sessions affected by absence, by reason for absence. Numbers of sessions lost to absence have been weighted using known GP headcounts^[37].

Table 6: Estimated absent GP sessions by reason, April 2022 - March 2023

Sick leave

37,099

Maternity/Paternity leave

37,882

Parental leave

559

Special leave

2,586

128. Overall sessions lost to absence are around 10,000 lower than was reported in the 2022 survey, but the changing impact of the pandemic and the inclusion of a self-isolation category in 2022 make it difficult to assess relative changes in absence over time. This may particularly be the case with sick leave, which has seen an increase of almost 10,000 sessions between 2022 and 2023. Absent sessions due to maternity/paternity leave increased between the 2022 and 2023 surveys by around 2,000 sessions.

Recruitment and Retention

129. Between 2008 and 2017 the headcount of GPs remained roughly constant at around 4900. In 2017, Scottish Government committed to increasing numbers by at least 800 over the next ten years.

130. We continue to make good progress towards this commitment increasing the number of GPs by 271 since 2017. As of September 2023, the headcount of GPs in Scotland was 5,168. This is a slight rise of 19 GPs compared to the same period in 2022. Prior to 2018, the headcount of GPs had remained roughly constant at around 4,900 since 2012^[38].

131. As of 30 September 2023, 1900 (37%) of the GP workforce were male and 3213 (62%) female^[39].

132. As we strive to meet our 2027 recruitment challenge, we have significantly improved fill rates for GP Speciality Training. GPST fill rates have achieved close to 100% over the previous five years, with 35 additional posts being approved last year for 2023 recruitment and a further 24 posts added in 2024. This will help towards meeting the Scottish Government’s commitment to have 800 more GPs in Scotland by 2027.

133. We have continued to offer the £20,000 bursaries for GPST posts in “hard to fill areas” in 2024. We also continue to increase exposure to primary care at undergraduate level. We currently provide a range of recruitment and retention initiatives for GPs. This includes early career fellowships to provide further opportunities for GPs to develop the right skills and experience to work in island and rural settings as well as areas of deprivation and bridge the gap between training and joining the workforce. We also offer enhance support for GPs in the first 5 years of practice through access to the Practice Based Small Group Learning scheme provided NHS National Education Scotland.

134. We are working with NES to jointly review and refresh the GP Retainer Scheme and the Staying in Practice Scheme to ensure that both continue to offer flexibility and professional development to GPs who may need additional help to remain in the profession

135. The Royal College of General Practitioners have reviewed their leadership offer with a new training package focussed on supporting GPs to develop the leadership skills needed for working within General Practice. This has also proved popular with all places filled already for this year.

136. NES provide coaching to over 100 GPs per annum, this has proved popular over a number of years, and we continue to work with NES to ensure that we meet the need for this support within the profession.

137. We have Expanded the GP Returners Programme to support those who have left the profession to return or to return to the UK following a period of working abroad.

138. To help retain current workforce, the GP Retention Working Group has established a set of recommendations to continue our work to develop effective approaches to supporting the GP career pathway and retaining our valued GPs in service. We are working at pace with partners to take these new recommendations forward.

139. Seniority Payments for Scottish GPs are set out in chapter 10 of the annual Statement of Financial Entitlements (SFE)^[40]. Seniority Payments reward experience, based on years of reckonable service adjusted for superannuable income factors. Seniority Payments are made to the practice for payment to individual GPs.

140. Presently a GP has to work for six years before any seniority payment is made; for 6 years to achieve a payment of £600 per annum, for 21 years to achieve a payment of £5,129 per annum, for 36 years to achieve £10,258 per annum, with the maximum of £13,900 per annum payable being made at the 47-year point^[41]. The contractor has to have been in an eligible post for more than 2 years in order to be able to apply.

141. The Scottish Government’s annual bill for seniority payments to GPs was £16.4 million in 2022/23^[42]. This is a decrease on the £16.9 million in the previous year 2021/22^[43].

Rural

142. The Scottish Government, in collaboration with the Centre for Workforce Supply and the National Centre for Remote and Rural Health and Care will develop a sustained model of direct support that will provide rural and island health and social care employers with the help they need to improve recruitment success.

143. This long-term, connective and dynamic model of support will enable the whole-system approach which is needed to provide employers with the help they need to overcome recruitment challenges.

Centre for Workforce Supply

144. To support workforce capacity across NHS Scotland and ensure it has the right people, in the right place at the right time, we commissioned NHS Education for Scotland to establish the Centre for Workforce Supply (CWS) in November 2021.

145. The CWS are conducting a series of workforce recruitment, retention and diversification learning sessions for NHS Scotland Boards and Primary Care teams, including sessions on GP retention and rural and island medicine.

146. The CWS will continue to work collaboratively to support the implementation of workforce initiatives which help tackle priority supply challenges.

Salaried GPs

147. The General Practice Workforce Survey Scotland 2023 estimated that 71.4% of GPs were Independent Contractors^[44]. It estimated that there were around 1249 salaried GPs (27.9%) and 51 GP retainees (1.1%).

148. The survey also found that Performer GPs, had an average WTE of 82.1%. The average WTE for Performer Salaried was 66.3% and for Performer Retainer 51.6%.

149. The document sets out a breakdown of the GP workforce by gender, however we do not have current data to indicate whether these GPs were independent contractor or salaried GPs.

Figure 2: GP Headcount and WTE by age and sex

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Alt A graph with a bar chartChart comparing GP headcount and WTE by gender

GP Expenses

150. Data on GP income and expenses data is provided annually by NHS Digital on behalf of the four countries^[45], and which, for the tax year 2022/23, was published on 29 August 2024. We invite DDRB to consider this report in its entirety, but for the purposes of independent contractor GPs in Scotland the report showed that:

151. The average taxable income for contractor GPs in General Medical Services in the UK was £140,200 in 2022/23. In Scotland the average taxable income for contractor GPs was £120,000. Ahead of Phase Two of the GP contract, this is the only data the Scottish Government has about general practice expenses.

Figure 7 – GPMS Contactor GPS – Mean Earnings And Expenses By Contract Type, Scotland, 2021/22 And 2022/23

Contract Type	Year	Report Population	Gross Earnings	Total Expenses	Income Before Tax	Expenses to Earnings Ratio
GPMS	2021/22	3,250	£269,000	£149,500	£119,500	55.6%
	2022/23	3,150	£276,600	£156,700	£120,000	56.6%
	Change	-100	+2.9%	+4.8%	+0.45%	+1.0 Percentage Points
GMS	2021/22	2,850	£265,100	£146,000	£119,100	55.1%
	2022/23	2,800	£272,200	£152,900	£119,200	56.2%
	Change	-50	+2.7%	+4.7%	+0.2%	+1.1 Percentage Points
PMS	2021/22	350	£300,200	£177,400	£122,700	59.1%
	2022/23	350	£312,200	£186,400	£125,800	59.7%
	Change	0	+4.0%	+5.1%	+2.5%	+0.6 Percentage Points

Workforce Data for Scotland

152. The General Practice Workforce Survey Scotland 2023 captures aggregate workforce information from Scottish general practices and each of the NHS Board-run GP Out of Hours services. It provides the most comprehensive information available on the staffing cohort of general practice, both in hours and out of hours, but does not provide the cost. The costs of running a practice are a matter for the GP partners, including what pay they award employees. The 2023 survey was published on 12 December 023^[46].

153. The 2023 results for Scottish general practices are based on survey data received from 730 responding practices. The response to the survey was less than 100% and appropriate weighting has been applied to statistics calculated from the survey data to provide representative estimates at NHS Board and national levels. Statistics including headcounts, WTE, numbers of contracted hours and sessions, and numbers of vacancies are therefore survey-based, weighted estimates.

154. For this year’s survey NHS Education for Scotland have also addressed missing data using data imputation methods. Missing data on contracted and vacant hours, contracted GP sessions, and staff age have been imputed using a donor-based imputation that relies only on this year’s survey sample data for replacement values and preserves existing relationships and distributions present in the sample data. These methods help to provide a more complete data set for analysis.

155. The results include information on:-

• Estimated WTE numbers of GPs in post in Scottish general practices, along with information on patterns of sessional commitment by age and gender (a GP's week is typically defined in terms of sessions rather than hours, with a working day generally being comprised of two or sometimes three sessions).
• Estimated headcount and WTE numbers of nurse practitioners and other registered nurses employed by Scottish general practices, along with information on the age profile of these staff.
• Use of locum GP time and extra nurse time by Scottish general practices.
• Known vacancies for these professional groups in general practices from April 2022 to March 2023.

156. Overall, 86% of all responding practices reported the use of a locum GP during 2022/23^[47], with the estimated use of 415 Locum GP WTEs. This is higher than the 292 WTE estimated from the 2021/22 survey.

Table 5: Estimated Locum/Sessional GP WTE, April 2022 - March 2023^[48]

Board		Practices using Locum	WTE Locums required	WTE Locums filled
Ayrshire & Arran		82%	17	13
Borders		78%	6	5
Dumfries & Galloway		87%	19	14
Fife		83%	30	17
Forth Valley		86%	17	15
Grampian		93%	50	43
Greater Glasgow & Clyde		87%	97	87
Highland		76%	32	27
Lanarkshire		88%	49	40
Lothian		92%	61	51
Orkney		83%	5	5
Shetland		100%	15	15
Tayside		88%	23	13
Western Isles		75%	5	5
Total		86%	415	342

157. Numbers of WTE locums have varied considerably over time. Referring to previously published reports for this survey since 2013, there were 290 WTE locums in 2013, 350 in 2015, 333 in 2017, 273 in 2019, and 292 in 2019^[49]

158. The 2018 GP Contract mandates the provision of workforce data to be made mandatory. This enables us to understand staffing levels across practices in Scotland and will inform projections around future staffing need to meet local population health need.

NHS Dentistry

NHS Scotland Public Dental Service

159. The Public Dental Service (PDS) is a salaried NHS Board dental service which has been in operation since 2013 and brings together the previous Community and Salaried General Dental Services. The merging of the previous two services was undertaken following the recommendation of the 2006 Review of Primary Care Salaried Dental Services in Scotland and allows for a single managed primary care service.

Statutory basis

160. The legal underpinning of the PDS is Section 36 of the National Health Service (Scotland) Act 1978 (“the Act”) and ensures delivery of NHS services where General Dental Services (enacted through Section 25 of the Act) have either:

• not secured the adequate provision of services, e.g. in rural and island areas; or
• not ensured that sections of the population, e.g. those with special and/or complex care needs, are receiving satisfactory treatment.

161. In addition, the PDS operates a dental public health function through dental inspection services to education establishments (enacted in Sections 39 and 47 of the Act) for the purposes of informing both the basic and detailed National Dental Inspection Programme (NDIP) which report on local and national population oral health of Primary 1 and 7 children. PDS also provides population oral health improvement services through Childsmile.

Underpinning Principles

162. PDS continues to be managed and delivered directly by Boards with due regard to their local population, and with reference to the following important factors which require to be appropriately balanced:

• Complementarity with General Dental Services. Independent contracting services continued to be the mainstay of NHS dental provision in Scotland and are the Scottish Government’s preferred vehicle for delivery of primary dental care; this position has been reinforced with the November 2023 dental payment reforms. There is, however, recognition that independent contractor services are not always viable in all parts of Scotland and that where gaps in provision arise, routine dental care should be provided by the PDS.
• Sustainability. Boards should ensure continued service and financial viability, with reference to the specialised nature of services and the vulnerable sectors of the population served. This may involve working with neighbouring Boards (e.g. cross-boundary) to achieve economies of scale.
• Equity. NHS Boards are required to ensure that NHS dental services are available to all who wish to access them in their area, including for vulnerable groups who are otherwise unable to access General Dental Services.
• Compliance. PDS must comply with all relevant legislation and regulations.

PDS Role

163. The role of the PDS was set out in the 2006 review which recommended its creation. This review sets out the role as below:

• Provision of a full range of treatment services to patients with special care needs (adults and children);
• Referral services to other health and care practitioners, including social care;
• Dental care for socially excluded people who have difficulties in accessing “high street” General Dental Services (e.g. ensuring equity of access);
• Specialised and specialist services e.g. special care dentistry, paediatric dentistry, sedation and general anaesthesia;
• Access services where there are known gaps in General Dental Services provision, and out of hours (OOH) services;
• Public health functions – inspections, screening, health promotion and epidemiology; and
• Teaching and research, including supporting undergraduate outreach and dental core training.

Funding

164. While core funding for the Public Dental Service salaried service was previously provided annually to Boards by way of Scottish Government allocation, funding was baselined to all NHS Territorial Boards in 2024/25. Annual pay uplifts for the service will continue to flow to Boards in the usual way, through specific in-year allocation.

165. Additional funding for PDS functions is received through:

• The Outcomes Framework bundle which was also baselined to Boards in 2024/25. This funding covers Childsmile activities and a range of other key service outcomes; and
• NHS Education for Scotland (NES), who provide funding for outreach services delivered in partnership with Universities.

Workforce Numbers

166. Workforce statistics published by NES report that as of 30 September 2024, there were 334 dentists working in PDS (headcount). There has been a decline in dental headcount in the service, with 368 working in the service as at 30 September 2019. Full detail is provided below:

	31 March	30 September
2019	381	368
2020	369	367
2021	359	375
2022	375	365
2023	361	334
2024	336	334

167. Each frontline NHS Board has an appointed Director of Dentistry, and Scottish Government maintains regular contact with the Director network to understand challenges and issues arising in both Public and General Dental Services. Since the pandemic, Boards have been increasingly live to workforce supply issues, with recruitment of staff posing a particular challenge.

General Dental Service (Independent Contractors)

Position Report -

168. The Scottish Government implemented major payment reform on 1 November 2023 with a new Determination of the Statement of Dental Remuneration. The reform was aligned closely to the Oral Health Improvement Plan (2018) where the Scottish Government signalled its intent to move to a streamlined system of payments that offered more clinical discretion to practitioners and reflected modern dental practice and technique.

169. In summary the reform comprises 45 Item of Service codes describing the comprehensive range of treatment items that continue to be available on the NHS in Scotland. This compares with around 700 codes pre-1 November 2023, showing the very real attempts that have been made by Scottish Ministers to address the concerns of dentists in Scotland that providing NHS dentistry was impacted by an overly administrative and bureaucratic system of payment.

170. While the non-pecuniary aspects of payment reform are important, the financial envelope has increased to reflect more closely the actual market prices of providing NHS care and treatment.

Funding and Pay

171. The 2024/25 Budget outlined the Scottish Government’s commitment to NHS dentistry, with almost half-a-billion set aside for the sector.

172. As part of reform, the Scottish Government agreed an attractive new fee package with British Dental Association (BDA) Scotland which saw significant uplifts to Item of Service fees, with some treatment items increasing by up to 295%. On average the overall value of item of service fees under the new system is around 20-25 per cent greater than pre-1 November 2023.

173. In addition, Scottish Ministers have accepted and implemented the DDRB pay recommendations of 6% in 2023/24 and again in 2024/25, which was applied to both gross Item of Service fees and capitation payments, noting the above inflation nature of most recent uplift.

174. The significant and continuing investment into NHS dentistry in Scotland reflects the core objective to retain the sector’s confidence in providing NHS dental services against the difficulties of post-pandemic recovery, challenging labour market conditions following Brexit, and inflationary pressures – all of which have been referenced as key issues in previous DDRB reports.

175. It is intended that these improvements to the overall funding package of NHS dentistry will enable us to keep pace with expenses. As the DDRB will be aware, the Scottish Government does not currently have a mechanism to discuss expenses with BDA Scotland, however this is a long-running point of contention with the Trade Union and Scottish Ministers are keen to seek resolution. As part of the 2023/24 pay negotiations, Scottish Government committed to a working group on expenses with BDA Scotland. The intention is that the working group will commence in early 2025 and this will consider the framework required to allow for a full discussion with BDA Scotland. It is important to note that this will not include a discussion on funding or payment. However, officials are mindful of the wider economic landscape and would welcome a view from DDRB on expenses.

Snapshot of NHS Dental – Official Published Statistics

176. Public Health Scotland provide a range of statistics, which can be found at (latest release 27 August 2024) NHS dental data monitoring report - Quarter Ending June 2024 - NHS dental data monitoring report - Publications - Public Health Scotland.

Registration

177. The basic measure of dental access is NHS registration. As at 30 June 2024, 94.5% or almost 5.2 million adults and children in Scotland were registered with a dentist providing NHS dental services. The Scottish Government recognises that in many situations patients who are registered do not necessarily have access, and for this reason registration is not seen as a comprehensive measure of NHS dental access. Nevertheless, these registration rates continue to show a much higher level of NHS registration in Scotland compared with the rest of the UK.

Participation

178. Participation is defined as the proportion of the registered population with a dentist providing NHS dental services that have seen a dentist in the last two years. As at 30 June 2024, almost 60% of registered adults and children had seen a dentist, a total of almost 3.1 million people. In comparison the period immediately prior to the pandemic (31 March 2020) 68.8% of adults and children were seen by a dentist providing NHS dental services.

179. Given that many people choose not to attend a dentist, unless they are in dental pain, we see the figure of 70% as a reasonable objective for payment reform. As the definition of participation means that presently most of the two-year period reflects lower levels of participation following the pandemic recovery period, and pre-1 November 2023, there is a growing sense that payment reform is providing sustainability.

Patient Contacts and Direct Activity Measures

180. The new system in Scotland has allowed Public Health Scotland to look at a wider suite of statistics to reflect both dental access and activity. One measure is the number of patients that had contact with a dentist providing NHS dental services; for the quarter ending June 2024 almost 1 million patients had contact with a dentist providing NHS dental services. The definition of contact means that the same patient receiving examination and treatment over multiple visits would count as one contact, thereby providing a more contemporaneous assessment of participation following payment reform. This provides some preliminary evidence that NHS dentistry following payment reform is providing improved access to registered patients in Scotland.

181. At a more granular level there are also positive signs of sustainable levels of NHS activity. Payment reform is a slightly misleading term for the changes in Scotland, as the new system of payment reflects significant reform of the care and treatment that can be provided on the NHS. The most notable change is the replacement of the basic examination with an enhanced examination and review appointment. For the quarter ending June 2024, around 620,000 enhanced and 104,000 review examinations were completed, 734,000 in total. That suggests an annualised figure of approximately 3 million examinations.

182. Payment reform was also purposed to address issues where NHS patients were not receiving more expensive treatments as dentists were finding it increasingly uneconomic to provide. This was a hidden access issue that Scottish Ministers were keen to address by introducing the new fee scale and better reflecting market costs. The latest statistics from PHS are only beginning to show something of this picture as patients requiring follow-up treatment move through the new system; nevertheless, for the quarter ending June 2024 we are seeing robust returns across key restorative procedures such as endodontics, crown replacement, and denture provision.

Present Challenges

183. We would like to advise DDRB against making UK-wide assumptions around the state of NHS dental service provision. The view of the Scottish Government is that NHS service provision in Scotland remains far higher than in other parts of the UK. That said, while the national Scotland picture is relatively stable, there are localised challenges, particularly in rural areas.

184. Our view is these are systemic problems, made worse by the combination of pandemic, EU exit and the cost-of-living increases. While the combination of these are challenging for larger city-based practices, they have a disproportionate effect on smaller rural practices. Areas of Scotland that are impacted presently include Dumfries and Galloway and parts of Highland and Argyll and Bute. The islands continue to struggle given the historic difficulties of recruiting and retaining front-line professionals to these areas.

185. The workforce position in Scotland is significantly better than the rest of the UK, with 57 dentists per 100,000 of the population, compared to 43 in England and 46 in Wales. That said we have seen a deterioration in the workforce position in Scotland. NHS Education for Scotland (NES) publish workforce statistics for NHS Scotland, including dentists, on a quarterly basis. Dental headcount is published as at 30 September and 31 March for each year. Dental workforce statistics as at 31 March for the past five years are set out below for General Dental Services. This is the latest data available.

Workforce (headcount)	Mar-20	Mar-21	Mar-22	Mar-23	Mar-24	5 year variance	% variance	1 year variance	% variance
NHS A&A	199	202	177	175	194	-5	-3%	19	11%
NHS Borders	50	50	46	46	49	-1	-2%	3	7%
NHS D&G	81	78	71	74	74	-7	-9%	0	0%
NHS Fife	214	207	190	173	186	-28	-13%	13	8%
NHS Forth Valley	170	170	164	152	152	-18	-11%	0	0%
NHS Grampian	293	294	287	263	277	-16	-5%	14	5%
NHS GG&C	837	834	796	749	768	-69	-8%	19	3%
NHS Highland	159	168	157	126	132	-27	-17%	6	5%
NHS Lanarkshire	419	410	390	352	365	-54	-13%	13	4%
NHS Lothian	531	523	497	460	499	-32	-6%	39	8%
NHS Orkney	12	12	10	11	12	0	0%	1	9%
NHS Shetland	5	8	8	6	9	4	80%	3	50%
NHS Tayside	259	259	248	227	240	-19	-7%	13	6%
NHS Western Isles	3	5	5	3	2	-1	-33%	-1	-33%
Scotland	3,232	3,220	3,046	2,817	2,959	-273	-8%	142	5%

Workforce statistics are available at the following link: NHS Scotland workforce | Turas Data Intelligence

In addition to this data, Scottish Government in collaboration with NES has produced a one-off practice-level workforce census, which was published on 31 October 2024: Dental Workforce Survey 2024 | Turas Data Intelligence

186. The purpose of the workforce census is to enable us to better understand the current dental workforce (both headcount and whole-time equivalent) as we develop our workforce plan. The census does not only report on GDPs in practice, but also support staff, both clinical and administrative. Notwithstanding the points made above regarding existential factors outside the control of the Scottish Government, there are a number of localised factors that have also impacted on workforce numbers:

• During the height of the pandemic, all undergraduate and vocational training was suspended for one year, effectively losing the benefit of an entire cohort of dentists. Training is now back at full capacity with c.160 VTs (c.5% of the dental workforce) moving into practice each year.
• There have been known shortfalls in VT recruitment for 2024/25 courses, with this issue again disproportionately affecting rural and island areas. NES are engaged with Scottish Government on this matter and are agreeing the actions required to mitigate against recurrence of these issues in future years, including alignment of the VT calendar year with rUK.
• Historically Scotland’s VT scheme has run from 1 August to 31 July while all others in UK operate schemes from 1 September to 31 August. From 2025, VT schemes will run from 1 September.

Looking Forward

187. As intimated above payment reform remains the national policy and has been implemented. Supporting payment reform informs the strategic priorities going forward in NHS dentistry in Scotland. Broadly speaking these are:

Sustainability of Service Delivery in Rural Areas.

188. Presently the Scottish Government rests on a number of long-standing interventions targeted at areas experiencing significant challenges. The Scottish Dental Access Initiative allows for additional grant funding support to new and extended practice provision in qualifying areas, and the recruitment and retention allowance offers ‘golden-hello’ payments to dentists joining the national dental list for the first time or returning after a period of five years and wishing to practise in qualifying areas.

189. The Minister for Public Health and Women’s Health (with NHS dentistry as part of her portfolio of responsibility) has recently hosted two Round Table Parliamentary events for all MSPs. The cost effectiveness of these targeted measures was raised, including the need to ensure that they more precisely focused on those areas most in need of additional support. As a result, officials are currently conducting further thinking on how the relative incentives of these measures might be better targeted, and other schemes that could potentially offer greater insights into how the funding can be more effective in attracting additional practitioners to rural areas. At the same time, it is recognised that rural recruitment is not specifically a dental challenge but rather sits across a much wider remit in Government.

New models for listing

190. The second key priority is looking at governance potentially developing new models for listing and taking forward provisional registration. The Scottish Government has been instrumental in pursuing four-country discussions between the respective Governments where a broad consensus has emerged that provisional registration – with staff working in the NHS while awaiting qualification – would be beneficial for overall workforce numbers. However, this requires UK legislation changes.

191. In February 2024, the UK Government (Conservative administration) launched a consultation on Provisional Registration of overseas dentists. This would amend GDC’s powers and allow overseas-qualified dentists to enter the UK workforce immediately. There has been no update on the consultation since the general election and resumption of Parliament in Westminster, and it is not known if the new administration is intending on implementing legislation to enact. The Scottish Government will continue to press UK counterparts for the necessary legislative changes to enacted as soon as possible. This change is required to significantly alter the workforce position both in Scotland and the UK.

Workforce

192. The third priority is workforce notwithstanding the requirement for provisional registration as described under the governance framework changes. The Scottish Government recognises the inherent limitations of workforce modelling (predicated on headcount and registration) with the intention to set the desire to model for participation (i.e. patients actually attending the dentist) as a means to identify the workforce needed (in WTE) for better access to Scotland.

193. Officials are presently working towards a workforce plan in 2025, alongside more significant reform and better support conditions for skill mix and direct access for dental therapists. Direct access would allow all GDC registrants – dental therapists in the first instance – to work to the top of their scope of practice and undertake dental care directly to the population, rather than on prescription/referral from a dentist.

Oral Health Improvement

194. The final priority centres around oral health improvement and recognises that improvements in patient oral health is the ultimate goal. Our flagship Childsmile programme offers every child attending nursery in Scotland free daily supervised tooth brushing, and fluoride varnish application to those in our most deprived communities. Official statistics from October 2024 show that the difference in the percentage of P1 children with no obvious decay in the most and least deprived areas has decreased from 32.2 percentage points in 2010 to 23.5 percentage points in 2024. This is the lowest recorded gap and shows the success of the programme.

195. As part of payment reform, we have also introduced oral health metrics for the adult population. This will be done in the background as part of the claims process, enabling over time the assemblance of oral health data that in turn will inform the policy interventions of the future.

Summary

196. We are aware that the information on GDP workforce has previously been insufficient, however it is hoped that the introduction of the new dental workforce survey will support better workforce planning.

197. With respect to the other requests on GDP workforce, turnover, vacancies, and average retirement ages, this is not something we can expedite at this stage for Scotland. As independent contractors much of this information cannot be requested, and although it can be linked to Quality Improvement (QI) cycles which offer a financial payment, practices are not obligated to participate. These asks are key elements to the development of workforce planning, but this is at an early stage in Scotland. Similarly, retirement ages are misleading; while information is available through the Scottish Public Pensions Agency, it does not differentiate between actual permanent retirement and twenty-four-hour retirement. Such information when made available through an FoI request has typically over-stated the actual scale of retirement amongst GDPs.

198. As described above the strategic focus of the Scottish Government going forward is to maintain the relatively positive engagement with payment reform by the profession and sector by ensuring that the comparative attractiveness of the new fees keeps pace with expenses. To that end we are in dialogue with BDA Scotland on a regular basis; in the absence of sector-wide information on expenses being made available to the Scottish Government, this remains the most expedient approach.

199. Secondly to build on payment reform by pursuing the strategic approach as identified in this written evidence summary. That should be seen in the context of an unparalleled challenge to public sector finances; progress is naturally limited by the present financial backdrop.

200. The Scottish Government would like DDRB to support our strategic position of on two specific points. We resolutely believe very little progress can be made without significant movement from the UK Government on provisional registration – while we acknowledge that the remit of DDRB is pay, workforce is a critical determinant, and enabling provisional registration will change the outlook considerably for the better. Second the situation in rural areas is particularly challenging given Scotland’s unique geography; for DDRB to focus on this issue in their deliberations would provide a well-respected intervention informing policy development going forward.

Consultants, Specialty Doctors and Associate Specialists (SAS) and Resident Doctors

Pay

201. Following publication of the 52^nd DDRB report, the Scottish Government engaged in direct talks with all BMA craft groups in the Acute Medical profession space in relation to pay uplifts for 2024/25.

202. This action was a consequence of the decision taken by the BMA Scotland Consultant and Specialty Doctors and Associate Specialists (SAS) crafts to not participate in the DDRB process for the 2024/25 round and the Scottish Governments continued commitment to the Resident Doctors, and Dentist pay deal which was agreed in 2023/24 (details of this agreement are below).

• For 2024/25, 2025/26 and 2026/27 a guaranteed minimum uplift of inflation for the financial year to which that pay deal relates.
• Agreement to enter full contract negotiations from Autumn 2023 with implementation by April 2026: outcomes to include contract reform and a new Pay Review mechanism.

203. The specific agreements that have been reached with Resident Doctors, Consultants and the offer to the Specialty Doctors and Associate Specialists (SAS) cohorts are detailed below. It should be noted that the offer to SAS doctors will be subject to a consultative vote that will be put to eligible BMA members in January 2025.

Resident Doctors

204. An 8.5% pay uplift from 01 April 2024, with a further 2.3% pay uplift from 01 October 2024. Due to the phased implementation this generates a cumulative uplift of 11% during 2024/25 financial year.

Consultants

205. An uplift of 10.5% across all consultants pay points with a further £5.7 million invested to uplift Discretionary Points from £3204 to £3600 per point. This offer represents a total investment £124.9 million and returns the consultant workforce in NHS Scotland back to a competitive space following other pay agreements in other parts of the UK.

206. The agreement reached with BMA Consultants also includes a commitment to undertake further work via task and finish groups under the Joint Negotiation Committee between Scottish Government, BMA Scotland and NHS Employers. These groups will seek to conclude in 2025/26 and are be tasked with:

• Taking forward discussions on the balance of different elements of the job plan for consultants to facilitate attractive employment opportunities within NHS Scotland and to enable retention of the existing workforce.
• Discussions to agree a national rate for internal short-term cover to improve continuity of care and help alleviate agency and locum spend within NHS Scotland.

Specialty Doctors and Associate Specialists (SAS)

207. As noted, an offer has been made to SAS doctors in Scotland. If accepted this would see a flat 6% uplift applied to Specialty Doctors on both 2008 and 2022 contracts, and Associate Specialist pay points.

208. In addition, the Scottish Government has committed to increasing the pay for Specialist Doctors on the 2022 contract to rates in line with other part of the UK. This means that Specialist Doctors at pay points 0-2 would receive an increase of 10.07% and those on pay points 3-6 would receive a 7.14% increase.

209. The offer made to SAS doctors also include the opportunity for SAS doctors to work with NHS Employers and Scottish Government on the following areas.

• The development of an agreed policy which would provide a mechanism to facilitate the potential regrading of Specialty Doctors to Specialist Doctors.
• Discussions to agree a national rate for internal short-term cover.

Engagement

210. We continue to engage the medical profession on Terms and Conditions of Service issues via the Joint Negotiation Committee comprising of with MSG (NHS Scotland employers/Scottish Government) and BMA Scotland Consultants, Resident Doctors and SAS committees.

211. Whilst this forum is still in its infancy having replaced the previous tripartite arrangements in late 2023, it is beginning to consider more strategic issues that impact on the terms and conditions of the medical professions and will be responsible for delivering the reform components of the agreed consultant pay deal and those aspects which relate to the SAS doctor pay offer, if this is accepted.

212. More broadly, the Scottish Government recognises that supply challenges for the medical workforce have a consequential impact on financial and service sustainability within NHS Scotland and engagement on this issue with Staff and Employers is critical.

213. Accordingly, we established a Medical Workforce Sustainability and Value Group (MWSG) with a range of stakeholders who have identified a number of actions designed to ensure NHS Scotland has a resilient supply pipeline of medical practitioners, thereby reducing reliance on medical locums. Implementation of these actions is now being taken forward by NHS Education for Scotland, including via their Centre for Workforce Supply (CWS). A specific focus was agreed on Psychiatry, which has significant vacancy rates and known high locum usage. It should be noted that in early 2024 the MWSG was reshaped into the Medical Locum Task and Finish Group (MLTFG), to ensure more appropriate and cost-effective locum usage.

Distinction Awards and Discretionary Points for Consultants

214. It remains the position in Scotland that no new Distinction Awards have been made as these do not align with progressive pay principles of the Scottish Government. There are Consultants who received awards priory to the freeze who are still in receipt. It remains the case that extant arrangements for DAs will remain in place.

215. Although DAs are frozen to new Consultants, the availability of new DPs increases in line with the number of consultants in post and we have recently uplift DP payments from £3204 to £3600 as part of the recent consultant pay agreement.

Summary and Recommendations

216. Whilst the Scottish Government did undertake direct talks with all the acute medical profession in 2024/25, we remain committed in our support of the DDRB process and the independent recommendations that the pay review body sets.

217. As outlined in the remit letter that was submitted to the Chair of DDRB we fully support the elements of reform to the DDRB process that were agreed as part of the DHSC pay agreement with Consultants in England in 2024-25.

218. Accordingly, we are seeking recommendations from the DDRB that are in line with the principles of the agreed reforms, for all medical and dental staff in NHS Scotland, with the exception of Resident Doctors. We remain committed to our agreement with Resident Doctors, and Dentists in Training and will therefore not be seeking a recommendation for this group.

219. Additionally, as a result of the increase in DP rate, which ensures that Scotland continues to offer a competitive pay package for consultants, we are not seeking any recommendations from DDRB on distinction awards and discretionary points.