Scots NHS dentistry about to 'collapse'

Key points

• Dental Association warns dentists will have to cease taking on NHS patients

• 64,000 people have been removed from NHS dentists' lists since 1999

• Borders' residents travel to England for dental treatment

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"Why are dentists in England able to offer such an excellent service while many practices on our side of the Border don’t entertain NHS patients?" - Valerie Robson, councillor for Liddesdale.

Story in full NATIONAL Health Service dentistry in Scotland is on the brink of total collapse, experts said last night.

The British Dental Association (BDA) has told The Scotsman that every practice in the country will be forced to stop taking new NHS patients unless the Executive carries out a radical overhaul of the system.

The BDA said the budget for NHS dental treatment must be trebled to stabilise the "crumbling" service.

The lack of available NHS treatment has forced thousands of patients into the private sector. But the higher costs of treatment mean that many choose not to attend regular appointments, worsening the nation’s poor dental record.

The dire situation facing patients is highlighted by the plight of up to 200 people in the Borders village of Newcastleton, who say they have been forced to travel to England as "dental immigrants" for NHS treatment.

The Executive is due to publish its proposals to modernise dental services within weeks. But an investigation by The Scotsman today underlines the urgency of radical action and planning for financial stability.

Never before have so many people been thrown off NHS lists by their own dentists.

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Since devolved power was handed to the Executive in 1999, nearly 64,000 people have been removed from NHS dentists’ lists, often either against their will or without being informed.

The situation reached a critical point in the last two years, when almost 40,000 were deregistered, with patients crossed off NHS lists for numerous reasons, including not visiting the surgery for more than 15 months.

Jack McConnell, the First Minister, has admitted dentistry is not up to scratch. In 2003 he appointed the then deputy health minister, Tom McCabe, to launch a consultation into the service’s future.

All of this is set against a backdrop of Scotland’s appalling dental health. The Executive’s own statistics show that more than half of all five-year-olds already suffer from dental disease and that at the age of 65, more than half of all adults in Scotland have had all of their teeth removed.

Dentists carry out more than 700,000 extractions every year and have to perform 200,000 root canal treatments.

People in Scotland suffer poorer dental health than many of their European neighbours. Scots have higher levels of tooth decay than people living in England and Wales, and by the age of 14 most children already have decay in their adult teeth. In Glasgow, the main reason for admitting under 12s to hospital is to have rotten teeth removed.

In 1999-2000, a total of 7,176 patients found themselves cast off from their NHS dentist’s list, but by last year that number had rocketed to 19,021.

Figures released by the Scottish Parliament underline that the crisis is at its worst in the Grampian region, where NHS dental services are at a real danger of grinding to a halt.

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Last October, Oddmar Faeroe, the owner of Aberdeen’s last fully NHS practice, announced he was making the switch because he could not give his patients proper care.

As a result, another 3,000 patients lost their registration with an NHS dentist and will either have to pay for private treatment or go without - a situation more than 18,000 others have faced in Grampian alone during the last five years.

An Executive report issued a year ago revealed that Aberdeenshire has the lowest number of NHS dentists in the country, with only 24.2 dentists per 100,000, compared with an average of 40.5.

An undercover survey conducted by the consumer group Which? found that in Aberdeen, 80 per cent of dental practices were not taking on NHS patients.

The situation in the Highlands is also dire. Nearly 7,000 people have been deregistered since 1999 and, together with Grampian and south west Scotland, it has become the most difficult place in Scotland to access NHS dentistry.

There has been a significant increase in the number of NHS dental patients dropped from registration lists in the past five years.

There were 6,848 deregistered patients in the Highland health board area, 1,032 in Argyll and Clyde and 235 in the Western Isles.

Dentists argue they do not head towards the private sector through greed. They blame the low rates paid them by the Executive for conducting NHS work.

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For carrying out a routine NHS check-up, Scottish dentists are paid 7.08. An optometrist receives nearly 18.

According to the BDA in Scotland this does not go far towards supporting running a practice, and therefore patient turnaround needs to be swift.

Andrew Lamb, the director of the Scottish BDA, said: "If the Executive’s preventative programme has to be delivered within that sum, you do not get paid to talk to a patient about smoking cessation, about dietary advice, about showing them how to brush their teeth.

"All of these things take time, but it is not funded."

The dental patients who make 60-mile trip to England for treatment

RESIDENTS of a Borders village have become "dental immigrants" seeking treatment in England, The Scotsman can reveal.

The plight of many people in the Roxburghshire village of Newcastleton has come to represent the misery suffered by people throughout Scotland as dentists close their NHS lists in favour of more lucrative private patients.

Now the head of one practice in Cumbria is considering setting up a clinic in Newcastleton after 200 people from the area asked for appointments at his surgery in Brampton, 30 miles away.

It was revealed last week that 7,706 Borders residents were de-registered as NHS dental patients in 2003/4 - 37 per cent of the Scottish total of 19,000.

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Valerie Robson, the councillor for Liddesdale, which includes Newcastleton, is one of them. She said she finds it incredible that 200 individuals from her community have flocked to Dr Jim Fotheringham’s Brampton practice after finding it difficult to get treatment in Hawick.

She said: "Liddesdale lost its very good four-days-a-week service recently when the dentist who provided it had to retire.

"I have been told some individuals have been asked to pay 100 to register and then pay again for their treatment, while others say they were never told their names were being withdrawn from lists because they had not attended for a routine check-up.

"Initially one or two patients decided to try Brampton as an alternative, and soon the word spread that it was easy to get an appointment there."

When Ms Robson called Dr Fotheringham’s practice she was told she could be seen the next day. "That was not suitable, and I was immediately offered three alternative dates", she said. "Why are dentists in England able to offer such an excellent service while many practices on our side of the Border don’t entertain NHS patients?"

Dr Fotheringham told The Scotsman: "We are seeing patients from Liddesdale, and Eskdalemuir in Dumfries and Galloway. Travelling long distances for treatment is not uncommon in rural areas. But while that is acceptable for those who have cars or are reasonably mobile, it is not convenient for elderly or disabled people."

According to Rhona Brankin, the deputy health minister, the sharp increase in the number of de-registrations of Borders patients has been due to dental practices in Duns, Eyemouth, Peebles and Hawick reducing their commitment to NHS general dental services.

Ms Brankin said the Scottish Executive had given approval to NHS Borders in August 2004 to appoint a further two salaried dentists for Hawick, and subsequently for a senior salaried dentist with a special interest in oral surgery.

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Julia Clarke, a spokeswoman for consumer group Which?, said: "The fact we now have proof that people are being reduced to dental tourism is a dreadful indictment of the state of NHS dentistry in Scotland.

"If this shocking situation was replicated by people seeking a GP there would be outrage."