TOWARDS BETTER ORAL HEALTH IN CHILDREN: ANALYSIS OF CONSULTATION RESPONSES
CHAPTER 8: ENHANCED DENTAL SERVICES
The consultation stated:
The strategic review of the dental workforce in Scotland is now delivering a workforce better structured to support the prevention of dental disease. Expansion of, and improved training for, the professions complementary to dentistry, has begun.
Enhanced payment schemes have been introduced, targeted at preventative treatments offered to children aged 6 and 7.
The Action Plan (for Dental Services) has encouraged NHS boards to look at how they can best use resources for programmes targeted at those most in need.
Through joint planning between local authorities and NHS boards, and greater use of the professionals complementary to dentistry, scope exists to bring the dental workforce closer to people in nurseries, family centres, play groups and so on, both through visits and advice.
Consultees views were:
In Brief: Respondents called for a better longer term strategy for dental services, underpinned by appropriate funding The current NHS fee scale was perceived by some as incompatible with a preventative philosophy Consultees considered that smarter financial incentive schemes for dentists could usefully be introduced It was thought that greater joining up of work between dental and other professionals could be beneficial A goal of access for all to a NHS dentist was suggested Some respondents called for dental checks for children to be undertaken at school It was recognised by some consultees that rural areas face particular problems in accessing NHS dentists and this needs special attention Many respondents suggested that dentists could promote a more modern and friendly image
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In Detail:
BETTER SUPPORT FOR DENTAL SERVICES
Ideas generated related largely to better long-term strategy and smarter policies for aligning funding so that it re-enforced and contributed to delivering that strategy.
A perceived shortage of specialist dental practitioners was highlighted by some. Shortfalls were identified amongst, for example, dental therapists (Glasgow Dental Hospital, SE Glasgow LHCC Oral Health Group) dental nurses (GDP 772), paediatric specialists (Specialists in Paediatric Dentistry in Scotland), hygienists (Highland Health Council) and orthodontists (Highland Acute Hospital).
Suggestions for tackling this included:
Training more dental professionals (indiv 1093, Queen Street Dental Centre, Peterhead, Directorate of Public Health Tayside, Clinical Director CDS, Moray)
Greater support for retaining trained professionals (indivs 170, 861, CDS Lomond and Clyde PCT, British Association for Study of Community Dentistry) particularly in rural areas (NHS Argyll and Bute)
Supporting conversion courses for hygienists to become therapists (Borders NHS Board)
Underpinning dental specialists with complementary practitioners (very many respondents)
Funding of services was a major focus of attention. Some respondents called, in general terms, for greater funding of the professions, remarking, for example, that, " dentists find itincreasingly difficult to fund the gap between costs and NHS charges" (Consumers Association), and that those working in deprived areas and areas with high child populations required additional financial support (GP 1207, GDP 1266, Dental Surgeon 1368).
Much comment was made on what was seen as the need for robust funding to support the priority now given to preventative work. One individual stated simply, ".. need to change the fee scale on which GDPs are remunerated, since this is currently incompatible with a preventative philosophy" (indiv 838). It was commented that the dental payment system within the NHS was seen as offering no real incentive to practice a preventative model of care (Westone/Riverside LHCC).
Many respondents took forward the notion of strategic financial incentives for dentists. For example, incentive schemes which encouraged pro-activity could be beneficial (Nutrition and Dietetic Service, Greater Glasgow PCT). Also seen as advantageous were those which rewarded the outcomes of prevention of dental disease (Dumfries and Galloway NHS Board, Market Street Dental Practice, Kilsyth) and encouraged dentists to deal with particular resource intensive audiences such as children (indiv 1393). A call was made for dental professionals who treat children to be salaried (Lomond and Argyll PCT).
It was suggested that the extra funding requested to support better dental services could be acquired by placing, " a whopping great tax on sugary products" (Renfrewshire Council and others, or re-directing funds which would otherwise have supported fluoridation schemes (e.g. indiv 1190, Wester Loch Ewe Community Council).
Again, a call was made for adequate support for dentist services for children with special needs (Dental Surgeon 1370). Others identified gaps in support for specialist training for dentists in dealing with very young children (e.g. Paedicatric Dental Specialists 214) and for further dental research relating to children (e.g. Greater Glasgow Health Board).
BETTER LINKS BETWEEN PERSONNEL
The need for better joined up working between dental and other professionals is a theme already covered in previous chapters. To summarise, many respondents referred to the need to strive for "holistic" and "multi-agency" approaches, with one respondent remarking that, " the current perception is that dental practices operate in isolation from other health care services" (indiv 847). The key links identified most frequently as advantageous were at an operational level:
Better integration of dental health services within wider economic and community regeneration initiatives was also suggested by consultees.
MAKING DENTAL SERVICES ACCESSIBLE
A common theme was the need to increase the accessibility of dental services to change the situation currently perceived whereby many people found it difficult and costly to access the services they required.
The limited availability of NHS dentists in many parts of Scotland was a major cause for concern amongst some respondents. Problems in some areas of deprivation were highlighted (West of Scotland Seniors Forum, Pilton Community Health Project) in addition to many rural locations (Clinical Director CDS Moray, Lothian Area Dental Committee, Peebles and District Community Council, NHS Grampian, Kiltearn Community Council). Several respondents felt strongly that access to a NHS dentist should be a " statutory right" (indivs 410, 411, 861, 1024, British Association for Study of Community Dentistry, MSP 810, Community Dental Service Lomond and Clyde PCT).
Services for children were viewed as a priority with several suggestions focusing on introducing more formal schemes of dental checks being undertaken at school (indivs 282, 578, Kirkcaldy West Community Council, Scottish Consumer Council, Oral health Action Team, SE Glasgow, William Street Clinic, Glasgow), or in health centres (Unison).
Some people in rural areas were seen as facing extra difficulties of long distance from the nearest suitable dental services. To address this, many respondents suggested greater use of mobile dentistry schemes (e.g. indiv 805, Banchory Health Clinic, Grampian PCT).
People on a low income were also viewed as facing difficulties in paying for transport to dental services. One solution made was to subsidise taxi fares, as appropriate, to enable regular visits (South Aryshire Council). Indeed there was a call for free dental care for all those unable to afford it (indiv 3), and confirmation of a continuation of free care for children requested by many respondents. Many saw the need for such free treatment extended to cover sports mouth guards. Specialist advice and assistance was requested for parents of children with special needs (LPCT) such as Autism or ADHD (indiv 7).
Linked to the issue of accessibility was the perceived need for dental services to rid themselves of their stereotypical unwelcoming and frightening image (particularly for children) and take on the mantle of a modern and friendly institution. People had clear ideas about what such a service should offer:
Finally, some respondents called for dental services to make greater use of techniques now available, such as tooth sealants, new technology to remove the erosive potential of soft drinks, permanent dental capitation for children up to 17 years, slow release fluoride beads, fluoride varnish and fluoride coatings.