Scottish dentistry – is it time for a work to rule?

Practice Plan's Cheryl Reynolds spoke with SDA chair Douglas Thain about the Scottish dental profession's thoughts on taking industrial action.

Practice Plan’s Cheryl Reynolds spoke with SDA chair Douglas Thain about the Scottish dental profession’s thoughts on taking industrial action.

In a recent poll, the Scottish Dental Association (SDA) asked members of the dental profession to share their views on the state of Scottish dentistry. Over 600 people responded and in answer to the question ‘Do you agree with taking industrial action?’, 94.8% said yes.

Practice Plan regional support manager, Cheryl Reynolds, spoke to SDA chair Douglas Thain to try to understand the background to this type of response.

That’s a massive number of people in favour of some kind of industrial action, Douglas. Many of the practices I look after are mixed – NHS and private – and they are starting to struggle with costs. Do you think that is behind this response?

The situation now, especially with denture work, is the lab costs are greater than the fees. The government figures showed that activity levels are at 70% for July and August, which is probably true. That’s partly because it’ll be the tail end of the flurry of activity when the multiplier was at a level that worked.

There’s also the fact that for many people, in areas of high deprivation, NHS work is the only work you’ll do. Doing nothing doesn’t pay, so people have to get on with doing what they can.

And if people are working hard and can only achieve 70% of what they used to before, it shows that the climate we’re working in now isn’t feasible. I think that’s because we’re doing so much more emergency treatment, so many more toothaches and starting root treatments, rather than just doing scheduled, routine check-ups.

We’ll get back to doing that eventually, but at the moment, you can be working just as hard as you were before but doing work that doesn’t pay, and that’s obviously shown in the 70% output figure the government talks about.

Our acrylic lab costs last month were £7,500 and pre-Covid-19, with more dentist work, it was usually around £5,000. So, it’s a serious increase in costs.

Talking to the banks, they’re willing to support practices up to a level. However, they’re losing some confidence and they tend to move relatively slowly when it comes to making finance available.

Especially in the current climate where money is more expensive now than it was. So, I think there’s a bottleneck coming where a lot of practices are really going to suffer. And when that happens, we know the corporates will hoover them up in a heartbeat for what seems like a relatively generous price.

The Scottish government seems to think that access to dentistry isn’t too bad. What do you think?

The 95% patient registration is still being touted as a thing, but it’s hard to tell just how historic that figure is now with the number of big practices who’ve deregistered lots of patients. Even more rational members of the profession are now discussing starting to deregister their lifelong registration patients.

Basically, anyone who’s not been in for three years plus could be deregistered, starting with those who’ve been absent longest. Because anyone at the moment who’s been in since 2006 is entitled to emergency care, so we can start removing these non-attenders.

But then we have another problem in that the health boards can’t cope with the unregistered patients. There were always quite a few and now there’s a lot, and doing work on their teeth isn’t especially popular.

In Glasgow, they’re now using student clinics and the dental hospital to treat unregistered people with toothaches in a kind of unofficial capacity, which I hear is one of the methods they’re using to maintain registrations. It’s a fully legitimate thing, and a good idea, but the Scottish government should make it clear that that’s what the situation is, rather than just quietly doing it.

The question in your survey about taking industrial action got overwhelming support. I can’t see many of the practices I work with stopping work altogether, so what action would you take?

If every practice deregistered 100 of their worst attenders, we’d easily find a few million patients without a dentist. Practices receive 25 pence a month for having these people on the books.

To lose 50 patients and 25 pence a month for each is an insignificant loss relative to the time and effort it takes to look after their emergencies when they come up.

So, this is the kind of working to rule type thing that I think they could do. We’ve suggested this type of thing and people have said they’ve been doing that already.

The difficult thing is when people do it individually, it can come across as callous. If we can get people to stand outside Holyrood explaining what they’re doing and why, it’s more like industrial action.

The power of coming together

I think the difficult thing is getting everyone together. As the SDA, we got over 600 responses to this questionnaire. That is more than the Scottish government got for their survey of dental practitioners about how the SDR should look. In some ways, that shows how much people believe responding to the government’s survey is going to matter.

It needs to be the main leaders in dentistry, the SDA, The Scottish Dental Practice Committee (SDPC), the BDA and the Dental Practice Owners’ Group that get together to challenge the Scottish government. But also, I would like the LDCs to take a more active role.

I think in the past, there was a battle to see who’d represent the profession. Whereas now I think everyone’s got over that and realised, if there’s a common stance, more is going to happen. But it’s just not happening very fast.

However, I hope something we’ve helped to achieve is that it’s now Humza Yousaf (cabinet secretary for health and social care) that speaks about dentistry rather than his subordinate who we were always told dealt with dentistry.

And the BDA and the SDPC had always accepted that they weren’t at a level where they could speak to the cabinet minister. So, I think the fact that we’ve created enough disturbance that he feels obliged to get involved is something.

I do wonder if what we have to do is have pre-populated letters to the local MSPs to give to patients, so they can just barrage the government. That might be the way to do it and make them take more responsibility for their constituents. If enough people did that, it might make a difference.

Perhaps involving patients will add weight to what you’re saying. Thanks for the update, Douglas, and I’m sure there’s more to come on this subject.

Practice Plan is the UK’s leading provider of practice-branded patient membership plans, partnering with over 1,800 dental practices and offering a wide range of business support services. For more information call 01691 684165 or visit

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