An Edinburgh dentist has challenged the prominence given to Scotland’s 95.1% registration rate, arguing that NHS dental participation in Scotland gives a less reassuring picture of access.
Hamza Al Haddad, director of City Dental Care in Edinburgh, said greater attention should be paid to figures showing that only 62.1% of registered patients had participated in NHS primary dental care within two years.
He said: ‘Someone who registers elsewhere and never attends is still on our list, and still on the national one. A register cannot shrink through inactivity, which is part of why registration sits at 95.1% while participation sits at 62.1%.’
As of 31 March 2026, 5,273,339 people were registered with an NHS dentist in Scotland, with 3,273,405 of them participating in NHS primary dental care during the previous two years.
Al Haddad described that difference as ‘a ceiling on the access problem rather than a measure of it’.
He said participation measured NHS dental use rather than access alone, because a registered patient who had not participated may have attended privately, moved away, died or chosen not to attend.
The Scottish Government has repeatedly pointed to Scotland’s high registration rate when discussing access, although it has also acknowledged that registration does not necessarily mean a patient can obtain care and is not a comprehensive measure of NHS dental access.
Registration with an NHS dentist in Scotland is generally lifelong unless the patient or dentist requests its withdrawal. It can also transfer when a patient receives treatment from another NHS dentist.
Deprivation was also identified as a significant factor in the registration-participation gap.
Children in the most deprived areas had a 77.4% two-year participation rate, compared with 87.7% in the least deprived areas. Participation was much lower among adults, at 53.4% in the most deprived areas and 62.4% in the least deprived.
How can NHS patient participation be encouraged?
Hamza pointed out that most patients who haven’t been to the dentist in a few years are ‘braced for a lecture’, with continuing to stay away being the surest way to avoid one.
He said City Dental Care’s approach to avoiding this feeling of shame is to send patients who have not attended in more than two years a ‘welcome back with no comment on the gap, and a link to online booking’.
Hamza said: ‘Our recall said one plain thing: that the patient is still registered, and welcomed them back without a word about the gap.’
After sending its recall message, City Dental Care made several observations about the patient response. More than half (55%) of those who clicked the link did so between 3 and 9pm, which Hamza suggests implies that patients respond to communications after work. Roughly five in six patients used the booking page instead of calling, and two in three of those who booked did so online.
He offered the following pieces of advice to Scottish dental practices:
- Treat participation, not registration, as the access metric
- Make the return effortless – including a welcoming tone and an easy, automated booking system
- Say plainly whether your NHS list is open, as patients will assume it’s a ‘no’ unless told otherwise.
Hamza concluded: ‘None of this closes a two-million gap. But on one Edinburgh list, four in ten patients had sat in our chairs and not returned within two years, and around one in eight had never come in. Registered isn’t the same as seen.’
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