Louise Bone discusses the impact of the OHIP with clinical director Dino Loizides…
The Scottish Government’s Oral Health Improvement Plan (OHIP) is set to significantly shake up NHS dentistry and will undoubtedly have far-reaching ramifications for practices. Coming into force in July 2018, the plan has been described by the BDA as the ‘biggest proposed changes to NHS dentistry in Scotland for decades’.
Among those proposed changes are the introduction of an oral health risk assessment, a reduction in the frequency of check-ups and a simplification of the current items of service list. To find out more about the implications for practices, in terms of their finances and also patient care, I spoke to Dino Loizides, clinical director at Dental Care Perth.
Louise Bone (LB): How do you think OHIP will impact dental practices?
Dino Loizides (DL): In one word – negatively. The problem is that the plan, as it has been published, is so full of ambiguity that no one knows what it means; there are no specific terms that you will do x, y and z, which is causing concern. The Government is promoting this as a way of providing tailored care based on patients’ needs, but we’re already doing that! The reality is that this is just a way for the Government to cut costs without looking bad to voters by wrapping it up in a nice package of ‘improving the oral health of Scottish people’.
LB: Based on what you’ve just said, what affect do you think there will be on patients?
DL: As a profession, we always try and do our best for our patients but, on the whole, I think it will have a negative impact on patient care. Under this plan I could potentially move from seeing my NHS patients four times in two years to just once. This means they won’t be getting the regular care and attention they need and there will be less opportunity to develop rapport – which is particularly important for delivering more complex treatments. If a practice has a high turnover of dentists there could also be less continuity of care as patients could potentially never see the same dentist.
LB: In what way do you think the finances of the practice will be affected?
DL: If we move from having a six-monthly check-up fee to a two-yearly fee, which the plan suggests, even if they increase the amount we receive, it will have a detrimental impact on cashflow. Not to mention the potential for more damage to be caused within those two years to patients’ teeth, and the work, and therefore cost, that could then be required to fix that.
We still don’t know yet exactly what changes there will be to the Statement of Dental Remuneration, but they will more than likely also have a short-term impact on cashflow and some practices may have to seriously re-think their business model. A lot of practices, if they are brave enough, will turn around and say ‘I can no longer provide NHS dental care’.
LB: What support do you think the profession needs to help them through these changes?
DL: There needs to be a lot more communication between us and both dental bodies and the Government.
The profession itself, including the dental bodies, needs to take responsibility for our futures and stop taking everything that is shoved at us and smiling politely. That’s exactly what happened in England with the introduction of UDAs; dentists said they would never sign up to the contract, and then did, and now NHS dentistry is a farce and patient care has gone out the window.
The professional bodies that represent us need to start speaking for us instead of, in my opinion, listening to what the Government wants and trying to make their model fit the profession, and if the Government really want to improve NHS access and services, a good place to start is by increasing our despicably low fees.
LB: Whether that will happen remains to be seen, but what do you think the long-term impact of OHIP will be on NHS dentistry?
DL: What I would like to happen is for every NHS dentist in Scotland to say this model is unworkable, we’re not going to do it. What is likely to happen is that a significant majority of dentists will knuckle down and just make it work as best they can. Then, in five to 10 years’ time the powers that be will come up with yet another model to screw it up again as every successive government wants to find a different way to tinker with an already broken system.
LB: There is so much more we could say on this, but we’ll have to leave it there. Thanks Dino for sharing your opinions on something that is clearly going to have a big effect on the landscape of NHS dentistry in Scotland.
Dino is the Clinical Director and Senior Clinician at Dental Care Perth, a mixed practice. Having qualified from the University of Edinburgh in 1993, he worked in general practice in Dunfermline before joining the practice in 1999. In addition to working in general practice he has worked in Orthodontic and Oral surgery departments at the Victoria Hospital in Kirkcaldy and the Edinburgh Dental Institute.