At the annual conference of Local Dental Committees (LDCs) earlier this month, delegates were updated on dentistry in the devolved nations. Here’s what Gillian Lennox, chair of the Scottish Dental Practice Committee (SDPC), had to say about Scotland. 

In Scotland, GDPs who deliver NHS dental care ,work within a blended payment model. With their NHS payments being made up of item of service or treatment-related payments, monthly capitation payments for each registered patient on their list, and non-treatment related payments, including NHS allowances.

But unlike England, we do still have patient registration in Scotland. Patients are registered with a dentist for life, and the Government like to use this figure all the time to tell us how it's great that everyone in Scotland has a dentist - and that's because if you've been once since April 2006, you're claimed by the Government.

Over the past year, several significant policy announcements have been made by the Scottish government and SDPC has been involved in shaping these.

The Scottish Government confirmed that, from November 2026, the prior approval system will move from a financial threshold to a clinically based system. This is a major shift. We have long argued that the current prior approval system creates unnecessary delays and is an administrative burden.

New system

A clinically focused model has the potential to be more efficient, more transparent and more aligned with patient need. But the details matter. We worked constructively with the Scottish Government to ensure the detail of this policy is reasonable, and we will continue to work closely with the Government to ensure the new system is workable, fair, and genuinely reduces bureaucracy. And if amendments are required in the future, we will be pushing for these too.

Also, from January 2026, the mandatory training requirements for dentists joining a health board list have been updated, and provisional listing has been brought forward. We support the principle of ensuring that all clinicians are appropriately trained and supported, but we have to be clear that any new requirements must be proportionate and we have emphasised that this must not become another administrative burden. It must be simple, fair, and aligned with existing processes.

Following calls from SDPC, further changes to the statement of dental remuneration have been brought forward, including updates to which teeth are eligible for fissure sealant application within the SDR to reflect changes with the SDCEP guidelines. And the revised list under unscheduled care and assessment and treatment has been brought forward with additional conditions and treatments added to the list and potential reasons for the appointment.  These changes are part of the ongoing evolution of the system and SDPC will continue to scrutinise every update to ensure it supports clinical practice.

In relation to a recommendation made by the Doctors’ and Dentists’ Review Body (DDRB), we are hoping that an index of dental cost frameworks can be agreed by SDPC and the government in the upcoming months, and that negotiation on the cost of care element uplift will take place as part of the next pay round.

Manifesto

As many of you will be aware, the Scottish parliamentary elections took place in May. In the run-up to the election, we launched our manifesto: Future Proof: How to Make Dentistry in Scotland Sustainable. The message at its heart is simple: if Scotland wants an NHS dental service in the years ahead, the next government must act and act decisively.

Our manifesto set out a clear plan for the next government.

First, we must improve dental access and reduce oral health inequalities. That means a national dental general anaesthetic recovery plan, restoring and expanding theatre capacity, so children aren't left waiting in pain. This follows on from a BDA report on dental GA waiting times, which was published last year. It means measuring access by attendance, not lifelong registration.

Secondly, we need to build the workforce Scotland needs, with a fully costed, fully funded dental workforce plan. Only 10% of dentists now describe the NHS as an attractive place to build a career and that should alarm every policymaker in Holyrood. We need to look at undergraduate places, guarantee vocational training for every graduate from a Scottish dental school, and invest properly in enhanced skills training from paediatrics to oral surgery.  We need fair pay for dentists and sustainable funding that reflects the real cost of delivering NHS dental care.

Thirdly, we must ensure that there is appropriate support for NHS dental practices. Rising costs -  from national insurance increases to the national living wage - are eroding practice viability. The employer national insurance contributions increase poses a significant risk to dental access and the improvements enacted through dental payment reform. We have continued to push for full reimbursement of these increases to avoid eroding the impact of investment in NHS dentistry, to improve access nationally and reduce oral health inequalities.

And finally, we must double down on prevention. Childsmile is a Scottish success story. We want supervised toothbrushing to be extended further. We want more investment in the adult oral health programmes under 'Caring for Smiles', too. We want stronger action on smoking and vaping, and we want healthier retail environments that don't push sugary products to children.

Doorstep issue

These aren't abstract policy ideals. They are practical, achievable steps that would make a real difference to the profession and the public. It's about ensuring that every family in Scotland, regardless of income, postcode, or circumstance, can rely on a service when needed, and that's why we want to ensure our profession's voice is heard with clarity and conviction.

The attention we've seen since the launch of our manifesto shows that the public is listening and policymakers are being pressed to act.

If you glance at The Herald back in March, you will have seen dentistry take a prominent place in the national spotlight. This front page article highlighted the BDA's stark warnings about the pressures facing NHS dentistry, and this was followed up by a topical question in the Scottish Parliament, which saw an MSP raise a pointed and timely challenge on the state of dentistry, echoing the very concerns that BDA had been voicing. The spotlight is firmly on dentistry, and it's up to us to make sure it stays there for the right reasons.

Polling we released as part of the manifesto shows that 65% of Scots believe the Scottish Government should be doing more on dentistry, and only one in five thinks it’s doing all it reasonably can. Dentistry now ranks alongside crime as a doorstep issue, and that tells us something important. The public is feeling the pressure too. Nearly one in five adults in Scotland has unmet dental need - 12% couldn't secure an appointment in the last two years and 7% have simply given up trying.

And we all know the stories: families travelling miles for care, children waiting over a year for treatment under general anaesthetic. They're symptoms of a system that is overstretched and, in some parts of the country, close to breaking point.

Next steps

We have warned ministers that they must not view payment reform as a final destination for NHS dentistry in Scotland. The Scottish Government must continue to carefully monitor the impact that changes have on access, inequalities, and practice sustainability.

We are continuing to work closely with the CDO in Scotland and officials from the Scottish Government as we highlight specific issues and concerns. Our work in the coming months will focus on workforce strategies, including recruitment and retention, and we will continue to press for a fully costed, fully funded dental workforce plan.

Our message to Government is simple. We want to work with you. We want to build a sustainable service. We want to secure the future of NHS dentistry in Scotland. But partnership requires commitment, and although payment reform has brought forward some positive changes, this will require sustainable funding and investment.

We will continue to work to support the profession and ensure their voice is heard by Scottish Government. Looking ahead, SDPC will continue to represent the profession with clarity and strength, hold Government to account on its commitments, push for continued dental reform, continue to work with LDCs as a backbone of local representation, and engage with BDA members across Scotland to ensure their voices shape our priorities.

SDPC will also continue to work collaboratively with Government. Whilst we will always challenge and hold them to account where necessary, we also recognise that progress is only possible when we work together in good faith.

We are facing significant workforce challenges, and not just in rural areas. Oral health inequalities are widening, and we are fighting to preserve a service that millions rely on. But we are not powerless. We have a clear manifesto, we have evidence, we have public support, and we have a profession that cares deeply about the people it provides care for.

 

This is part of a series on the devolved nations. Read the updates on Northern Ireland and Wales.