The Scottish government needs to stop reacting and be more proactive with GDPs remuneration, Robert Donald says.

The Doctors’ and Dentists’ Pay Review Body (DDRB) published its 45th report at the end of March. You will all probably know by now that the headline figure was a derisory 1% increase in pay. The award is extremely disappointing and does nothing to address the crisis of morale amongst my Scottish GDP colleagues. It guarantees that we remain the lowest paid dentists in the whole of the UK. While our earnings have been driven into the ground, costs associated with red tape, and an overbearing regulatory regime, are spiralling out of control.

Ministers must know that dentists have had it to the back teeth in terms of doing ‘more with less’. Year on year underinvestment means that there is no give left in the system without compromising patient care. The credibility of the so-called ‘independent’ pay review body process has run out with my GDP colleagues.

GMP funding

Even before the report was published you could tell that the whole approach was going to be a disappointing whitewash. It didn’t help matters that the Scottish government jumped the gun and published its response to the DDRB recommendations on NHS pay five days before the report was actually published for the rest of us mere mortals to see. This alone would have made any concerned participant question the validity of the whole process. Instead ‘shambles’ and ‘mockery’ are words that spring to mind.

To rub salt into the wound, whilst GMPs also received a derogatory 1% pay increase, they at least received a major funding boost a few weeks earlier courtesy of the Scottish government. The announcement by the Health Minister at this year’s Scottish LMC conference trumpeted that GMP funding will rise £250m per year by 2021, with investment in general medical practice to increase by over £71m this year. This £71m GP investment for 2017/18 includes a 1% uplift for staff expenses and 3.5% uplift for other expenses through the GMS contract, depending on the DDRB recommendations – in addition to a £60m investment in direct support on top. Not only that, GMPs had responsibility for vaccinations stripped from their GMS contract to ease practice workload. The chair of the Scottish GP committee was obviously delighted with this extra funding pumped into primary medical care. He stated: ‘Practices are currently facing unprecedented workload pressures against a backdrop of an ageing population with increasingly complex care needs. Freeing up practice time by removing responsibility for immunisation will give welcome relief to overloaded practice staff, allowing them to concentrate more on the needs of patients.’

Not surprising then that no Ministers were able to attend the Scottish LDC conference this year in order to announce no more funding for GDPs.

The extra GMP funding comes on the back of a number of GP practices closing and the difficulty in recruiting and retaining GMPs in Scotland. This was highlighted in a recent article in the Glasgow Herald, which focused on one Ayrshire GP practice and blamed ‘impossible’ funding as it announced plans to close its surgery this summer: ‘We have been left with no reasonable alternatives that will allow us to maintain our clinical standards.’

Does any of this sound familiar to my GDP colleagues?

How to manage the NHS

Here is my interpretation of the Scottish Government handbook on ‘How to manage the NHS’.

  • Lesson 1 – delay taking action, even if the workforce is demoralised, demotivated and can’t wait to quit the service
  • Lesson 2 – take action only when practices close and patients lose access to services. This is because the bad publicity and complaints that follow from patients and the workforce is likely to make the Scottish electorate think that Scottish government has lost control of the situation.

In any other business or organisation, this is commonly acknowledged as crisis management. Only when there is a crisis, do Scottish government decide to take action and start to deal with the problem. It would be much more productive for the government to prevent these problems from appearing in the first place. As Benjamin Franklin once said: ‘An ounce of prevention is worth a pound of cure.’

Substitute GDPs for GMPs and it’s only a matter of time before history repeats itself. Who remembers the Scottish dental practice closures and the access problems before the Dental Action Plan funding boost in 2005? It’s quite a few years now since politicians and health boards were inundated with complaints about accessing dental care. Does Scottish government really want to go back there?

How much financial punishment can my Scottish colleagues take, and how much goodwill towards government intransigence does the profession have? We are after all, continuing to see a collapse in Scottish GDP earnings without parallel in the public sector.

Crisis management

For all the faults of the DDRB process, it has at least conceded a few important points we can all agree on. In its report, DDRB admitted that with inflation rising and forecast to reach 2.5% by the end of 2017, a ‘1% award would most probably be below inflation’. It also states that Scottish GDPs have the lowest taxable income in all of the four countries. As a consequence the DDRB has recommended that the dental profession and Scottish government negotiate directly on expenses.

Moreover, the DDRB expressed its concerns regarding the evidence it received from Scottish government for this year’s pay uplift.

‘The Scottish government, like the other three UK governments, seems to have given little consideration to the possible effects of ongoing pay restraint on the recruitment, retention and motivation of our remit groups in their pay proposals.’

In view of the dreadful Scottish GDP morale and motivation statistics published by NHS Digital over the last few months, will the Scottish government give consideration to these effects and enter into meaningful negotiations with the profession to address their chronic underinvestment in dentistry?

Or will we have to wait until dental practices start to close and patients lose access to their NHS dentist before they take action and prescribe another dose of crisis management?

The opinions and views expressed here are personal to the author and do not reflect the policy of any organisation with which he is associated.