NHS Dental Services (Moray)
I ask members to move along and clear the chamber. I also remind those who wish to speak in the debate that they should press their request-to-speak buttons now.
The final item of business is a members' business debate on motion S1M-3309, in the name of Mrs Margaret Ewing, on NHS dental services in Moray.
Motion debated,
That the Parliament recognises that the provision of NHS dental services in Moray has reached crisis point; finds it unacceptable that residents of Moray now have to travel to Aberdeen to register with an NHS dentist, and believes that the Scottish Executive and Grampian NHS Board should increase their efforts to recruit and retain dentists to the area.
I thank everyone who signed the motion. I am glad to see such a huge interest in Moray. I particularly welcome Nora Radcliffe, because although Keith is not within the Moray constituency, it is within the Moray area and I know the problems that there have been in Keith. I would also like to thank members who have stayed behind for at least the opening of the debate.
When I lodged the motion, it was in the knowledge that there is also a general problem throughout Scotland in the context of national health service dentistry. Any of us who are interested in the subject must have seen the extremely useful research document by the Consumers Association entitled, "The gap in Scotland's dental care". No pun is intended. The research shows that access to NHS dental treatment has turned into a geographical lottery, with patients' ability to access treatment increasingly dependent on where they live. Nowhere are those problems more acute than in the Moray area.
In my parliamentary office, which I share with Angus Robertson MP, we have received well over 200 complaints from individual constituents. We have met and spoken with dental practitioners in the area and sent out a full questionnaire to all the practices in Moray. The dentists who have responded so far represent approximately 40,000 of my constituents. I have a couple of quotations from those dentists. The first said:
"I am currently resisting the move of my practice to private work but I am working longer hours with higher expenses for less income and will be forced to go private to maintain my standards or go out of business."
Another dentist said:
"My practice receives up to 30 calls per day from people wanting to join the NHS and private lists that closed over a year ago."
In some areas of Moray, waiting lists for both NHS and private patients have been closed for as long as four years. Not a single practice in Moray is taking on any new NHS patients. Additionally, it can take as long as three years to be given an appointment to see an orthodontist, never mind the length of time that might be involved in subsequent treatment.
The nearest place for registration with an NHS dentist is in Aberdeen. The most westerly tip of my constituency is Forres and surrounding areas. A trip from Forres station to Aberdeen costs up to £25.30 per adult and £12.75 per child. That is expensive for anyone on a basic income, not to mention the fact that a child would need to be taken out of school for a day and that an adult would lose a day's wages. Not everyone has a car. The monthly costs for private dental insurance for two adults and three children range from £17.62 to £78. Those are the basic facts about what is happening in Moray.
I am sure that the minister will point out that, last December, the coalition Executive allocated money for three additional salaried dental posts in the NHS in Moray. However, those posts were finally advertised in the British Dental Journal only in August this year. The closing date was 20 September. If we assume that the successful applicants might need to complete contracts elsewhere, it will be the end of this year before those dentists can possibly be in place.
I tried to find out from Grampian Primary Care NHS Trust why the appointments had taken so long. I know that the money is not time-barred, but given the fact that the crisis already exists and that the money is there, I wanted to find out why on earth the three dentists could not have been appointed earlier. The primary care trust claimed that the reason for the delay was the need to find accommodation at Dr Gray's hospital, where at least six months were required for the alteration of sewing rooms. It seems to me that, in the interim period, at least some of those who were interested in becoming dental practitioners in this beautiful part of the country could have been accommodated somewhere else in the area or even with the other existing practices. It seems to me and to my worried constituents that a whole year has been wasted.
The fact that the posts will be filled in the near future is of some comfort, but I wish to highlight the need to address the medium and long-term effects of the current situation. The report of the chairman of the local dental committee pointed out that, of the 21 local practising dentists, 11 were over 55 years of age.
The Scottish survey of general and community dental practitioners in 2000 highlighted areas of serious cause for concern for the future. Two thirds of dentists said that they planned to retire early at the age of 55. Half of that group planned to reduce their clinical hours in the years before retirement. Of those planning to retire early, 74 per cent said that they might stay on if the NHS system were to value quality rather than quantity of treatment.
When those three new dentists arrive, we will welcome them with open arms. They will have taken a wonderful choice to come and live in Moray, which is a marvellous community with great facilities. However, the problem will not stop just with those appointments. We need a medium and long-term strategy if we are to lose people through early retirement.
In April, the minister announced the concept of the golden hello as a step to help rural areas. Now that the graduation period is over, will the minister indicate whether there has been any interest in the golden hello? What has the take-up been?
I ask the Government to address the age levels of practising dentists throughout Scotland, to ensure that there will be a continuous supply of new graduates coming into the profession and that we do not end up with many practices having no newcomers while everyone else is retiring.
Those matters are vital and I appreciate the fact that members have stayed behind to listen to the debate. I hope that the positive way in which I have explained the issues will meet with a positive response from the minister.
I remind members that the debate is specific to Moray, so I will be listening for some geographic or service links to Moray in members' speeches.
Part of my constituency lies in Moray, but the problems of a lack of dental services, or a lack of access to dental services, are acute throughout the north-east. The seriousness of the problem is not in doubt, as Margaret Ewing has demonstrated.
We should commend the efforts of Grampian NHS Board and the Scottish Executive in measures such as the golden hello and the attempts to recruit salaried dentists—not only in Dr Gray's but, in years gone by, in Aberdeen and other parts of Grampian. However, those efforts come up against the underlying problem of there simply not being enough dentists, full stop. Margaret Ewing highlighted the age profile in the profession—a profile that means that the problem will get even worse.
Part of the problem has been that professional bodies, when projecting the number of training places required, have failed to realise that most professions are now gender balanced. If half of their professionals are female, the bodies will have to factor in the career breaks required for child bearing and child rearing. That may sound sexist. I hope that, in years to come, either parent will take the career break for child-rearing purposes. However, we are not there yet.
Even if we had enough dentists, the issue would arise of whether they would choose to practise in the NHS. The way in which NHS dentists are treated and remunerated has serious effects and will have to be considered carefully.
One thing that will have to happen if we are to meet the requirement for dental practitioners in the north-east is that dental training places will have to be provided in the north-east. If people have completed a university course and graduated, have done vocational training, have committed themselves to accommodation, and have built up social networks, they will tend to stay where they are. To get equity of access to dental services, we will have to train more dentists and ensure that some of those training places are in the north-east.
It is great to have Margaret Ewing back. I thank her for raising an extremely important issue and I hope that we will hear positive answers from the minister. Many of these questions require long-term answers, but we have to make a start now.
I, too, am delighted to see Margaret Ewing back. If I may say so, Margaret looks very well. It is nice to see her back in her stride, as feisty as usual, for the people in Moray.
I picked up the following figures in the tea room about 10 minutes ago. I was actually quite shocked to see the fall in the number of registrations for general dental services. Since 1997, the registration of children has fallen by about 64,000 and the registration of adults has fallen by 197,464. When comparing health board areas, we see that the percentage of adult registrations in Highland is 38 per cent and in Grampian is 46 per cent, while in the Borders it is 58 per cent. The situation is mixed throughout Scotland.
We often talk about access to dental services and I have come across something that has surprised me. Will the minister confirm that there is no guarantee of access for patients to general dental services, unlike the case with general medical services?
As Margaret Ewing has outlined, the position in Moray is particularly critical. I, too, draw members' attention to the Consumers Association report, which notes that more than 50 per cent of dentists in Moray are over 55. Unless action is taken, the position is likely to get worse rather than better. In the same study, the Consumers Association pointed out that in Edinburgh, 40 per cent of dental practices were not taking on all NHS patients and in Aberdeen 80 per cent of dental practices were not taking on all NHS patients. That means that if Moray patients are seeking NHS dental treatment in Aberdeen, they will have to seek out the 20 per cent of practitioners who will welcome them as NHS patients.
The Consumers Association report also states that dentists had commented that it was not worth taking on NHS patients because of the low fees that dentists get from the NHS. In the Highlands and Islands, one practice had not taken on an NHS patient for five years and another practice quoted charges of £105 an hour. Several dentists in the Highlands said that NHS work did not pay enough to make it sustainable.
Like many members, I welcome the dental action plan, "An Action Plan for Dental Services in Scotland", which was introduced in August 2000. I know that we can all be quite carping and critical about the glossy brochures, but the action plan is excellent and two years later it is probably time to carry out a progress report and produce an update. If everything in the plan had been implemented, people in Moray would not face the problems that they do today.
The other point that has come to my attention in the Highlands is the statutory obligation on authorities to provide dental checks for schoolchildren three times throughout their education. It was confirmed quite recently at a meeting between MSPs and NHS Highland that NHS Highland does not meet that obligation.
Looking back at my file on dentistry, I found several letters from dental therapists, who were seeking to review the dental auxiliaries regulations under the National Health Service (Scotland) Act 1978. The regulations allow them to practise in the public health services but forbid them to work in general dental services. I understand that dental therapists are not the answer to the shortage of dentists. Nonetheless, given that they can carry out some extractions, some fillings, cleaning and polishing, scaling and giving advice, the removal of those restrictions would be very helpful. I understand that Westminster is currently considering that issue.
The dental action plan proposes the establishment of drop-in centres in the major cities and enhancing the role of mobile services. I understand that a drop-in centre is being established in Edinburgh. The use of mobile units would undoubtedly be helpful in rural areas.
Can the minister confirm that NHS 24, given that it is up and running in Aberdeen, is giving advice on dental problems, as promised in the action plan? Can the minister confirm that NHS 24 is also giving advice on access to dental services, which would be so helpful for the people in Moray?
Page 13 of the action plan says:
"Primary Care Trusts should review locally how GDS and CDS"—
that is general dental services and community dental services—
"can work together effectively to complement each other's services"
and draw up a local service plan. Do all areas in Scotland have a local service plan? Are they doing what the Executive has asked them to do and are such plans sufficient to meet the needs of patients?
Finally, I am sorry that Ian Jenkins is not here tonight because he regularly makes the point that the difficulties in accessing dental treatment mean that in many cases oral cancer is not picked up.
I, too, welcome Margaret Ewing back to the chamber. I am pleased that she had the first question of question time and opened today's members' business debate. As one would expect, she presented her arguments with dedication and focus. I congratulate her on securing the debate.
As we have heard, nearly every member of the Parliament has some experience of the issue of dentists and the lack of NHS dentists. I receive a large number of letters expressing concern about the lack of dental provision in Moray and throughout the Highlands and Islands. Far too many people feel that they have been left high and dry by the continuing drift of dentists into private practice. I do not altogether blame the dentists. I receive letters from dentists who say that they have tried to include an NHS dentist in their practice, but that they cannot attract new NHS dentists. People come to a town, examine the practice, see what they will be paid by the NHS and then go to another place where they can work privately and be paid more.
This problem dates back not four years, but as long as 10 years. I remember when my dentist closed his NHS lists. I hung on and was assigned not to a partner, but to an assistant. Assistants came and went, while the partners practised privately. People could have their teeth examined and take out Denplan at vast expense. I refused to have my teeth examined so that an estimate could be made of the cost of keeping them in trim, because I knew that it would be horrendous. I said that I wanted to stay with the NHS and that, if I needed to have extensive work done on my teeth, I would face that problem when it happened.
Recently two old-age pensioners who had been with an NHS dentist all their lives were suddenly told that they could no longer receive treatment on the NHS and that they had to go private. The alternatives were not explained to them properly. They had to ask their MSP where to find a dentist who would treat them on the NHS. People in that situation must be given much more information. I raised the issue with the local health board, which said that it would ensure that people were given proper information about where they could access NHS dentists.
For many people there is no alternative. As has been mentioned, people in Moray have to travel to Aberdeen, which means paying £25 for a return ticket on the train. If they do not do that, they are forced to pay more for the treatment that they previously received. That is not an option, so they do not go to the dentist. I am convinced that, as a result, dental health is declining in the Highlands and Islands.
Mary Scanlon mentioned oral cancer. All sorts of problems may go undetected because people have stopped going to the dentist. We do not want to return to the situation that existed in my mother's generation. People would go to the dentist at 20 to have all their teeth removed, so that they would never have to pay to go again. We must ensure that this problem is addressed.
As Margaret Ewing said, the situation in Moray is very serious. No practices in Moray are taking on NHS patients. The Executive has responded to concerns by announcing investment of £1 million, which I welcome, and I hope that the money will improve the recruitment and retention of NHS dentists. There are some training practices in the north—the practice that I use is one of them.
The new investment is welcome, but will it be enough to stem the movement of dentists into private treatment work and to encourage new dentists to work in the NHS? The answers to those questions are not immediately forthcoming, as the investment will take time to filter through. We must accept that. However, I notice that in the announcement this investment was described as an initial package. I hope that, given the spending review and the increase in health service spending nationally, dental service provision will feature heavily in forthcoming spending announcements.
Grampian Primary Care NHS Trust is also taking action. At the beginning of August, the trust informed me that it intended to mount a recruitment campaign for salaried dentists who will be directly employed by the trust, as a way of tackling the shortage. As Margaret Ewing indicated, the new suite at Dr Gray's hospital in Elgin is receiving financial support from the Executive. However, again there has been a delay.
In mentioning Grampian Primary Care NHS Trust, I am reminded of another case that I dealt with in Moray. The case involved a young teenager who required orthodontic treatment on the NHS. She was told that she would have to wait five years—she would be grown up before the treatment could take place. The alternative was for her to pay several thousand pounds to have the work done within a few months. It is not on for people to have to make such choices.
We need long-term thinking and long-term plans if the problems in Moray and elsewhere are not to be repeated. I hope that the minister and her officials will examine closely the reasons why this situation has developed. The situation is not new; it did not start under the current Administration. It started at least 10 years ago, when the then Government cut the fees that dentists received from the NHS. The situation has developed over time, but many people are left wondering why the welcome measures that the Executive has announced were not put in place much earlier. Hindsight is valuable, but so is an evaluation of why the situation has developed so that we might try to prevent something similar from happening again.
As of now I would be grateful if the speeches were kept to under three minutes.
I say very well done to Margaret Ewing for securing a debate on this important topic. It is good to be able to add my welcome back to her. It is also good to see her introduce, so early on, a debate on a topic that members can get their teeth into. In Margaret Ewing's abscess our hearts have grown fonder, but meantime we have tried to put the best floss on it.
That is enough of the cheap jokes. Although perhaps, given that we are talking about the decline in dentistry in the NHS in the north-east, they are entirely appropriate. The trouble is that we are trying to get dental health on the cheap and that simply does not work.
In the NHS in Grampian as a whole, we have half the number of dentists per head of population that Edinburgh has and a quarter of the number that there are in Manchester and, Dr Ewing advises me, in Cuba. In rural Aberdeenshire and Moray, matters are considerably worse.
I pose a few questions. If members were dentists, would they wish to work in an area in which they would have to work four times as hard as dentists in Manchester? Would they wish to work in an area in which the backlog of dental decay is likely to be large? Would they wish to work in the NHS when they could earn more, get more time to do a quality job and get some time off by working in the private sector?
To be fair, I acknowledge that initiatives have been taken. Investment is being made in community dental facilities, but it has proved impossible in my constituency to get dentists to work in them. We have had the bounty to bring in new staff after they graduate. One dentist of whom I am aware managed to recruit someone to their first appointment after graduation, but they failed to qualify for the bounty because more than a year had passed since they had qualified. The dentist coughed up the money to ensure that they got the member of staff.
Advertising in Finland has been conducted. Finland has too many dentists and we have too few, but even so we are still unable to recruit dentists from there. We are on a downhill disaster curve and things can only get worse. There is an economic risk to life in the area that NHS Grampian covers. Senior people are coming into companies in the north-east and finding that they cannot get their promised dental care. That will damage the reputation of the north-east's quality of living.
As an MSP I am extremely fortunate that I can get NHS dental care in Lothian, but I cannot get it in my constituency. We support Nora Radcliffe's suggestion of conducting NHS training in the north-east. I suggest that we follow the Australian model of encouraging graduates to go to the areas of greatest need. One of the ways in which we might think about doing that is by allowing the Executive to pay off graduates' student loans. There is a gap in dental care in the north-east and we must address it as an absolute priority.
I congratulate Margaret Ewing on keeping the subject of access to NHS dental care on the agenda.
We have heard a lot of statistics and I want to throw in a few more that are relevant. The Scottish Executive's figures show that 51 per cent of adults and nearly 25 per cent of our children are not even registered with an NHS dentist. It is not surprising to find that 56 per cent of our five-year-olds have signs of dental disease and 18 per cent of adults do not have any teeth at all. One third of Scottish dentists no longer take NHS patients and a further 10 per cent will accept only certain NHS patients. The problem is not just focused on Moray and Grampian; it is a Scotland-wide issue.
I want to focus on the last statistic that I will present, which is that the British Dental Association's recommended ratio of dentists to the population is one dentist for every 2,000 people. In Moray and Aberdeenshire there are 4,400 people for every dentist. That unacceptable situation has not improved since we had our first members' business debate on the subject two years ago.
I recognise and welcome—as I did at the time—the Scottish Executive's £1 million package and the attempts that have been made to encourage, with golden hellos, recruitment of dentists to the rural north-east. So far in the debate, the minister has been listening to the problems that members have described, but, although I am short of time, I will identify two solutions to those problems. We are here not only to identify problems, but to share our ideas on how to solve them.
The simple issue is that, with the closure of the Edinburgh dental school, we do not have enough dentists—full stop. We must open another dental school, and the best place for that would be Aberdeen. The problem is particularly focused on the north-east because, as we have heard, it is difficult to bring people up to the north-east unless they are training there. A new dental school in Aberdeen is necessary.
I am afraid that we must also focus on breaking the link with the UK national health service. One hundred per cent of dentists said in a survey that a review of NHS and laboratory fees is necessary. Therefore, we must change the system. It is about time that the Scottish Executive examined the situation. If it identifies a problem that is specific to Scotland, it must break the link with the UK approach. We should have Scottish solutions to Scottish problems. This is a devolved matter, and we must tackle it. I ask the minister to consider breaking that link with the UK arrangements.
I congratulate my colleague Margaret Ewing on her initiative in leading this important debate. I hope that the minister will address the problems in Moray as a matter of urgency.
The problem of access to NHS dentists in Moray is replicated elsewhere in Scotland and must also be addressed with urgency. I have pursued the situation in Angus with the Government and Tayside NHS Board on behalf of my constituents. I ask the minister, in her reply, clearly to set out the situation in Moray and nationally with respect to the appointment of salaried dentists and the joint appointment of community dentists, who provide general services for part of their time. How have such dentists contributed to a solution to the problem? I know that, in Arbroath, an application has been approved for a joint salaried general dental/community dental practitioner, which should help the situation. How many such joint appointments have been made recently and how might they help, not only in Moray but nationally?
I also ask the minister to give us an assurance that the Executive will deal with all such applications as expeditiously as possible. Can she indicate how long it takes to process applications for joint salaried general dental/community dental practitioners and applications made under the Scottish dental access initiative? There must be no delay in processing those applications, because patients urgently need those dentists. I note that a dental access initiative application for Arbroath is in the hands of the Executive. I ask the minister to undertake to investigate that application and to ensure that it is dealt with as quickly as possible.
I congratulate Margaret Ewing on drawing attention to a problem that extends beyond Moray, but about which she feels acutely on behalf of her constituents. She has performed a service not only for the people of Moray, but for worried patients throughout Scotland.
I congratulate Margaret Ewing on securing this important debate. I welcome her back to the Parliament—she is back with a bang. SNP parliamentary group meetings over the past few months have not been the same without her.
The problem exists not only in Moray but across Grampian. I have with me a letter that is being sent to all the patients at Westhill dental practice this week by the eight dentists who work at the practice and who serve that large community, which is outside Aberdeen. The opening line of the letter, which indicates that the practice will no longer take NHS patients, says:
"We have continually strived to maintain and improve standards, but this has become increasingly more difficult under the National Health Service."
The situation pertains elsewhere in Grampian. New figures today show that, in Aberdeen, only three out of the 38 practices take NHS patients. That is a tiny percentage. Indeed, the dental health line that was set up in Grampian 18 months ago because of the number of people who were looking for NHS dentists receives—believe it or not—3,500 calls a month.
If someone has an examination at a dentist on the NHS, they have to pay £5.32, which is topped up by the NHS to £6.65. A scale and polish costs £13. A dentist sees around four patients an hour, which means that, if they all get an examination and a scale and polish, the dentist gets about £60 for that hour. Out of that money, the dentist has to pay for trained nurses, all of their equipment, control of cross-infection, a receptionist, rent for the premises and a living wage for themselves. That is the root of the problem. As Mike Rumbles said, we have to address that situation. If a dentist goes private, they can charge £25 for an examination alone, so the economics of the situation are evident.
Salaried dentists are a small step forward. The ones in Grampian have huge waiting lists and can make only a limited impact. There is a time-bomb element to the problem as well because, if someone has not been to the dentist for 18 months, their membership of that practice automatically lapses, which means that that practice will not readmit them to the NHS list. We need an education campaign to counter that.
Salaried posts are not the only issue, as the problem in Grampian also relates to a shortage of dentists. Today's figures show that 40 out of 190 posts in Grampian, including Moray, are vacant—that means that there is a 21 per cent shortage of dentists. Grampian cannot attract dentists because dentists see the area as "professionally isolated", to use the official phrase. In order to get adequate training in the area, we have to consider the consultants' position in hospitals, which is also under stress, and we have to establish a dental school in the area. Dundee dental school has five applications for every place, which demonstrates that there is a demand for places. We should create those places in Aberdeen.
The problem is a serious matter for Grampian and many issues relate to it. We seem to be putting obstacles in the way of people who are trying to lead a healthy lifestyle and we have to address that urgently.
In an entirely impartial and unbiased way, I warmly congratulate Margaret Ewing on her excellent exposition of the topic.
I will address some of the deeper issues that have led to the crisis in Moray. If young children have proper oral and dental care, they will not need to see a dentist other than for a check-up. A simple plan such as sending a birthday card from the dentist to every one-year-old child, as happens in the Highlands, will make parents aware of the need to register and will encourage them to do so, if we assume that there is someone for them to register with. Why not extend that scheme to include two and three-year-olds? Perhaps it should be rolled out across Scotland.
Toothbrushing in nurseries and primary schools does not seem to cost a lot but would make children aware of the importance of brushing their teeth, especially if they do not have proper support at home.
We need more trained dentists, dental hygienists and therapists, as Mary Scanlon said. I am not sure that a new dental hospital could be delivered—I do not know how much money the Liberal Democrats plan to commit to that in their manifesto—but I would like the minister to address the serious problem that is faced by the Glasgow dental hospital. It has a budget of £3.6 million, but that goes to the University of Glasgow, with only £2 million being passed to the dental school. The other £1.6 million is taken by the university for administration. I do not know the answer to that, but I think that it is a serious problem. The dental school is being asked to train more dentists—the number of students in the first year has risen from 70 to 77—which is to be welcomed, but the problem is that there are only 45 members of staff, as opposed to the 79 that there were 10 years ago. I think that it is wrong that £1.6 million is being creamed off by the university for administration and I urge the minister to examine that matter closely.
The problem of dental erosion will become increasingly serious. I do not want to be alarmist and describe the situation as a time bomb, but one study shows that the consumption of fizzy drinks by children has increased sevenfold in the past 30 years. The acid in fizzy drinks is corrosive and one of the primary causes of dental erosion, which is hugely costly to treat. Indeed, it can be treated only by some experts. As a result, should fizzy drinks be sold at schools and in vending machines? I think not.
I am happy to support other members' suggestions about training. It might be possible to have another training facility for hygienists and therapists and to extend the range of their work, as happens in the NHS.
Mary Scanlon mentioned that there is not a similar legal duty to register with a dentist as there is with a general practitioner. However, there is another problem. I believe that a child's registration with a dentist lapses after 18 months. What is the point of that? At the very least, a child's registration should continue until he or she becomes an adult. That simple step could again be taken without a great deal of cost.
I, too, join members in welcoming Margaret Ewing back to the chamber. It is great to see her and I look forward to debating many other issues with her. However, it seems that I keep having to return to the subject of dentistry, and I am glad to have the opportunity this evening to hear about people's difficulties.
I must start my speech by acknowledging that there have been difficulties. However, as members have pointed out, those difficulties have not arisen over the past year or two, but are the result of progressive problems in the profession. The Executive seeks to address those problems and to find answers that will ensure that my constituents and other members' constituents are able to access dental treatment.
In the primary care sector, where about 90 per cent of dental patients are treated, most general dental practitioners are independent contractors to the NHS who are free to choose whether to accept NHS patients. It is regrettable that in some parts of Scotland, including Grampian—Moray in particular—there has been a declining commitment to the NHS by some general dental practitioners.
Access is one of a number of problems that are being addressed by the implementation support group, which was set up to progress the action plan for dental services in Scotland to which Mary Scanlon referred. In order to achieve improvements in dental provision, we need the people to deliver them; indeed, we need the right number of people with the right skills in the right place.
In planning the dental work force, we have agreed a target output for the dental schools of 120 graduates per year and we have put the funding in place to reach that target. That is way ahead of our neighbours south of the border and we recognise that it is an important part of delivering the service.
Two years ago, in the initial debate on the matter, I said that the target of 120 dentists in the dental action plan was not a great one to achieve. In fact, we were producing many more than 120 dentists in Scotland. The problem is that we do not have enough dentists—we need more.
One hundred and twenty dentists is an achievable target. Instead of simply increasing that number, we need to find out how to retain those people in Scotland and in our more remote and rural areas.
Will the minister consider giving more support to training practices in the Highlands? More training practices being in receipt of support would attract new dentists who—it is to be hoped—would be retained in the area.
I will come back to that point in a moment.
We are also able to offer postgraduate vocational training places for all Scottish graduate dentists. Moreover, to enhance the dental team, we have put funding in place to increase significantly the numbers of trained professionals complementary to dentistry.
As well as getting the numbers right, we regard the quality of training as being vital. Although dentists can register to practise on graduation, the NHS insists on one year's postgraduate training. In Scotland, we have successfully piloted two-year general professional training and we aim to increase the provision for all graduates of Scottish dental schools.
Planning the dental work force is also about having people and their skills in the right place. We need to make sure that dentists will choose to live and work in all parts of Scotland.
One of the issues that has been raised is that of fees being paid. Fees are set annually by the Review Body on Doctors' and Dentists' Remuneration—which is independent of the Government—following representations by the professions, and particularly by the British Dental Association and by health boards. In Scotland, we have accepted those recommendations in full and we have also provided additional allowances for rural and remote areas.
On 25 April, a £1 million package of measures to improve recruitment and retention of NHS dentists and to ensure that patients are able to access NHS dental treatment was introduced. That package includes funding for vocational training places for all new dental graduates and a £3,000 allowance to each new dental graduate who takes a training place in any of eight designated areas—including Grampian—where access to NHS dentistry is outstripped by patient demand. It also includes a £5,000 allowance over two years to dentists who have completed training and are entering substantive NHS practice, or £10,000 over the same period where the post will be in one of the designated areas. That will enable the development and funding of an education and support programme for all new dentists who have completed training, and will provide grants of up to £10,000—based on the amount of NHS work—to dentists establishing new vocational training practices and offering a training place. We want to ensure that training places are available in order to ensure that people stay in Scotland.
We are also currently in discussion with the dental profession about further measures to encourage recruitment and retention, focusing on the older dentists and returners to NHS general dental services. Margaret Ewing mentioned the fact that many dentists are in the older age bracket. We recognise that and are discussing with the British Dental Association in Scotland how we can assist those dentists to remain in the profession and ensure that they get a living wage for what they are doing.
From 1 April, we also introduced a new career structure for salaried dentists employed in NHS general dental services, with salary scales for two new grades of promoted posts. That will enhance recruitment and retention by providing new opportunities for advancement and will enable the provision of a wider range of treatments through the salaried service. We are currently discussing the details with the profession.
We recognise that many dentists prefer to be close to the area where they did their undergraduate training. I do not accept that that necessarily means that we must have a dental school in Aberdeen, but it does mean that the local trusts in Grampian, with support from the NHS board and the Executive, must make particular efforts to recruit and retain staff. To that end, we have encouraged both dental schools in Scotland to develop outreach training that will give undergraduates experience in rural areas and in hospitals away from the dental schools, for example in Aberdeen. That will build up a relationship and attract dentists to the areas where we know we have difficulties.
We already have in place a number of measures to encourage dentists to further their contribution to the NHS and to locate in areas where NHS services are underprovided. Those measures include the availability of grants under the Scottish dental access initiative and the provision of salaried dentists. I can tell Andrew Welsh that we deal as quickly as possible with requests for salaried positions. There have been no delays and there is no question of delays. I am also aware that, this year, we have agreed to 14 additional places. I do not know the total number, but I will get that information for Mr Welsh.
Does the minister acknowledge that Mike Rumbles's suggestion that there should be a new dental school in Aberdeen would be extremely difficult to implement, given that there is a need for a wide range of training, skills and experience to set up such a school? Does she agree that it simply would not be possible to do that, given the shortage of dentists in Scotland now?
As I said, we must consider what we have at the moment and decide how we can use it in the best possible way. By ensuring that students leave the dental hospitals recognising the opportunities that exist in other parts of Scotland, we can build on the numbers that are moving at the moment.
The dental access scheme encourages dentists to establish or to expand NHS dental practices in areas of high oral health need, or in areas where patients wish to receive NHS treatment, but are having difficulty in finding a dentist who is willing to provide such treatment. To date, more than £1 million has been offered to practitioners in Scotland under the initiative. In Grampian alone, £94,500 has been spent. I encourage other dentists who are committed to the NHS to consider whether there is scope to expand their practices with the help of the capital grant that is available.
Margaret Ewing referred to the fact that Grampian Primary Care NHS Trust has recently advertised for salaried dentists to work in Moray. I understand that the trust has received expressions of interest, and that work at Dr Gray's hospital will be completed this year. I regret the delay that Margaret Ewing mentioned, but the completion of the work represents progress.
We have recently introduced a remote areas allowance of £1,500 for dentists in remote and rural areas and we have increased the continuing professional development allowances for such dentists, to reflect the increased travelling time to their local postgraduate centres.
I hope that although the measures that I have outlined are not conclusive, they demonstrate that we are taking the issue seriously and that we are seeking to increase the numbers of dentists throughout Scotland, particularly in the areas in which we know there are problems in accessing NHS dental services. We are not complacent—we acknowledge that we must intensify our efforts and I am willing to listen to suggestions about how we can do that. The Executive wants in Scotland a dental service of which we can all be proud.
Meeting closed at 17:56.