National Health Service (General Dental Services) (Scotland) Amendment Regulations 2025: final business and regulatory impact assessment

Section 1: Background, aims and options

Background to policy issue

From 1 November 2023, the Scottish Government introduced significant reforms to the NHS dental payment system, moving to a high-trust, low bureaucracy model, which focuses on modernised service provision through clinical discretion and patient-centred care based on need. Within this we made substantial improvements to the fee structure, designed to incentivise dentists to provide more NHS care, and in turn improve patient access to services. Payment reform was intended as a first step in ensuring sustainability of NHS dental services, therefore further changes to the current system and processes are required.

Prior Approval

Prior approval is a method of reviewing dentists’ proposed treatment plans, as part of the clinical governance of NHS dentistry. The prior approval function sits with the Scottish Dental Practice Board (SDPB) with the Common Services Agency (NSS) providing support to deliver. Currently, one of the main triggers for prior approval is based on financial rather than clinical considerations, with dentists having to apply for prior approval for courses of treatment where the cost will exceed £660.

Following the introduction of dental payment reform, there has been an increased volume of low clinical risk treatment plans being submitted for prior approval as they exceed the financial limit, creating a higher workload for NSS clinical advisers who process the claims on behalf of the SDPB. It also makes it more laborious for dentists to undertake treatment plans and can result in delays to necessary treatment for patients due to a financial limit rather than for any clinical considerations.

There are no other policy developments being taken forward at present that may be relevant to this issue. Requirements for prior approval are set out in regulations and these changes require amendment to the relevant regulations. These changes will also allow the detail of the new system to be set out in the Statement of Dental Remuneration (SDR), ensuring that the treatments which require prior approval can be more easily updated in line with the latest clinical considerations.

Mandatory Training

At present dentists who wish to provide NHS dental services in Scotland for the first time, or after a break of 12 months or more (subject to some exceptions), have to complete a course of mandatory training and undertake a test of knowledge before they can join a dental list. There is a requirement that the test of knowledge is completed within 6 weeks of completing the course and that an application for listing is made within 12 months of the successful completion of the test, otherwise the applicant will need to repeat mandatory training. The mandatory training courses are currently offered four times per year which can mean a dentist may have to wait for several months before they can undertake the mandatory training. This can result in dentists choosing not to work in Scotland at all or choosing to only provide private dental services.

Other proposals to improve the dental workforce are also being taken forward at present. Scottish Government’s Operational Improvement Plan has set out a package of actions to improve access and support the NHS dental workforce, supported by new funding in 2025/26. Within this we plan to increase the domestic student numbers into our Bachelor of Dental Surgery Courses by 7% from September 2025, supporting the long-term and sustainable growth of our workforce. We also plan to take forward an innovative new training package for overseas-qualified dentists (currently registered with the General Dental Council to work in the UK as therapists) to safely practice in Scotland, boosting workforce capacity in the short-term. With regard to international recruitment, the Public Health Minister has taken the leading role in bringing all four UK nations together to discuss the actions required to improve recruitment pipelines. However, the General Dental Council is enacted under reserved legislation and any amendment would require to be taken forward by the UK Government.

These proposals are longer term actions, which is why we are proposing to amend mandatory training to allow dentists to join a dental list on a provisional basis to help address current recruitment and access issues.

Purpose/ aim of action and desired effect

The overall purpose of these policy proposals is to improve access to NHS dental services for patients. The outcome of the changes to both prior approval and mandatory training will be measured through official data on the dental workforce and activity levels.

Prior Approval

It is intended that changing the requirements for prior approval, will reduce the onerous nature of the system, which may encourage more dentists to engage with NHS dental services. It will also reduce potential delays to treatment for patients, particularly in relation to low clinical risk treatment plans that are being caught by the financial limit. Additionally, it will help to align the prior approval system with the high-trust low bureaucracy ethos of the new payment system. If no action was taken on this issue it would risk more dentists moving to provide private dental services and patients facing unnecessary delays to access NHS treatment and potentially having to opt for private care. Management information from NSS will be monitored to ensure that the changes to prior approval are having the desired effect of reducing delays to treatment.

Mandatory Training

In terms of the changes to mandatory training, it is intended that this will support practices to recruit dentists, ultimately helping to mitigate the challenging access issues that exist in a number of areas across Scotland, whilst work continues on longer terms measures to improve the dental workforce. Not taking action on this issue risks limiting our ability to mitigate challenging access issues, and could impact the growth of the dental workforce.

Options (considered so far/ still open)

As the requirements for both prior approval and mandatory training are set out in the regulations, the only option for making changes/improvements is to take forward an amendment to the regulations. It is not possible to make changes to guidance or rely on voluntary regulation.

Sectors/ Groups affected

Prior Approval

The changes to prior approval will impact all dentists in Scotland that provide NHS general dental services. NHS dental services is primarily delivered through independent contractors working in a small business environment or through a dental body corporate. NHS GDS is also provided through the Public Dental Service, and the requirements for prior approval will also apply to those dentists employed in the PDS who are providing GDS. We do not envisage these changes having any adverse impact on dentists, and they should potentially reduce the bureaucracy associated with prior approval.

Patients may also be affected by the changes to prior approval, however, this should generally be a positive impact, which decreases delays to treatment.

Mandatory Training

The changes to mandatory training may affect those dentists who are new to working in NHS dental services in Scotland and those who are returning to work in NHS dentistry in Scotland after a break of 12 months or more. The requirement for these dentists to undertake mandatory training is not being changed and dentists will be able to continue to complete mandatory training before applying to join a dental list, as at present, if they wish. For those who choose to apply to list provisionally, we consider that this could have a positive impact, enabling them to start providing NHS dental services sooner than they would otherwise. Similarly, this may help practices to recruit dentists and improve access to NHS services for patients.