Meeting the Needs of an Ageing Population
Current projections suggest that the population of Scotland will rise to 5.7 million by 2039, with the proportion of people aged 65 and over increasing by 53% between 2014 and 2039.  It is therefore vital we take this into account when planning NHS dental services for the future. We want to ensure that everyone, no matter what their age, can have access to dental care in order to maintain good oral health.
At present one in five of the population of Scotland aged 75 years or more are not registered with a NHS dentist.  We have identified a substantial gap in domiciliary care provision, both in care homes and for patients who may be confined to their own homes.
The PDS is currently the main provider for delivering domiciliary dental care to those people resident in a care home or those unable to leave their own home. With the population who are likely to require domiciliary dentistry increasing, it is important that we support GDPs to provide domiciliary care.
New Domiciliary Care Provision
We intend to develop an accreditation scheme for GDPs with the necessary skills and equipment to see patients in care homes. These practitioners and their teams would work with care home staff to ensure adequate preventive care is in place for residents, complementing the PDS, which will continue to provide those procedures that cannot readily be done by a GDP. With the increasing numbers of people living in care homes it will be necessary to ensure the PDS are only used for patients requiring their advanced skills.
Action 11: The Scottish Government will introduce arrangements to enable accredited GDPs to provide care in care homes. These practitioners will also work with care home staff and the PDS to ensure the maintenance of good oral health and hygiene.
Having a clean, healthy mouth is fundamental to human dignity and when someone is unable to maintain their own oral health they should be given help to do so. Routine oral care should be happening as part of a duty of care, and we want to ensure this is given the appropriate level of priority.
‘Caring for Smiles’ is the national oral health promotion, training and support programme for older people. The accompanying guide acts as a helpful training tool for care home managers and staff in conjunction with hands-on training from oral health teams. We recognise that there is often a competing number of demands on those who care for older people, however, we want to ensure that oral health care is recognised as a priority. Therefore we will work with organisations such as the Care Inspectorate on a campaign to raise awareness of ‘Caring for Smiles’.
Action 12: We will work with organisations such as the Care Inspectorate to ascertain how we can continue to raise the profile of oral health care in care home settings.
People in their Own Home
We also need to find ways to ensure older people who are cared for in their own home continue to receive dental care. Our intention is that the patient’s GDP would continue to provide routine monitoring, care and treatment, but where it might be necessary to carry out more complex treatment in the patient’s home, there is likely to be a role for an accredited GDP or the PDS.
Action 13: Once we have sufficient numbers of accredited GDPs in place, the Scottish Government will introduce new domiciliary arrangements for people who are cared for in their own home.
Health and Social Care Partnerships
In setting out our plans for future improvement we need to be mindful of the valuable role HSCPs can play. The Health and Social Care Delivery Plan states that “For better integrated care to become a reality, the new Health and Social Care Partnerships must plan and deliver well-coordinated care that is timely and appropriate to people’s needs.” 
Action 14: The Scottish Government will work with Chief Officers within HSCPs to establish how we can work together to improve the oral health of people who are cared for in domiciliary settings.