Health / New oral health strategy aims to bolster NHS-run dental service

AN “INNOVATIVE” new oral health strategy which aims to improve access to dentistry treatment in Shetland by enhancing the NHS-delivered service has been approved by the local health board.

It covers three phases, and it is estimated to cost nearly £1.8 million in total to enact.

The key aim is to consolidate, enhance and expand the NHS Shetland public dental service provision.

One ultimate aim is for a large Lerwick dental facility within a new Gilbert Bain Hospital, while there are also objectives to improve training facilities.

NHS Shetland chief executive Brian Chittick told a health board meeting on Tuesday that the current provision in the isles is “not enough” to meet demand.

Figures show that in order for the community of Shetland to access dental care to the same level as the national average, there needs to be a more than doubling of the current dental workforce.

At the moment one independent operator in Lerwick takes in NHS patients under a general dentist service scheme, while the health board offers its own services for certain groups such as children and people in care from premises like Montfield in Lerwick and some health centres.


But since the Covid pandemic struck in 2020 access to dentist treatment in Shetland has generally been for emergency and high priority cases only, with routine work put on the backburner.

The strategy, for 2023 to 2027, said there will be “public engagement/consultation at the appropriate time” things progress.

It added that due to “ongoing workforce pressures and a rapid contraction in the independent general dental service sector in Shetland, NHS Shetland public dental service is operating at a reduced service providing only high-priority and emergency NHS care”.

Dentistry director Antony Visocchi told Tuesday’s meeting that the strategy is a “real departure from the norm”.

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It received broad support, with board member Kathy Hubbard saying she felt the strategy was “absolutely the way to go”.

Discussions are ongoing with the Scottish Government on funding, but Visocchi told the meeting that an extra £150,000 has been underwritten by the government to support delivering dentistry in Shetland in the meantime.

NHS Shetland’s dental director Antony Visocchi.

There is a hope that a couple of new dentists may come to Shetland at least for fixed term contracts in the new year.

The strategy says it is recommended that a return to a directly NHS board managed combined service would provide “sustainability and self-determination” for the service in Shetland.

It says that whilst any development of the general dentistry service – “high street” dentists – would be welcomed, “this should not be considered as part of any long-term solution” for sustainable provision for the whole of Shetland.


The first phase of the strategy aims to recruit an additional 3.3 whole time equivalent (WTE) dentists for the health board’s public dental service, returning to pre-Covid levels of service. This would cost an extra £306,751.

The second phase, over one to three years, would seek to establish the foundations of a sustainable health board delivered service for the whole community.

This would come with an additional 6.8 WTE dentists in the health board service, costing around £1 million extra.

The third, more longer term phase, would enhance the public service, with a hope to integrate it into the planning and development of any new hospital facilities.

The strategy says a consolidated Lerwick facility within a new hospital could, in theory, include eight to ten dental surgeries, education rooms and office space.

Phase three would include three additional WTE dentists, with costs coming in at £444,000.


Visocchi suggested that the costs could potentially be met from redirecting funding which the government currently gives towards general dentistry.

He said the additional funding required for the proposed new Shetland model could actually be “good value for money” for government – “rather than leaving it up to the nuances of an independent contractor”.

The strategy says the current independent provider, which opened its Market Street premises in 2016, has experienced recruitment and retention challenges, which has been amplified by the national “workforce crisis”.

It adds that the opportunity to develop the general dentist scheme by attracting independent contractor to invest in an additional or new practice is “significantly compromised”.

The report says as of 31 January 2023 the independent practice offering NHS work had 3.0 WTE dentists. It said the NHS activity of these dentists is currently at 36 per cent of pre-Covid levels.


Meanwhile Chittick, who has a background in dentistry, told Tuesday’s meeting that the contract for general dentist services changes in November.

The strategy added that at the moment, due to budget pressures and lack of secured, recurrent funding, the NHS is only able to recruit dentists to 12-month fixed posts.

“The whole profession is having a workforce crisis and this is magnified in remote and rural regions,” it said. “Therefore to cast the net as wide as possible, Shetland needs to be able to offer the option of a substantive contract in order to attract the interest of the group of dentists who would not consider a fixed term option.”

It highlights there has been a “marked decrease” in the number of dentists in both the public and general sectors providing NHS care.

There is said to be 8.3 WTE dentists in total providing routine NHS care in Shetland, but the requirement to meet national averages is 15.1 WTE.


Chittick added there was still an aspiration from the Scottish Government for free dental care “across the whole life course” – so without planning for that potential outcome “we could be left quite high and dry”.

He said, however, there is still opportunity to continue to have a blended model of independent and public services in the future, but he said the status quo is “not enough” for Shetland.

Speaking about the strategy, a supportive board chair Gary Robinson said there is always risk with doing things differently.

“But I think in the situation that we’ve been in, the greatest risk might have been in not doing something different,” he said.

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