History of Lanarkshire Local Dental Committee
At the inception of the NHS in 1948, Lanarkshire Local Dental Committee was formally established by statute under the NHS (Scotland) Act 1947. The purpose was to represent the views of the local practitioners to the Lanarkshire NHS Executive Council which was responsible for the administration of the local GDS and other primary care contract services. The LDC was an independent committee to be financed by a levy on the NHS earnings of practitioners, which was voluntary in Scotland although mandatory in England.
The 1948 NHS scale of fees was designed to provide the ‘Target Net Income’ for the average dentist working the average number of hours in the average practice. The target net income was to be reviewed annually by an Independent Review Body which would advise the government, accordingly.
If the government accepted the report (or otherwise), the new net income figure was passed to the Dental Rates Study Group, a joint NHS / BDA group, whose purpose was to create a scale of fees which h would produce the correct target net income. This, of course, also had to take into consideration all the practice expenses and, for this, the Group received anonymised practice information from HM Inland Revenue.
At that time, this was the only NHS source of income for practitioners. There were no block payments, such as Practice Allowances, Rates repayments, etc. These do offer a guaranteed payment but the associated conditions allow the NHS to have more control/influence over independent practitioners.
The concept of the NHS was to provide treatment for the entire population, free at the point of delivery. In view of this forthcoming prospect, many members of the population elected to defer any dental treatment until the NHS had started operating.
At that time, most adults were denture wearers so there were big savings, and probably no pain, to be made by waiting for the new NHS to start. And, of course, if you had a problem with your new denture, you could go to different practice and simply get another new one!
The dentists had never been so busy and, indeed, so well off. Consequently, my predecessor, a single-handed practitioner in Wishaw, employed up to six technicians in the practice’s own laboratory, or six dental mechanics in a dental workshop, as it was known at that time.
My father in law, who was an apprentice at Skelly’s Garage in Motherwell, years later would still reflect on the month that all the dentists came into collect their brand new cars. They were the only ones who could afford it in those post-war years.
All went well until the first statutory pay review which revealed that target net income had been exceeded by about 40%. This is what lead to the huge reduction in treatment fees so that overall earnings returned to the target net income. It also led to the introduction of patient charges in order to moderate the unrealistic patient demand.
In 1947, many dentists had been sceptical about joining the NHS and the fee review confirmed their fears but, by that time, there was no turning back.
Locally, all the NHS primary care services, namely GDPs, GMPs, Opticians and Pharmacists, were administered by the Lanarkshire NHS Executive Council.
However, there were also other providers of dental care:-
- The Schools Dental Service was provided by Lanarkshire County Council
- Hospital dental treatment was provided by the West of Scotland Regional Hospital Board
- Burgh Health Clinics - Pregnant/expectant mothers and their under-5s could be treated at local Health Clinics provided by individual Town Councils such as Motherwell & Wishaw, Hamilton, Airdrie, Lanark and others.
The LDC sent representatives to the annual UK LDC’S Conference, which was a very effective means of learning from the experiences of other LDCs nationwide.
The aim of the 1972 NHS (Scotland) Act was to bring all these somewhat disjointed healthcare services together, under the auspices of Lanarkshire Health Board. It’s first Chief Administrative Dental Officer (CADO), was Charles Downie, a well respected member of the LDC who had practised in Whifflet and later was elected President of the BDA. Each Health Board would receive its professional advice from its Area Dental Advisory Committee (ADAC). This, in turn, was to be advised by three subcommittees, namely primary care, community care and hospital care sub-committees.
The remit of these sub-committees was limited to reporting to the ADAC which, in turn, was restricted to advising the Health Board and no other activity. In view of this LDCs throughout Scotland decided to continue their other activities which were on a much broader scale, with limits restriction on communications or other activities.
Whereas the ADAC is serviced by the Health Board, the independent LDC has to appoint its own secretary and, in Lanarkshire this has normally a person with legal qualifications. The present incumbent, solicitor Maggie Fulton, is due to retire after twenty years of very valuable secretarial and advisory help.
For example, the Lanarkshire LDC would send delegates to the annual UK Conference of LDCs.
This continued until 2005 when the new system of remuneration was introduced in England. This empowered the NHS Local Area Team (LAT) to choose which practices to contract with, and to reimburse them in Units of Dental Activity (UDAs) whose value would be assessed for each individual practice. The total number of UDAs is also strictly specified. The system also places a great number of restrictions on the development of practices and the establishment of new practices. In Scotland we are not burdened with these restrictions.
As a result of this, in 2006, the annual Conference of Scottish LDCs was established and has proved to be a very successful and effective forum since then. From this, a small number of observers are sent to the UK conference and this is a valuable tool in liaising with our colleagues throughout the UK, although the structure of the four country NHS systems vary greatly.
It is to our pride that Lanarkshire always plays such an important part in the Scottish Conference, including by the submission of numerous proposals for debate. Unfortunately, however, the 2020 conference has been cancelled due to COVID-19.
In these uncertain days, when the long term future of general dental practice is so very much unknown, the influence of the LDCs and, of course, the BDA is vital in striving for the best dental care for our patients. It is vital that the profession speaks with a united voice.
Although membership of the LDC is governed by election, meetings are open to all GDPs practicing in Lanarkshire and their presence as observers is always welcomed.
Past members include
Charlie Downie – CADO
Jimmy Dolan - Airdrie
T Neil Rose MBE - Airdrie
Tommy Bell – RDO (Regional Dental Officer, now as DRO Dental Reference Officer)
Tom Bennet - Airdrie
Andrew Jameson – Lanark
Bill Hutton – Lanark
John Arthur – Motherwell
Graham Mckirdy - Hamilton
Ian Gilkinson (Larkhall accountant)