Cuts are the wrong cure: Dentists warn future of service now at risk in Northern Ireland

The British Dental Association has warned officials that planned cuts will devastate a service already on the brink.

In an open letter to Peter May, Permanent Secretary at the Department of Health, representatives of every field of practice in Northern Ireland stress “If the axe falls on dentistry – indeed if there is a failure to provide needed investment – this service faces collapse. The price will be paid by patients across Northern Ireland.”

Dental leaders say Northern Ireland faces ‘a three-tier system’, where those who can’t get registered for NHS care but can’t afford to pay privately are left without routine access, short of accessing emergency services.

The letter cites bleak evidence from the frontline, with the crisis on the high street being felt acutely across community and secondary care:

  • Oral cancers: Red flag referrals for suspected oral cancers from high street dentists to secondary care set at 2 weeks are currently running at 8.5 weeks in some areas
  • An access crisis in primary care: Last year the BBC found 90% of practices were not accepting new adult patients and 88% were not accepting child patients. Activity levels have only recovered to approximately 80% of pre-COVID levels. A workforce crisis is fuelling this access crisis, combined with unviable fees to dentists for providing NHS care. 60% of dentists intend to increase their amount of private work. 41% of practice owners intend to decrease their health service work. This picture is set to worsen.
  • Multi-year waiting times: We have 5-6 year waiting times for routine assessment for Oral & Maxillo-facial services; 219-312 weeks Hospital Orthodontic waiting times for patients with facial deformities; currently reliant on a surgeon from Wales to come over every two months to treat children with cleft lip and palate. Cuts could mean waiting times increasing further, and some treatments being no longer available in Northern Ireland
  • Widening Health inequalities: NI residents are twice as likely to have filled teeth as their counterparts in England, and children are three times as likely to have multiple teeth extracted under General Anaesthetic. Children in our most deprived communities are least likely to be even registered with a dentist (63% registered in most deprived areas vs 80% least deprived). Health inequalities will widen further if, as a result of reduced funding access to the full range of dental services is reduced.
  • Plummeting Morale: COVID has had an enormous impact on the dental profession. 63.6% of community dentists – treating the most vulnerable in society – say their morale is ‘low/very low’, with a key factor being the ongoing patient backlog. Existing difficulties accessing theatre space is having an impact on the vulnerable groups these dentists serve. 
  • A growing pay gap: Additional in-year funding will in effect not be available for pay uplifts here, rather it will be prioritised to settle the £297m debt. Northern Ireland has a shameful track record of delivering late pay uplifts. The possibility of no uplift would have a devastating impact on recruitment and retention and the financial sustainability of practices. In hospitals, Dental Core Trainees (DCT) have a pay gap of up to 25% compared to other UK nations. This is having a huge impact on recruitment with 9 of 22 DCT posts currently unfilled.

Michael O’Neill, Head of General Dental & Ophthalmic Services wrote to dentists on 3 May that work is ongoing to secure savings and raise revenue across health budgets.

In the absence of government, the BDA is calling on MLAs to step up, and protect the future of NHS dentistry across Northern Ireland.

Fears for future of Health Service dentistry in Northern Ireland

Dentistry in Northern Ireland has taken another blow, as the profession’s representatives have labelled as ‘totally inadequate’ new funding arrangements for General Dental Services announced by the Department of Health this evening’.

A new Rebuilding Support Scheme will see a 25% enhancement apply to dental fees, as the Financial Support Scheme to mitigate the impact of COVID on dental practices is wound up from April. BDA says what has been imposed represents a downgraded offer from a 35% increase that had previously been put forward, owing to budget uncertainties. It also compares less favourably with an initial 70% enhancement that has been introduced in Scotland.

Following the toughest two years in dental history, BDA has said hopes that the extra costs in dental practice had been grasped by the Minister and his officials, and that an expected enhancement would enable practices under financial pressure to start to rebuild the service, have been left completely shattered. Instead, practitioners have been left deeply disappointed by the Department of Health’s decision, and worried for the future of the service, particularly those practitioners who are most NHS committed.

Two years of providing care for unregistered patients, providing out of hours cover at weekends and relying on short-term funding has caused a collapse of morale within the profession. This latest scheme is another short-term stop-gap that offers practitioners little certainty, at a time when there is a crisis of confidence continuing to offer Health Service dentistry.

While the so-called Rebuilding Support Scheme (RSS) is intended to increase and incentivise activity by enhancing fees – what has been offered will make it practically impossible for health service dentists to balance their books, pay their staff, or provide a safe service.

News comes on the very day dentists gathered at Stormont to launch the BDA’s manifesto for the coming Assembly elections.

Ciara Gallagher, Chair of the Northern Ireland Dental Practice Committee (NIDPC), said: “We have told the Department and HSCB in no uncertain terms what is required to provide safe, affordable health service dentistry – but years of real-terms pay cuts, combined with the massive impact of the pandemic, and now soaring costs have brought us to crisis point.

“Health Service dentistry simply cannot continue on this downward trajectory, where what is paid bears no correlation with the actual costs to deliver the service. The latest DoH offer simply does nothing to address those real costs of delivering dental care, or provide anything by way of future certainty. Practitioners have had enough. Unless this is remedied, we are likely to face a possible exodus of dentists away from health service dentistry”.

“We were left bitterly disappointed when an initial offer of a 35% enhancement in fees was subsequently downgraded to 25%, and this despite papers from BDA outlining the crisis the sector is in, including a 40% reduction in dental earnings since 2008, costs soaring, and the continued impact of the pandemic.”

“This scheme is such that we simply cannot stand over it or support it – our members expect and deserve more. Our warnings to the Department have been clear in recent months – yet we feel strongly that our words have fallen on deaf ears.

“The profession has invested so much into ensuring NHS dentistry can emerge out of this pandemic, that patient care can continue, particularly for those who need it the most. On the very day that we urged Political Parties to commit to the rebuilding and reform of Health Service dentistry at our BDA Manifesto launch, any hopes we had that government was serious about moving forward on dentistry have been left shattered. And this short-term uncertainty will do nothing to help move new contract discussions along.  

“We provided the Department with a carefully thought-through counter offer that clearly detailed what was required for a reasoned, sustainable, safe service. We are disappointed this has been rejected, and that the Department has steam rollered ahead with its enhancements which fails to adequately reward or properly incentivise ailing practices.

“By this approach, we are left wondering if it is only the dental profession that values safeguarding NHS dental care for patients.

“In order to maintain viable businesses, dental practice owners increasingly feel they are being pushed towards private practice. They will have no alternative. Associates – who often do the bulk of health service dentistry –will increasingly be driven into private practice, because working in the Health Service means their salaries will not reflect the years of learning, the cost of living or the university fees that need repaid.

“Stress levels have soared. Morale has reached an all-time low. And we have a crisis of confidence among GDPs in Health Service dentistry having a viable future. It isn’t practitioners wanting to step away from their NHS patients, this is government pushing practitioners out. We simply cannot endorse a return back to the pre-pandemic treadmill of high volume, and low /loss-making fees with the promise of jam tomorrow.

“At the very point in time when a new package should have been about incentivising GDPs to increase Health Service treatments and get through high patient backlogs, this scheme falls flat.

“We had high hopes that our solutions-based approach to negotiations would lead to a fair outcome for both patients and practitioners. Sadly, we are left dismayed.

“Reverting back to a situation where decisions are once again based solely around DoH budgetary constraints while ignoring the financial realities practitioners are facing, is repeating the mistakes of the past. It is for the Minister and his Department to explain to the public -and the profession -how this will help move dentistry forward at this critical juncture. 

“Sadly, health service dentistry and patients in Northern Ireland are left today with nothing to smile about. More than ever, we urge all Political Parties to take action to salvage dental services now, and into the next Assembly mandate.”

Call for urgent action on financial support for dentistry in Northern Ireland

BDA Northern Ireland is calling for urgent action to ensure dedicated financial support for mixed/private-orientated and NHS practices is achieved across Northern Ireland.

In a recent letter addressed to the First Minister, Rt. Hon Arlene Foster MLA, and Deputy First Minister Michelle O’Neill, the BDA urged them to address the issue to which individual Ministers have, to date, failed to provide an adequate response, highlighting the severe financial situation facing many practices who have been unable to access wider government support measures.

The BDA states that the lack of any meaningful support for mixed/private dentistry, whose business model renders the FSS package entirely inadequate, is alarming and wholly unacceptable. The association is also pressing for additional funds to be committed to the GDS budget, and no abatement to be applied, to reflect the sky rocketing of costs.

In addition, the BDA has argued the plight of private dentistry and the case for support directly to Health Minister Robin Swann, and to Economy Minister Diane Dodds on three separate occasions: 24 March, 16 April and 8 June, and has also presented its case to the Economy Committee through its evidence to the Health Committee, as well as on repeated occasions with officials.

The responses received by the BDA are shared below:

The BDA is now calling for all its members to share their stories of how Covid-19 has affected their practices by writing to MLAs and urging them to contact the First and deputy First Minister. For more information, click here

Chair of the BDA Northern Ireland Dental Practice Committee, Richard Graham, commented: “It is not in the public interest to see mixed/private oriented practices fail. Nor are we prepared to stand for this disjointed approach, and the longer Covid-19 limits the ability of practices to generate revenue at pre-Covid-19 levels, the increasingly desperate the financial situation facing practices with a higher reliance on private earnings is becoming.

“We need a dedicated support package to be put in place for private dentistry, and additional funding is needed for the GDS that recognises the additional costs of providing services post COVID-19. We look forward to the Executive’s response to our call for urgent support.”