Go to content

700 dentists press for urgent action to save service, with authorities ‘asleep at the wheel.’

Health Service dentistry in Northern Ireland is caught in a “death spiral” without radical action, over 700 dentists have warned.

In an open letter, backed by the overwhelming majority of NI’s high street dentists, signatories warn DoH Permanent Secretary Peter May, that a combination of the looming ban on dental amalgam, paralysis at Stormont freezing health budgets and a financially unviable contractual framework could doom the service.

Northern Ireland looks set to be subject to the EU ban on dental amalgam from 1 January 2025, with practices braced for a huge hit from increased costs and time pressures from the shift to alternative materials. NHS dentistry works to a discredited high volume/low margin model, that has already seen practices delivering some treatments at a financial loss, fuelling an exodus to the private sector.

In this unprecedented call to arms, signatories say the financial situation facing HS dentistry is now unsustainable, and that continued inaction by authorities is no longer an option. They say officials must urgently follow the lead of the Scottish Government, who rolled out wide ranging changes to a similar contractual framework in November. They stress the Department of Health needs to reinvest the significant underspend projected for this year’s dental budget to aid struggling practices, who are unable to deliver pre-pandemic levels of activity. The BDA understand that spend on HS dentistry will be more than £10m below ‘normal’ levels, not because of any lack of demand, but because of capacity issues at struggling practices.

Text of the Open letter to DoH Perm Sec Peter May to be delivered by BDA NI on Tuesday 30 January 2024 at 11am at Castle Buildings, to be received by a senior DoH official:

For more information regarding the delivery contact Tristen Kelso on 07793 957218.


Dear Peter

We, the undersigned General Dental Practitioners feel compelled to write at this time, to ask: What is the Department of Health’s plan to ensure Health Service dentistry has a future?

Despite clear evidence and repeated warnings issued by the British Dental Association about the death spiral Health Service dentistry in Northern Ireland appears to be in, we have seen inaction from the authorities.

Vital public services are at stake. Livelihoods hang in the balance. We ask that you are transparent with us, and with the patients who rely on our services.

Scotland has recently moved to reform dental payments. Meanwhile, your Department has so far failed to bring forward any serious proposals to put dental services on a sustainable financial footing.

We now have an underspend projected for this year’s dental budget. Not because of any lack of demand from patients, but because struggling practices need support to deliver. DoH has failed to commit to reinvest this underspend into stabilising a service which is on the brink.

The imminent ban on dental amalgam represents an existential threat to NHS dentistry. In Strasbourg, MEPs backed amendments calling on member states to support practices with the added costs of alternative materials, and to reduce the clear impact this will have on the patients who need us most.

We require the Department to do no less.

Our signatures are testament to the intolerable pressure which this service is under. We cannot go on as we are. We need your Department to show leadership and take action now.

Evidence shows that the move away from Health Service dentistry is well and truly underway. In the continued absence of payment reform proposals, colleagues will be increasingly driven out of Health Service dentistry to keep their practices afloat.

We are passionate about maintaining a future for Health Service dentistry, and we want to continue providing access to these vital services for our patients.

But this now hinges on you acting, urgently in the public interest, and investing to stabilise and reform the service. Continued inaction will result in significant detriment to the provision of this vital public service. We cannot wait on if, or when, politicians decide they want to restore a devolved Assembly and Executive.

This isn’t a matter of the Department finally delivering a late pay rise this year. We need to know what you intend to do to fix the crumbling foundations this service is built on.

Please share your plan for Health Service dentistry with the profession, and the public.