Our lobbying work intensified in the face of an inadequate budget and the absence of a functioning Assembly and Executive. We engaged directly with the political parties and Department of Health (DoH) on the major challenges within dentistry, such as the need for General Dental Service (GDS) payment reform against soaring costs and a failing contract model, on dental workforce issues, the need for an updated Oral Health strategy, and on the unfair pay issues impacting on our salaried colleagues.
And we’ve sought to blow out of the water any previous notion that dentistry is not a political priority. Our issues were elevated at the behest of the political parties in their monthly meetings with the Permanent Secretary; and areas of dental reform also featured in the high-level multi-party talks between the parties and the UK Government in December.
Our open letter to the Permanent Secretary highlighted the significant pressures across all dental services, and our online campaign and subsequent meetings with Peter May were instrumental in securing progress on several key areas –including a Dental Workforce Review, the publication of Oral Health Improvement Plans, as well as a commitment to review Hospital Dental Service Trainee pay points. The DoH also committed to looking closely at the GDS reforms in Scotland as a starting point to emulate in Northern Ireland -subject to funding and ministerial approval.
Uplifts and DDRB evidence
In March, the newly uplifted Statement of Dental Remuneration was confirmed, applying +4.5% on fees and expenses. Following this, an additional 25% enhancement to denture fees was announced and an increased Prior Approval Limit to £380. This followed extensive efforts by the Northern Ireland Dental Practice Committee (NIDPC) evidencing increased costs to deliver care.
Our Doctors’ and Dentists’ Review Body (DDRB) evidence this year focused on the inadequate mechanisms to account for the increased costs of delivering NHS dentistry. Ciara Gallagher presented oral evidence in March alongside our Review Body and Evidence Committee Chair Peter Crooks, and the 51st DDRB Report recommended a 6% uplift.
Our evidence of the systemic deficiencies impacting on all aspects of Health Service (HS) dentistry landed squarely with the pay review body, who in turn were highly critical of the Government’s approach for failing to mitigate for rising expenses. Their 51st Report reads as a blueprint for what governments need to do to fix NHS dentistry - to progress contract reform, invest in our workforce, and implement timely pay uplifts.
Your NIDPC representatives presented robust evidence in favour of maintaining interim funding after the money that was available during COVID dried up. However, budgetary pressures caused the DoH to reduce the Rebuilding Support Scheme uplift from 25% to 10% with effect for Q3 and Q4. In March, a letter to all GDPs confirmed the 10% enhancement to Item of Service (IoS) fees would continue until the end of Q1 23/24 with a further review to be carried out. The 10% enhancement was ultimately withdrawn following the setting of a standstill Northern Ireland budget at the end of June.
Highlighting the issues
The unviable nature of HS dental remuneration was at the forefront this year, with detrimental impacts on dental practices and patient access. Your BDA representatives stepped up to share the reality of the issues impacting across dentistry; stories featured on television, radio and online outlets highlighting the situation and drawing on practice-level figures to illustrate the difficulties of delivering NHS care.
We took part in a BDA timings study, observed by the DoH, establishing evidence of the time involved in completing various clinical treatments, the labour costs, and lab fees. This will provide an evidence base to support future contract reform across the whole of the UK.
We wrote to the GDC highlighting the impact of hygienist registration delays on dental practices. In the absence of a hygienist training provision, applying an ‘overseas’ process to applicants is having a disproportionate impact when practices are already facing a shortage of hygienists.
Significant progress has been made to improve the representation of hospital dentists in Northern Ireland. Our newly established Northern Ireland Hospital Dental Services Forum has helped push for much-needed progress on fair pay. This year, we put the spotlight on Dental Core Trainee (DCT) pay disparity, resulting in the landing page for DCT National Recruitment being modified with a salary warning, and a direction to our website for further pay information where we have published a table comparing DCT salaries across the UK nations to make the pay differential more transparent at the outset.
With our support, Educational Supervisors (ES) achieved the retention of the block grant funding model, rather than reverting to the IoS method. This followed a survey showing that 90% of ESs would withdraw from supervising if the block grant was not retained. This request, backed up with strong supportive evidence, resulted in the block grant funding model continuing for the 2023/24 Dental Foundation Training Scheme year.
We continue to review and develop the support we offer to private practices as one of the five priorities of our new strategy. Our updated advice pages provide support to members who are considering a change in business model by moving into mixed or private practice.
Supporting each other at events
Alongside the BMA, we held a face-to-face engagement session with Hospital Dental Trainees to gather feedback in July. This event resulted in your views being shared with the Permanent Secretary on pay issues and trainee morale.
And we broke new ground by pioneering our Life beyond the SDR: the Business of dentistry event which took place in October. This was a combined response from Branch, NIDPC, the BDA NI office, and working with expert colleagues from right across the BDA in equipping and empowering practitioners with essential business skills and offering professional development. It was a positive response in light of the challenges of working within a failing HS business model, showing that practitioners do have options to look at doing things differently according to their own circumstances. This was a particularly positive event with excellent delegate feedback.
The CDS Group hosted an Annual Study Day, covering a wide range of topics from the treatment of diabetic and bariatric patients, to bringing awareness of restorative dental material available. Almost half of all CDS dentists in Northern Ireland attended, and the feedback was overwhelmingly positive, with opportunities for networking and learning.
Our Northern Ireland Branch excelled under the Presidency of Philip McLorinan this year, hosting a sell-out Centenary Gala Ball at Belfast City Hall in October, celebrating 100 years since the branch’s inception. The event was an invaluable opportunity to support colleagues and meet new people, with City Hall illuminated in BDA blue. And we continued to see strong attendance at Branch CPD events over the course of 2023, and the profession re-connecting after the disruption of COVID.
What is ahead in 2024?
Immense challenges remain to move forward on dental reform in the year ahead. We will be starting the new year balloting our Dental Trainees and Consultants on industrial action over pay.
Having convinced DoH of the need to move forward on a Dental Workforce Review and updating our Oral Health Strategy, we will be looking to see important progress in the year ahead, and we will be prioritising GDS dental payment reform to stabilise HS dentistry here.
The year has demonstrated that we are here for all our crafts - CDS, GDS, and HDS - as well as for those who choose to provide NHS care, or private dentistry. We will endeavour to fight for better terms and conditions for HS dentistry practitioners, at the same time as demonstrating leadership to support those who want to diversify into more mixed/private earnings. We will be relevant to the needs of the profession and will continue to represent these at the highest levels and throughout the services we offer.
And we look forward to seeing you at more events in 2024, the Great Hall at Queens University will be the venue for the 2024 Presidential Installation Dinner on 26 January, where Professor Gerry McKenna will be installed as President. And it’s fitting that Prof. McKenna has identified developing closer links between BDA Northern Ireland and the QUB School of Dentistry, encouraging students to get involved by attending our events in his Presidential year.
An end of year review can only be a snapshot of what is done on your behalf. Regardless of the external pressures, we are committed to supporting you in moving forward in 2024 - with professional development, terms and conditions, and in seizing new opportunities to move your businesses forward. We look forward in confidence to 2024, building on the firm foundations laid in 2023.