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It's time for radical change

​The crucial but perilous position of Health Service dentistry and contract reform in Northern Ireland.

Ciara Gallagher
Ciara Gallagher Chair of the Northern Ireland Dental Practice Committee

To fall at the last hurdle is the hardest loss to take, it does not matter that the race was good, and that your form and pace were on point, what matters is that you did not make it over the line. This was the case with the recent outcome of the Rebuilding Stakeholder Scheme.

As we look at what happened and analyse what lies ahead, it’s clear that Health Service dentistry is in a perilous position in Northern Ireland and that it is the time for radical change.

Rebuilding Stakeholder Scheme disappoints

We worked tirelessly across the months to co-produce a viable new scheme that could replace the FSS, to allow dentistry across Northern Ireland to find firm and fresh stability post-Covid, to no avail.

The Rebuilding Support Scheme (RSS) officially replaces the Financial Support Scheme (FSS) from 8 April 2022. Under the RSS the SDR will be uplifted by 25% to encourage activity and there is no threshold for receipt and no upper limit which will be a relief for those with no baseline assessment year. The conditions imposed are the same as the FSS. Weekend cover and seeing unregistered patients will continue, the most unreasonable condition of all given the meagre uplift, especially in relation to Scotland who are uplifting fees at 70%.

BDA NI simply cannot stand over the RSS.

Due to the huge disparity between what was proposed and the final outcome BDA NI simply cannot stand over the RSS. We’re grateful for the FSS, but the reality is that health service dentistry in Northern Ireland was in serious trouble long before Covid. Many dentists in NHS and mixed practice are now actively exploring options outside the NHS system. An unfortunate, but completely understandable situation, which government fiscal policy is creating.

Health Service dentistry in Northern Ireland must have a future for those patients who depend on it for care. So here, I’d like to look to the future and what’s on our agenda right now.

Contract reform is essential

As chair of the NIDPC, I’m keen that we look forward and develop a vision for the new contract. I want us to actively progress towards an outcome that works for everyone. We need to see health service dentistry safe, secure, and salvageable from the wreckage of years of underfunding and the crisis of Covid.

I think it’s all to play for, as the state of Health Service dentistry in Northern Ireland can’t get any worse.

If we are to design a new contract from scratch – in the spirit of co-production and co-design – we need to examine it from all angles. We must collaborate to identify our priorities and ensure that our new contract is built on firm foundations, endorsed by the original principles of the NHS – from cradle to grave. We must ask:

  • What will it look like for patients, for practitioners and for the public purse?
  • How do we balance prevention and necessary treatment?
  • How do we ensure that costs to provide are factored into every financial year?
  • What are the timescales?
  • What does success look like?

We are on the threshold of entering into fresh negotiations with the Department, which I’m approaching with a spirit of optimism. The stakes are high, but I think it’s all to play for, as the state of Health Service dentistry in Northern Ireland can’t get any worse.

Radical change is needed

The last time contract negotiations were initiated was six years ago – in 2016 and that went nowhere. This cannot be allowed to happen again, the future of health service dentistry depends on it. This is therefore a pivotal moment. It represents a once in a lifetime opportunity to get the new contract for health service dentistry right – not just for us, but for future generations.

Whatever the outcome, I guarantee that my committee colleagues and I will put our hearts and souls into it, for you our members, for our teams and for our patients. To help us, I encourage you to share your views and feedback via [email protected] on how best to shape, design, create this contract so that it works for all dental practitioners, and delivers oral health for all.