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Mind the gap: NHS dentistry faces continued uncertainty

As funding continues to fail to keep up with costs, practices have been forced to reduce their NHS capacity and faith in the future of NHS dentistry is a rapidly diminishing resource.

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

The gap between the reality of running a practice and the fees provided by our underfunded, outdated contract is widening and NHS dentistry is rapidly losing talented practitioners.

We know where we are now and where we need to be. We know that the danger for businesses, their practitioners and the patients depending on their care is the space in between, which is filled with uncertainty. Successful businesses do not run on uncertainties.

Unsurprisingly, there is no news on our journey towards contract reform and there are no breakthroughs to report. We remain in a hiatus where the lack of government and the budgetary deficiencies are stalling meaningful progress and interim solutions.

Cold comfort from the Department of Health

We met with Chief Dental Officer (CDO), Caroline Lappin, and the Head of Dental Policy, Michael O'Neill, on 24 July. The Department of Health (DoH) officials fully recognise the dire situation facing General Dental Services (GDS) in Northern Ireland, and genuinely want to see progress happen. However, their hands are tied by unyielding purse strings. This can feel like cold comfort, but at least we have reached a mutual understanding of the current issues.

We will continue our dialogue into the autumn, pending political developments. A meeting with the Permanent Secretary has been confirmed for 10 November 2023. Following the July meeting, I sent a letter to the DoH, detailing our views on the budgetary constraints, the 2023-24 underspend, the lack of any measure of or uplift of 'cost of care' (formerly known as 'expenses') for 2023-24, and activity now that the Rebuilding Support Scheme (RSS) has ended.

The undeniable reality

During our meeting in July, the DoH asked if the Northern Ireland Dental Practice Committee (NIDPC) had any suggestions on what could be done to help ease the current access crisis and stem the exodus, in a cost neutral framework. As per NIDPC feedback, I responded by stating that no, this is not possible in the current budget. I elaborated that certain fees needed to go up by 200%, while for others 10-15% might suffice.

NHS practitioners knows that they cannot mitigate rising costs with more NHS work.

To be 'cost neutral' any fee enhancements would have had to come from capitation and continuing care and to disturb the cap and cons balance would come with significant consequences. Especially since the cap and cons already covers elements such as exams and radiographs for children, dressings, prescriptions, new denture adjustments, and reviews.

In the past, practice owners worked harder in response to a reducing bank balance. Now even the most dedicated of NHS practitioners knows that they cannot mitigate rising costs with more NHS work. This means that capacity will not increase, and access will not improve under the current fee level and funding model.

The undeniable reality is that NHS fees are now completely out of sync with the cost of care. To continue to care for NHS patients, NHS dentists need hope, and hope costs money. The DoH needs to face this sooner rather than later, indeed for many it is already too late.

The DDRB report is on our side

Our focus is on reforming and recalibrating the GDS payment system, and we will continue to press the DoH over the coming months. NHS dentistry must move forward - as clearly outlined by The Doctors and Dentists Review Body (DDRB) 51st report, supported by our evidence.

The DDRB report published in July accepted much of our evidence, including that: 'contractual models everywhere across the UK are no longer capable of providing a stable and sustainable basis for the delivery of widely accessible NHS/HSC dental services' and the need for 'fundamental contract reform'. In respect to expenses, the report accepted the failure by all governments to uplift the expenses element in a way that, 'should be sufficient for the full value of our recommendations to be reflected in earnings for NHS/HSC work done by providing performer and associated dentists at typical dental practices'.

The report notes the DoH NI's position that there was no capacity to afford a pay uplift in 2023-24 with concern, which they estimate would add £40m to the overall pay bill. The DDRB report is also critical of the unacceptable delays in implementing pay awards in Northern Ireland each year. They expect pay uplifts to be made in a timely fashion and to see progress towards a defined formulaic approach, which reflects the actual cost to provide care, before next year's report. We need the Department to commit and prioritise contract reform. Most notably they must deliver GDS payment reform, and a robust model based on the real costs of providing modern dental care

Looking ahead

It is clear from the latest report by the DDRB that the onus is very clearly on governments to act. We will continue to press for action on the DDRB recommendations, urgent payment reform, and progress on a cost of care analysis being taken forward, regardless of having an Assembly or not.

On Friday 20 October 2023 we are holding our 'Life beyond the SDR' seminar in Templepatrick, Northern Ireland. The event is aimed at empowering practitioners to take control of their professional development and informs you on how to transition to the business model best suited to your practice. We support dentists in all fields of practice, and we aim to ensure the profession is as up to date as possible on the latest developments in GDS contract reform.