Last Thursday, Ciara Gallagher, Chair of the Northern Ireland Dental Practice Committee (NIDPC) and I met with Minister Nesbitt on the Cost-of-Service Report and discussed next steps for General Dental Services (GDS) in relation to payment reform.
The meeting focused on the accepted financial pressures at practice level in delivering a service which is so considerably under-remunerated. Alongside this, finding a way forward which pays dentists at the accepted rate determined by Professor O’Neill’s findings, and in the context of dire public finances was a key challenge.
It seemed to us that the minister was accepting of the need for urgency in acting on Cost-of-Service findings over the coming months. We discussed not only publication of this Report, but the plan which would accompany it to rebase fees according to Cost-of-Service hourly rate findings. The whole purpose of this report being commissioned was that a fee rebasing exercise would follow, informed by the Report’s findings.
If additional public funding is constrained, then we consider the onus is on the Department of Health (DoH) and Finance to decide how they will cut their cloth accordingly. Practically speaking, they need to determine the total financial envelope they choose to make available to dentistry, and, applying Cost-of-Service findings, work with the profession to rebase fees accordingly.
We are adamant that work must take place over the coming months, beginning from September.
Our representatives have invested significant time and energy engaging with this Minister on the array of issues impacting on the entire profession. In turn, we recognise that Mike Nesbitt has given dentistry considerably more airtime than any of his predecessors. This is not to airbrush that we have also witnessed the largest shift away from Health Service dentistry during his tenure; the cumulative effect of years of underinvestment.
Increasingly, Minister Nesbitt ‘got’ our issues and a sense of the crisis; he ended previous DoH denial about fees being adequate; and, crucially, he bought into the need for real urgency to find a meaningful solution working with us, which would put GDS back on a sustainable footing.
A sustainable GDS is not just imperative to Health Service committed practices, but also to addressing the pressures impacting across our salaried services. It is about paying properly and fairly to recruit and retain practitioners to provide care under the Health Service, addressing the access issues and oral health inequalities stemming from an unstable and shrinking GDS.
It may also be about prioritisation of how DoH wants to spend a finite budget, but that they pay practitioners at the accepted market rate.
The Cost-of-Service Report will provide an objective expert evidence-base for taking dental payment reform forward. Alongside this, consideration of an Index of Dental Costs would prevent future dental inflation and cost increases undermining dental remuneration - the very thing which caused the unfolding crisis over the course of many years.
We believe the promise of real and timely progress on payment reform starting in the coming weeks was given by Minister Nesbitt; it is absolutely critical that despite the personnel change, this work must be taken forward at earnest in what is left of the Assembly mandate.