The Northern Ireland Hospital Dental Services Forum (NI HDSF) works tirelessly to improve the terms and conditions for our hospital dental workforce and to improve the service that we can provide for our patients. Darren Johnston outlines the recent work the Forum has been doing.
Critical specialist shortages, and waiting lists
A lack of certain specialists means we are unable to provide a complete service and it can lead to more unnecessary expense and delays in providing patient care.
Dental and Maxillofacial Radiologists
Northern Ireland is the only UK region that does not have direct access to a Dental and Maxillofacial Radiologist (DMFR). This results in an inequity of service and resources for the population and places dental clinicians at a significant disadvantage when providing care for their patient cohort.
In terms of hospital dentistry, two Trusts have an ad hoc arrangement to obtain reports from a DMFR in England while the other Trusts and indeed all General Dental Practitioners do not even have this indirect access.
NI HDS Forum has highlighted this issue with the NI Department of Health, which has resulted in the appointment of a Leadership Fellow who will complete a needs assessment for a DMFR service. I recently also wrote to the Regional Medical Imaging Board regarding this issue too.
Regional Cleft Orthodontist
Northern Ireland is the only UK region that does not have a dedicated Regional Cleft Orthodontist, to advise on and treat children with cleft lip and palate. A region with Northern Ireland’s population should have a cleft orthodontist with at least eight sessions per week dedicated to providing this service. Until recently we had funding for only two sessions but earlier this year we managed to increase this to four. NI HDSF will continue to lobby for further funding so that we can provide a service that is on a par with other regions.
Maxillofacial surgeons
Maxillofacial surgeons have a very long training pathway, and while they are in short supply across the UK, this is especially the case in Northern Ireland. This greatly impacts the service that can be provided for patients. Waiting times for assessment are in excess of five years in some units and orthognathic patients often have to wait two to three years for their actual surgery after completion of pre-surgical orthodontics. Recruitment and retention of these highly trained surgeons is difficult.
Loss of existing senior staff
We have observed a concerning pattern of senior staff exodus from hospital dentistry in Northern Ireland. In fact, over the last two years around 12 of my colleagues from various specialties have left their posts. Some have moved to the private sector or have gone to work in the Republic of Ireland where remuneration is significantly higher than in the UK. It is not all about income, as some have moved to jobs in Great Britain, while others have simply taken early retirement.
Some staff feel that they are unable to provide the level of care that they want to for their patients. The “moral injury” from working in a broken system is clearly taking its toll, and those left behind have to pick up the pieces and take on extra work.
Service delivery gaps, and the pathways we need
Patients undergoing cardiac surgery or cancer treatments need to be made dentally fit prior treatment to reduce the risk of post-treatment complications. However, many patients in Northern Ireland are now unable to obtain access to an NHS dentist in a timely manner. This puts additional pressure on already struggling Hospital and Community Dental Services. Dentistry is only as strong as its weakest link.
Northern Ireland has one dental school in Belfast where patients have access to most dental specialties. However, travel to Belfast from rural areas can be difficult, especially if multiple or regular appointments are necessary. Regional Restorative, Paediatric and Special Care Dentistry Consultants are required to provide care in district general hospital sites as occurs with hospital orthodontics.
Northern Ireland does not have any managed clinical networks. There is a lack of joined-up thinking; we need better lines of communication between high street, community and hospital dentists.
The NI HDS Forum’s work highlighting workforce planning issues
In February I was part of a BDA delegation which met with the health minister, Mike Nesbitt at Stormont where we raised many of the issues that currently affect dentistry in Northern Ireland. I specifically mentioned the problem of retention and recruitment of hospital dental staff; that it requires a significant amount of time, funding and resources to train dental consultants and even more so for maxillofacial consultants; it is a travesty when these individuals feel that they can no longer work in the NHS in Northern Ireland.
During my twenty years as a consultant I have observed how the dental workforce has significantly changed both in terms of gender balance, and the number of staff working part-time. Workforce planning is key, but unfortunately sadly lacking in Northern Ireland.
The last review of consultant led Hospital Dental Services was undertaken 15 years ago, and remains unpublished. There has not been a body in place to undertake HDS workforce planning and to determine projected needs since the Hospital Services Sub-Committee of the Central Dental Advisory Committee (CDAC) was stood down in 2009.
Looking forward
This summer, the HDS Forum invited Michael Donaldson, Head of Dental Services at the Northern Ireland Strategic Planning and Performance Group to speak to the Forum in relation to workforce planning. Michael gave us a valuable insight and advised us on the how the Forum could try to improve matters.
Subsequently, in September, we wrote to Phil Rodgers, Director of Workforce Policy at the Department of Health to raise our issues, and asking to open a dialogue on how we can make progress. We also requested that CDAC be reactivated.
Pay uplift not delivered - yet
Earlier this year the Review Body for Doctors’ and Dentists’ Remuneration recommended a 4% pay uplift for 2025-26. Colleagues in England and Scotland received this over the summer, but it remains unpaid in Northern Ireland. While the NI Health Minister has committed to paying this uplift, he has indicated that further funding would be required from the Northern Ireland Executive.
BDA continues to lobby for this year’s pay uplift to be implemented in full as soon as possible.
Making Northern Ireland attractive for resident dentists, and expanding training programmes
Northern Ireland has funding for 22 Dental Core Trainee (DCT) posts but this year the Northern Ireland Medical and Dental Training Agency were unable to fill a number of these posts. This is concerning, because if we cannot attract young dentists to hospital posts we will struggle to train the specialists and consultants of the future. Additional specialist training posts may make Northern Ireland more attractive to DCTs, but we also need to retain sufficient capacity of senior hospital dental staff to be able to provide the training for these young dentists.
Currently, we have a system at risk of collapse where not enough young dentists are coming in, and experienced consultants are leaving.
What we want to see
The 2025-26 pay uplift needs to be paid immediately so that hospital dental staff in Northern Ireland are paid the same as their colleagues in Great Britain.
Northern Ireland needs meaningful dental workforce planning for Hospital Dental Services. Our HDS workforce needs to grow according to existing and future needs.
We are hopeful that progress can be made, and one significant first step would be to put in place the infrastructure to take a strategic approach towards workforce and service needs - such as the reinstatement of the Central Dental Advisory Committee. We must consider the needs of the entire dental system, with HDS a core part of the mix.
Finally, the local support from BDA Northern Ireland is fantastic. I am confident we can continue to make important progress.