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Reviewing a rollercoaster year

This year, we have worked to ensure that everyone has a voice within our profession, while acknowledging our different approaches, and presenting with a united front and a unified message.

Ciara Gallagher
Ciara Gallagher Chair, Northern Ireland Dental Practice Committee

A challenging year

As we reach the end of a difficult year, I am reminded of an old saying, 'The more things change the more they stay the same'. If only that was the case for dentistry, after a year of petitions, presentations, papers, research, endless evidence, and multiple meetings, we have somehow ended up in a worse position than this time last year, but we will continue to fight for the profession.

In what must be seen as a small victory, we have at least ensured a place for dentistry at the top of a very full healthcare agenda. is available to students if they are struggling.

The economic downturn has blown a hole in all healthcare budgets, but for dentistry, rising costs and disproportionately low fees means that we are feeling the pressure more than most. The sense of togetherness borne from the pandemic has been replaced by a sense of impending doom. 

In what must be seen as a small victory, we have at least ensured a place for dentistry at the top of a very full healthcare agenda, making a strong case for the rebuilding support scheme (RSS), gaining some minor uplifts, and achieving a temporary slowing in the relentless demise of NHS dentistry.

The year that was

The revenue grant scheme was welcome news early in 2022. Following requests from the NI Dental Practice Committee Rebuilding Stakeholder Group, I acknowledge the considerable efforts of the dental strategic planning and performance group to ensure that this £5m was retained in dentistry and made available to GDS. 

March marked the launch of our manifesto at Stormont, attended and supported by MLAs from all political parties and Department of Health officials. In the aftermath of the launch, the department announced that contrary to its initial proposal and despite a huge body of evidence, the uplift to Item of Service fees was to be downgraded from 35% to 25% as we moved from the financial support scheme (FSS) to the activity-based RSS.

The announcement of this inadequate figure was made just after the manifesto launch media coverage had finished. A cynical person would suggest that this timing was calculated to attract minimal media attention, dentistry having just had its place in the spotlight. Having presented compelling arguments and evidence which was ignored, we elected to walk away from the rebuilding stakeholders' group - 25% was simply not enough.

Evidencing the mounting costs

In April, the dental practice committee considered the shortcomings of the RSS and the framework for engaging in new contract negotiations. The key asks were for transparency of the NI health budget; an acknowledgement that the Department understands the true cost of delivering Health Service dentistry; an acceptance of the causes of low morale within NHS dentistry and an understanding of the harsh reality of practicing GDS in Northern Ireland.

April also saw our negotiators and representatives giving evidence on the inadequacy of recent pay uplifts, soaring expenses and lack of mechanisms to deal with dental inflation. A huge amount of work went on behind the scenes to research, collate and present compelling evidence.

Early May saw the NI Assembly elections. In a strange parallel to our own stalled progress, there was no Executive, no functioning Assembly, and no sign of a solution. In May, our contract reform group met with Department representatives about the need to recognise the actual cost to provide health service dentistry with a detailed 'cost of service investigation'. Our current contract dates back to 1991 – a different era. Piecemeal rises in funding have failed to keep pace with technological and legislative changes.

Mounting concerns for the future

June began with no Assembly in place, a caretaker Health Minister with limited functions and Health Service dentistry in crisis. We met with the new Permanent Secretary at the Department, Peter May. In preparation for this meeting, we constructed the most comprehensive spreadsheet yet, complete with Item of Service (IoS) fees, approximate times taken for procedures and operating costs per surgery per day along with allowances to give a true picture of the shocking inadequacy of IOS fees. We made the dire state of NHS dentistry and the need for funding that was proportional to costs to deliver care very clear.

Dentistry was on every news outlet throughout the UK, with unprecedented media coverage.

We also met with MLAs who tabled numerous written Assembly Questions to the Health Minister on our behalf.  However, without a functioning Assembly and Health Committee, the capacity for action was reduced. Following this, summer saw the release of a major BBC investigation into dental access issues. Dentistry was on every news outlet throughout the UK, with unprecedented media coverage. When the media calls, timing is everything and a very memorable moment from this coverage was doing an interview with BBC Radio Ulster from a stairwell in Athens Airport in the middle of my family holiday!

In July, the pay review body's 50th report recommended a 4.5% uplift. The report placed responsibility for calculation of expenses firmly with the Department of Health (DoH), stating clearly that the Government must ensure the financial sustainability of practices. In August, the DoH sounded out our views on reducing the RSS from 25% to 10%. We made it clear that this would be unacceptable, suggesting instead a tapered approach starting at 20%, which was completely ignored, and the department went ahead reducing the RSS uplift to 10%.

Supporting members

In September, the Dental Practice Committee met for discussions on how to deal with the 'there is no more money' mantra. This mantra has become a staple feature of all our meetings with the Department. We also discussed how to accelerate the current snail's pace progress of contract reform and support colleagues to reduce dependence on the NHS. This tied in well with the BDA's CEO presenting the new three-year strategy for the organisation which includes focussing on ways to support members who choosing to increase the provision of private dentistry.

In October I was invited to the Western LDC to attend a meeting where we discussed options to reduce the provision of the loss-making NHS portion of our dental businesses to ensure financial viability. In presenting the spreadsheet we had supplied to the Department in the summer showing the true cost of delivering NHS dentistry, I stressed that we should not lose sight of the fact that we are independent contractors and that we need to exercise this independence and ultimately control our own destiny. 

As caretaker ministers stepped down on 27 October, with departmental permanent secretaries taking the reins, the 25% increase in dentures fees, a commitment to honour the pay review body's percentage recommendation and an increase in the prior approval limit were very minor wins.

The end of an uncertain year

In November it was announced that not only would the increase in SDR fees take zero account of soaring costs to provide care, but there was also an altered and downgraded approach to calculating expenses which changed the already inadequate anticipated 5.38% to 4.5%. This marks a death knell for NHS dentistry and a devastating blow for patients and practitioners alike. I wrote to the Permanent Secretary to express my alarm at this new and completely unevidenced approach and received a reply devoid of hope for dentistry for the foreseeable future.

I am not afraid to say that I take great pride in our profession and all that we do.

We know that the health service budget is under the most stress in its entire history, but to simply cite lack of money as a mantra, while taking away our ability to look after our vulnerable, is to refuse to see what is before our very eyes. It has become impossible under the NHS to care for those who need our care the most and retain a viable business. At present, contract reform negotiations are on hold until the New Year.

I am not afraid to say that I take great pride in our profession and all that we do. We are leaders, managers, businesspeople, compliance officers, stock controllers and many other things besides. Dentistry is a specialty and dentists must be valued for their role both in terms of their position in wider healthcare and for the unique skills they have. The Dental Practice Committee exists to represent all dentists, in NHS or private dentistry. One of our roles is to negotiate with the Department on the terms and conditions of NHS dentistry. The current terms are untenable and neither acknowledge or adequately remunerate our skills and the pace of change is glacial. For the sake of our NHS patients and on behalf of our profession, we will always present ourselves at the negotiating table, however 2023 will see a change in our approach. Whilst negotiating the contract to continue to care for patients under the NHS, we aim to source ways of actively helping those who choose to increase the provision of private dentistry.

It has been a difficult year; I thank my committee colleagues who have worked tirelessly on your behalf. We may be in different boats but we're all in the same storm. We are stronger together.

I hope for a peaceful and happy Christmas for you, your teams and your families and a New Year of positive change, both individually and collectively.

[1] NHS Digital Dental Earnings and Expenses 2021 – BDA Analysis shows that 'Associate dentists have seen their pay fall in real terms by 36% since 2008/9, and by 43% for practice owners.'

[2] BDA Paper to DoH NI 2022

[3] BDA Survey 2021