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The road to rebuilding NHS dentistry

New Chair of the Northern Ireland Dental Practice Committee, Ciara Gallagher, tells us about the work being done to reform and secure the future of NHS dentistry.

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

On 21 January this year, I was both delighted and humbled to be elected Chair of the Northern Ireland Dental Practice Committee (NIDPC) for the next triennium (2022-25). The NIDPC is comprised of passionate and dedicated practitioners at every stage in their career and is one of the hardest working and resilient committees within the BDA.

The Committee officially meets three times a year, however given the extremely fluid circumstances its work is ongoing on a daily basis. The committee is divided into sub-groups to better progress key issues and is in constant communication both with the team at the BDA NI office and through them regularly meeting with Department of Health officials, arms-length bodies and of course, the Northern Ireland Assembly, Health Committee, political parties and MLAs.

The past few years have been an unprecedented era in the history of general dental services in Northern Ireland, with persistent, ever evolving and complex challenges impacting us in a way that could not have been anticipated prior to the beginning of 2020.

As a practice owner, I am all too aware of the spectrum of issues that face the profession, so I wanted to outline for you the work we’re doing, the broad direction of travel and where progress is being made. This work includes 'here and now' issues as we emerge from a global pandemic and rebuild services, and the work to reform and secure the future of NHS dentistry with a new contract.

Revenue Grant Scheme

You will recently have been made aware that the Department announced a £5 million Revenue Grant Scheme for dental practices to help upgrade and make improvements. Having requested this in a recent submission to the department, BDA NI welcomes the scheme as an important, tangible benefit to GDS.

There is a lot of work and negotiations behind the scenes to bring such schemes to fruition, both in the department and in the BDA, and we acknowledge and welcome this much needed support.

Financial Support Scheme

A lifeline and a safety net for practices providing NHS dentistry, the Financial Support Scheme has helped see GDS through the various lockdowns and extremely difficult working conditions and we are grateful for that.

The new financial year will see changes come into place where remuneration is more closely linked to activity.

Ciara Gallagher

Chair of the Northern Ireland Dental Practice Committee

You will have received Michael O'Neill's letter via GDS Correspondence on 7 January indicating that the FSS will soon come to an end. Activity thresholds have been kept under review, and the new financial year from 1 April will see changes come into place where remuneration is more closely linked to activity. This new Rebuilding Support Scheme is intended to help practices as IPC relaxes, community transmissions decrease, and patient throughput increases.

Rebuilding Support Scheme

We would support a move towards activity-based payments, stepping away from the Baseline Assessment Year calculations thus allowing new entrants to the GDS the opportunity to be remunerated according to their activity rather than an arbitrary baseline. It will in effect be a proportional payment without thresholds or targets.

These activity-based payments should take into consideration the backdrop of current and future IPC guidelines, necessary reduced patient throughput, staff absences due to Covid and the ongoing need for weekend cover and are aimed at rebuilding and reforming health service dentistry.

The BDA continues to input to proposals to ensure that although practice revenues will be related to activity, they also can remain stable. Our GDS Rebuilding Stakeholder Group meets monthly to discuss developments, input to solutions, address any difficulties and to source and agree tangible, workable solutions.

Moving from a top-up system to an activity-based system carries difficulties such as straddling claims, approval delays, potential surges in forms and so on – but by identifying these issues in advance we will do our best to smooth this necessary transition.

It is not a return to normal; it is a rebuilding of the current situation, in parallel with discussions regarding reform.

New contract negotiations

In parallel with the Rebuilding Stakeholders Group, the NIDPC New Contract group will be progressing vital negotiations towards a brand new GDS contract. This as you know, is long overdue for Northern Ireland and if we are to secure the future for health service dentistry, we need to get this right from the outset.

We all know how much is at stake and I can confirm that NIDPC and its sub-groups will be working tirelessly behind the scenes, often into the small hours – to do everything we can to help government get it right for the full profession – for practice owners, for associates, for dental nurses, for our non-clinical staff and most of all, for our patients.

Near future

From April there will be a transition from the FSS to the Rebuilding Support Scheme. We have asked for at least a month's notice, full transparency, a comprehensive list of FAQs, advice on straddling claims and much more to enable practices to prepare. It is currently in the hands of the Department, awaiting Ministerial sign off for the proposal and the necessary funding bid. I hope that we will have a workable, beneficial solution to announce in the near future.

One thing is sure, we cannot return to the underfunded treadmill with all its adverse consequences.

Ciara Gallagher

Chair of the Northern Ireland Dental Practice Committee

One thing is sure, we cannot return to the underfunded treadmill with all its adverse consequences. We hope that the proposed activity-based enhancement system would lead into the newly reformed GDS with a new contract and additional funding.

We continue to work closely with our new Chief Dental Officer at the Department, Caroline Lappin, her team, and officials at the HSCB and BSO. There are many challenges ahead – re-establishing out of hours services, incentivising emergency care of unregistered patients, schemes to encourage registration of children and hard-to-reach groupings.

It has been a gruelling two years – our surveys show that morale has plummeted and the mental, physical and emotional health of the profession and our staff have been impacted in more ways than we can evaluate right now.

However, looking to the future, I am confident that there are brighter days ahead – that we can get high street, health service dentistry back on an even keel. Our simple aim is for us to be able to do the job we are trained to do, with contemporary materials in a modern environment where finances are no barrier to patients accessing quality care. A pipe dream? Maybe. An aspiration? Definitely.

If I can be of any help, or if you would like to share your views on the rebuilding and reform programme, or what our new contract could look like please do not hesitate to contact me via the Northern Ireland Office – [email protected]