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Health Service dentistry ‘has run out of road’

Update on BDA NI meeting with Peter May, DoH Permanent Secretary

Meeting with Department of Health (DoH) in Northern Ireland

In November, we held a further meeting with the Department of Health (DoH) to discuss the worsening outlook for Health Service dentistry, and a range of workforce issues heavily impacting the profession.

The meeting took place as hospital dental trainees and consultants prepare to ballot on industrial action over pay; Within the Community Dental Service, dentists report feeling increasingly overworked, underpaid, and underappreciated in a progressively pressured working environment; Meanwhile, in the General Dental Service (GDS), the shift from health service dentistry into private work, linked to an unviable remuneration model, is thoroughly underway and set to escalate in 2024.

Other issues raised include the progression of dental workforce planning, noting the Workforce Review Day which took place in September, amalgam phase-out, and the application of the outstanding pay uplift recommended by the Doctors’ and Dentists’ Review Body (DDRB) for 2023-24.

The meeting was respectful, yet forthright. The DoH Permanent Secretary, Peter May, listened to the current substantial pressures impacting heavily across the entire dental workforce, as relayed by our committee Chairs. He also received our latest assessment on how the situation facing Health Service dentistry in NI has worsened considerably since our last meeting in June, particularly for the most Health Service committed GDPs.

We made it clear to Peter May that Health Service dentistry has run out of road.

We have recently seen what has been necessary in Scotland to stabilise a similar service to our own. While the Permanent Secretary expressed his wish to see dentists here paid at parity with their colleagues in GB, he said he is not in a position to proceed with dental payment/contract reform at this time, not least because of the wider Budget situation and the absence of an NI Executive.

Clearly, inaction as the GDS contract is failing so spectacularly is a major cause for concern.

We may yet see some progress in the margins, such as a revised PUPAS scheme, and perhaps even some movement on a pay award, but nothing of the scale that is so urgently required to recalibrate fees to a level that makes the service financially viable -or which addresses the pay disparities and pay erosion impacting on dentistry right across HSC.

Health Service committed practitioners’ exposure to ever increasing costs to provide care was laid bare in the Chancellor’s Autumn Statement, which provided for a 10% increase to the National Living Wage from April. In the absence of any mechanism by DoH to ascertain and mitigate rising costs required to provide HS care on an annual basis, the current GDS model becomes increasingly unsustainable.

That is why we have subsequently formally written to Peter May, asking him what process his department will put in place to achieve the objective outlined by the DDRB -the independent pay review body -to mitigate practice expenses/operating costs in a way that does not erode any recommended pay uplift.

This issue goes to the heart of whether the Department is able to shore up a dental service in Northern Ireland that is financially sustainable.