Almost a month has passed since the landmark report commissioned by the Department of Health (DoH) confirmed a massive 60% funding gap between what Government is currently paying dentists to provide Health Service dentistry, and the £145 hourly figure the evidence shows is needed.
It is the clearest evidence-based explanation yet of how the data is translating into the most rapid shift away from NHS dentistry anywhere in these islands.
This exodus, and the funding gap at its core is being recognised right across Northern Ireland - whether you measure it by the dramatic fall of patients registered, in much reduced health service activity, or in political terms; the high volume of MLAs submitting Assembly questions of the Health Minister week-on-week on the access issues being experienced by their constituents.
We are seeing strong political interest in our issues - which is why since the report was published we have spoken at political party conference events, briefed MLAs and councillors, and engaged with the Assembly Health Committee on the urgency of dental payment reform - while meetings with officials and the Minister are in the diary.
However, fine words or interest will not pay the bills. That requires a tangible shift in the funding being received by practitioners to provide care under the GDS model.
Now that the evidence is in the public domain, we have been clear that we need to see urgent dental payment reform - including a fee-rebasing exercise - taking place immediately, informed by Cost-of-Service findings.
The starting point must be to pay dentists at the recognised rate for each and every aspect of Health Service dentistry our Government chooses to commission going forward; if there is a funding shortfall within DoH or at an Executive level, then it is for DoH and the Executive to own those decisions and, ‘cut its cloth’ accordingly.
Cost of Service confirms that continuing to impose that cost burden on to the profession comes with direct and damaging consequences.
Over recent weeks we have been engaging extensively with a range of key stakeholders to try to progress payment reform. Days after the report was published, our NI Dental Practice Committee engaged directly with Queen’s University Belfast Health Economist Professor Ciaran O’Neill who carried out the Cost-of-Service report, and Martina Moore, Director of Primary Care at DoH on the key findings of the report and on the next steps from the DoH respectively.
We have also engaged directly with the Assembly Health Committee.
Read our letter to the Assembly Health Committee.
We impressed upon the Permanent Secretary the obligation on him and his Department to act with immediacy if this service is to be put on a financially viable footing.
Read our letter to Mike Farrar, Permanent Secretary.
Over recent weeks we have heard MLAs describe the reality of what is happening in Health Service dentistry. This is no longer a service ‘in crisis’, but a service undergoing ‘collapse’.
Health Service dentistry requires urgent and meaningful intervention.
And we have also raised our concerns at the length of time it may take to complete a payment reform exercise, even if this work is completed as planned ahead of a wider public consultation being launched next spring before the end of this Assembly mandate. Every day that passes is a day longer that this service is being underpaid, and that is not a tolerable position.
We will be meeting with DoH officials and the Minister in relation to payment reform in the weeks ahead.
As well as closing the untenable funding gap, payment reform must ensure we never get to this position again in the future. That is why we need to see the introduction of an Index of Dental Costs recommended by the Review Body on Doctors’ and Dentists’ Remuneration which measures and mitigates against inflationary cost increases at practice level on a regular basis.
Extra investment in GDS is clearly required; but reverting to what was previously the DoH default position where payment reform cannot be taken forward due to the position of public finances would be irrational, it would be a deliberate choice to ignore the evidence and would represent the death-knell of this vital service.
Cost of Service is clear: the starting point to payment reform must be to apply the true cost which the data shows practices and practitioners need to be paid to deliver Health Service dentistry.
It will be for DoH to work back from that according to the total financial envelope allocated to dentistry. Ultimately, DoH now needs to determine how it will ‘cut its cloth’, and what future shape General Dental Services in Northern Ireland will take.