On Thursday 22nd January we met with Health Minister Mike Nesbitt to discuss the key issues facing dentistry.
GDS dental payment reform
Presenting the Minister with stark patient de-registration figures and practitioner testimonies pointing to how untenable the GDS funding model has become, we have invited him to ‘grasp the nettle’ on progressing dental payment reform at pace.
We have said the Department of Health (DoH) must be realistic about what dental care it can afford to commission, and to prioritise its spend accordingly. While the menu of items may need to reduce, each and every item of dentistry commissioned by DoH must be properly costed and paid for at practice level, informed by Cost-of-Service review findings.
It must be financially sustainable to deliver for mixed and heavily NHS committed practices.
This is not about reducing care, ultimately it is about saving a core element of NHS dentistry.
The alternative, in our view, is the end of Health Service dentistry on the high street.
DoH has agreed to establish a working group ahead of Cost-of-Service reporting to the Minister in March. For our part, dental payment reform and a shift to a realistic, honest payment model must be expedited.
Uplift payment delays
We also discussed the wholly unacceptable delays in processing payments to GDPs. The Business Services Organisation have recently advised that the Review Body on Doctors’ and Dentists’ Remuneration 2025-26 uplift arrears to GDPs will not be completed until June/July - which is a further wait of four or five months compared with salaried colleagues, who will receive their 2025-26 uplifts in February.
This clearly goes against the spirit of ensuring pay uplifts would be received in February pay, expressed by the Minister and reiterated by us throughout this process. Indeed, DoH is planning to issue 2026-27 uplifts to Health and Social Care (HSC) staff by June this year.
We have expressed our deep concern at what we consider to be unreasonable and impactful delays in getting monies owed to GDPs. Having raised this matter directly with the Minister, we will continue to press for an approach which meets fair and reasonable payment timeframes.
Workforce planning
The absence of workforce planning for the dental workforce - in particular the Community Dental Service (CDS) and Hospital Dental Service (HDS) - was another important issue raised.
In particular, the lack of clarity about where responsibility and accountability lie for taking forward workforce plans, within DoH.
We took the opportunity to present the Minister with of our CDS Workforce Roundtable Report which comprehensively captures the full range of core issues impacting on our CDS workforce.
Read the CDS Workforce Roundtable Report.
We also highlighted the absence of a reply from Phil Rodgers, Director of Workforce Policy to a letter from our HDS Forum highlighting key workforce gaps and seeking a way forward to progress these.
Read the letter from our HDS forum.
There was agreement these issues need to be progressed by DoH, and that both a bottom-up and top-down approach is required. There was a real sense of concern that there are no five to10 year dental workforce plans in existence.
Overregulation
We also highlighted the overregulation that exists towards dental practices in Northern Ireland, citing the blanket approach to Health Technical Memorandum (HTM) 03-01 and new dental surgeries as an example, and the inappropriate and unhelpful designation of dental practices as ‘independent hospitals’.
This is another area where we appealed for reform.
‘In a rush’
This was a crucial face-to-face meeting between the chairs of our NI committees and the Health Minister, as the enormity of the crisis in the GDS is unfolding in such stark terms. We have witnessed the biggest drop in patient registrations in a generation as practices can no longer recruit or afford to continue to deliver NHS care; also, at a time when a range of factors, not least a failure to grow headcount is impacting so acutely on our salaried dental workforce.
The DoH budget position for the year ahead is grim as a £200m deficit is carried over from last year; we are facing the prospect of less money and cuts to HSC, not additional funding.
And yet, it is precisely in that difficult context that a pragmatic way forward must be found, one which can deliver financial stability to practices which continue to provide HS care, at the same time as preserving a core element of such an important public service.
The Minister has said he is, ‘in a rush’ to make significant change within the Health Service over the next 13 months; that is precisely the pace needed to put Health Service dentistry on a sustainable footing.