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Northern Ireland: Financial support and the road ahead

Blog Author Richard Graham

Blog Date 23/06/2021

Taking a look at financial support measures, future prospects for dentistry in Northern Ireland and how far we’ve come in the last 15 months.

When the pandemic closed dental practices last March, I don't think that anyone thought we would still be so badly affected 15 months on. Dental practitioners are still severely restricted in the amount of work they can do and our teams are still working under extreme physical and mental stress. So, what’s on the road ahead?

Changes to financial support

Following intensive negotiations, the Financial Support Scheme was put in place last year. There are over 365 practices and over 1000 individual dentists working within the General Dental Services, so no 'one size fits all' scheme could ever work for everyone. The Department of Health and Social Care didn't have the staff needed to provide a formal appeals process from the start. This was eventually somewhat mitigated by their agreement to look at exceptional circumstances through the GDS correspondence e-mail address. But this scheme continues now with only minor alterations.

“We have made clear to the Department that financial support funding must be in place for the rest of the financial year.”

The further we get from the baseline assessment year of 2019/20, the less appropriate the current Financial Support Scheme is. As practices increase their activity levels, the costs of Level 2 PPE are still prohibitive and are becoming a barrier to the levels of treatment possible. There are also associates changing practices, dentists retiring and dentists building up lists. The Department also feel that some dentists with low activity levels are being unfairly rewarded at the expense of those with higher activity levels, and wish to change the Financial Support Scheme to more closely reflect the activity being carried out.

We have made clear to the Department that financial support funding must be in place for the rest of the financial year to give practices some much needed financial certainty and allow them to plan more than one month, or a quarter at a time. Imperfect as it is, practitioners are by now used to the current Financial Support Scheme and are making it work. It should be possible to tweak this without introducing the added stress of an entirely new system.

There must be an opportunity for individual practitioners to challenge any unintended unfairness in the system. The Department has to recognise that all costs have gone up, not just PPE, and they must be accounted for in any amendments to the support scheme. Activity targets must remain low over the summer due to the uncertainty over the delta variant, and to allow practitioners the opportunity to take some much-needed time off for a holiday without the fear of missing an unachievable target.

A win for prevention?

“A ‘pile it high, sell it cheap’ business model is not fit for purpose within healthcare.”

The only good thing about this pandemic for the profession is the fact that it has highlighted just how inappropriate the present contract had become. A contract that counts widgets of activity with a ‘pile it high, sell it cheap’ business model is not fit for purpose within healthcare. A contract based on prevention is needed for our population to drag NHS dentistry into the 21st century.

After tireless campaigning, we’re pleased to see the Department is now in agreement with the BDA on this, and the Minister for Health has agreed to set up a new formal ‘GDS Rebuilding Stakeholder Group’ looking at the rebuilding of the GDS. We will keep you up to date on progress made, but in the meantime it is vital that you all engage with your representatives through your local LDCs. We need your input to help design a new contract that is good for dentists, improves the oral health of our patients and provides the Government value for money.

We know just how stressful dentistry has become, due to the burden of wearing of level 2 PPE and the loss of the out-of-hours services. That’s why, we’ve called on the four chief dental officers to provide us with a road-map out of the enhanced cross infection control measures that are putting such a strain on dental teams. With new figures showing over three million fewer treatments delivered since April 2020 in Northern Ireland, we’re also campaigning for a resolution to this crisis in patient care.

Looking back

I have always been proud to be a dentist, but never so much as over the last 15 months. I have nothing but admiration for all of you. At the start of the pandemic, you donated PPE and oxygen to care homes, hospitals and local pharmacies even though practices had been shut and there was uncertainty over whether financial support would be forthcoming. That PPE was a lot more expensive when it had to be replaced.

“You all have my admiration and my thanks.”

You volunteered to work in urgent care centres and other areas of the health service which were well outside of your comfort zones. We were the first part of the UK to have these urgent care centres up and running to provide care for our patients, and the community service has to be thanked for their work in putting this together. You have continued to look after your patients under the most challenging of circumstances. You all have my admiration and my thanks.

BDA staff and all of your representatives from the LDCs and on Dental Practice Committee meanwhile have had more meetings in the last year than the last ten years put together. They have worked tirelessly on your behalf, and continue to do so, to ensure practices and individual practitioners have the support and stability needed to get through this crisis.

I must thank BDA staff locally for going above and beyond the call of duty. Tristen, Laura and Iain have taken calls and answered e-mails at all times of the day and night. They have also fought hard to make sure the voice of dentistry was heard in the midst of the clamour from every other part of the health service asking for extra support.

Richard Graham

Richard Graham
Chair of Northern Ireland Dental Practice Committee