Richard Graham outlines the concerns we’re raising regarding financial support, fallow time and PPE on behalf of dentists in Northern Ireland.
With last week’s publication of the SDCEP report on aerosol generating procedures (AGPs) in dentistry and impending deadlines regarding financial support, we are working hard to ensure that policymakers understand the potential implications of reduced fallow times. We’re also seeking to ensure that Health Service, mixed, and wholly private dental practitioners receive the financial support they need.
Extension of Financial Support Scheme required
We have made it very clear to the Department of Health that the intolerable financial uncertainty currently surrounding the financial support scheme cannot continue. The Department must extend the current Financial Support Scheme (FSS) for at least another month.
"Without additional financial support many mixed practices are finding it difficult to continue."
The closing date for the October Schedule is very close. Indeed, practices submitting paper claims are already conducting dental activity without any certainty on what financial support will be available in the October-November payment period. The Northern Ireland Dental Practice Committee (NIDPC) and the Department of Health continue to negotiate on Post-October GDS COVID financial support.
With regards to private practices, we continue to put pressure on the Department of Health and Department for the Economy to provide financial support for the private component of mixed dental practices. We are well aware that private practice has supported Health Service dentistry for many years and without additional financial support many mixed practices are finding it difficult to continue to provide Health Service treatment to their patients.
The potential impact of reduced fallow time
The current sense of uncertainty has been heightened by the possible financial implications of recommendations on fallow time in the recent
SDCEP review of AGPs in dentistry. The hour-long fallow period associated with each AGP has been one of the biggest bones of contention in dentistry since the outbreak of the coronavirus pandemic and has resulted in severe repercussions for public health and dental practice finances.
The SDCEP report makes a series of recommendations which could result in fallow time being reduced to as little as 10 minutes if a treatment room features an air change per hour rate of at least ten. Even if a treatment room does not have the necessary ventilation, the use of high-volume suction could reduce fallow time to 20 minutes.
"Fallow time reduction is not a silver bullet and access issues will continue."
What this report means in practice for the profession is dependent on the final guidance from the Chief Dental Officer. If the recommendations are taken on board, lower fallow times will have a transformative impact on dental capacity and the population's oral health. However, it’s vitally important that activity expectations are not pushed too high. Both policymakers and the public need to understand that the fallow time reduction is not a silver bullet and access issues will continue for some time.
Increased activity will mean higher PPE costs
The physical impact of Level 2 PPE, and the continued disinfection requirements, places a significant restriction on the number of AGPs that a dental practice can undertake in a day. Long-term this will mean a significant restriction on the amount of dentistry that can be undertaken in a given day which will have serious ramifications for the whole profession – GDS, CDS, HDS – for a long time to come.
Our immediate concern is the impact a reduced fallow time will have on Health Service funding. At present the Department compensates GDPs for the increased PPE costs associated with AGPs by removing the abatement from the FSS. Their position is that as dental activity rates are very low, the reduction in variable material/lab bill costs cancels out the increased PPE costs.
"Without this additional funding, GDPs will not be able to substantially increase the number of Health Service AGP treatments."
We know this is not the case. According to our recent activity survey, 72% of respondents cited PPE costs as a key inhibitor to increasing activity and 75% believed that the removal of the abatement did not cover the costs of providing AGP treatments on the Health Service.
There is now concern about what happens when lower fallow time restrictions result in higher activity rates – which in turn results in higher variable material/lab bill costs and higher PPE costs. The funding model will fall apart in these circumstances, unless further funding is made available to cover the increased PPE costs. Without this additional funding, GDPs will not be able to substantially increase the number of Health Service AGP treatments they currently provide.
Looking ahead
Over the coming days and weeks, we will continue to work hard to ensure that policymakers understand the potential implications of reduced fallow times. We’ll also seek to ensure that Health Service, mixed, and wholly private dental practitioners receive the financial support they need to continue to treat patients during this pandemic.
Richard Graham
Chair of the Northern Ireland Dental Practice Committee
