Soaring expenses and the growing disconnect between SDR fees and the actual cost to deliver Health Service dentistry has been a major focus for us over recent months.
The 25% enhancement to SDR fees has continued into Q2 under the Rebuilding Support Scheme (RSS) but there is considerable uncertainty about what percentage enhancement will apply from Q3. What is clear is that the 25% enhancement is depended upon by many members to try and make the sums add up. Even at 25% a significant portion have opted not to apply for the RSS enhancement.
We are also seeing significant access issues across Northern Ireland as uncovered by our collaboration with
a major BBC investigation with 90% of practices not taking on new adult patients, and 88% child patients. The lack of financial incentivisation associated with taking on new NHS patients is a key factor influencing this.
How can NHS dentistry survive?
"NHS dentistry needs additional investment at this critical juncture to address patient backlogs"
NHS dentistry needs additional investment at this critical juncture to address patient backlogs, and to rebuild confidence among the profession that there is a future in offering these services under the GDS. We have been making this case to DoH vehemently on your behalf.
The key to GDS survival is maintaining interim support arrangements until a new fit-for-purpose contract can be drawn up. It's important we don't lose sight of the external environment as we aim to get our messages across:
- We are still without a functioning Executive, and as a result the budgetary situation is even more constrained
- While accepting the DDRB's 4.5% recommendation for dentists, Minister Swann has said his Department does not yet have the necessary funding in place to award what represents a below-inflation uplift
- Inflation is running well into double digits and rising.
The impact of Covid
"Soaring expenses are clearly a massive part of the context practices are struggling to operate in, but those issues are being separated out in their response."
According to the Department of Health, the RSS enhancement is based solely on ongoing COVID-related impacts, and not other factors such as rising expenses facing practices.
Soaring expenses are clearly a massive part of the context practices are struggling to operate in, but those issues are being separated out in their response. We are answering this by providing the rationale for ongoing impacts from COVID despite a return to Standard Operating Procedures.
We recognise how significant it is for you to see the continuation of RSS as close to the current 25% level as possible - while a meeting dedicated solely to expenses issues has been scheduled with the Department for 9 September.
"Our mantra is that to be sustainable, Health Service dentistry must be financially viable to deliver in its own right i.e. without being subsidised by private earnings."
Our mantra is that to be sustainable, Health Service dentistry must be financially viable to deliver in its own right i.e. without being subsidised by private earnings. We require adequate interim funding ahead of the transition towards a new contract to keep Health Service dentistry afloat, because the SDR on its own is clearly wholly unfit for purpose.
We appreciate LDCs and individual dentists for responding to our call to provide personal examples of rising expenses as well as fees that are loss-making or so derisory, they are unworkable. It's clear we have a system-wide problem that must be addressed going forward. Your evidence is being collated and will be used to make the case for maximum funding to be diverted into dentistry.
On Thursday 8 September, as the Department intends to communicate RSS arrangements ahead of Q3. The net impact of any future funding arrangements will be vital to how practitioners will assess their options, either to maintain their Health Service commitment or to look to alternative income streams.
We've reached the point where GDS remuneration under the SDR - certainly in the absence of considerable interim funding - is not fair and reasonable to deliver. It's why one of our key asks is for the Department to commission an expert third party to undertake a cost-of-service investigation (CoSI) to look at the lack of correlation between current fee values and actual cost-to-deliver HS care. Such objective evidence is key to informing a future remuneration model that can be fairly and reasonably delivered.
We want to ensure there is a future for Health Service dentistry in Northern Ireland - for the profession and for the public who rely on it. Putting forward compelling evidence to support the case for interim funding, and for specific actions on expenses is key to that.
Whatever happens with interim funding will have direct repercussions on whether we rebuild confidence among our dedicated professionals, or if confidence is damaged even further.
The next meeting of the group taking forward GDS contract reform issues will take place on Thursday 29 September. We've welcomed recent Department of Health engagement at LDC level, but we believe direct consultation with the profession at independent practitioner level is also key to uncovering current issues, and to helping inform the change that is needed.
We have asked that a 'perceptions audit' is carried out by the Department in the coming weeks to help to meet this objective, ensuring GDP voices are heard and used to inform any significant reform to the GDS contract.
While COVID put the GDS on an emergency footing, this next phase of emerging from the pandemic is no less significant, particularly as the profession grapples with new threats from double-digit inflation. Already, we have an SDR which bears little correlation with financial realities at practice-level, and we've made the case for additional investment.
We will keep you updated as the future of HS dentistry will require an adequate response from government to the challenges facing us in the coming weeks and months.
BDA Northern Ireland Director
This blog was written ahead of the RSS decision for Q3 being made public by DoH on 21 September 2022.