Left to right: Tristen Kelso, National Director BDA Northern Ireland; Darren Johnston (Chair, NI Hospital Dental Services Forum); Minister of Health Mike Nesbitt MLA; Ciara Gallagher, Chair NI Dental Practice Committee; Ann McAreavey, Chair NI Community Dentists Committee.
BDA NI Chairs and Health Minister Mike Nesbitt MLA examined these core themes.
General Dental Services
Addressing the true cost of providing care at practice level, including additional cost from imminent National Insurance and National Living Wage increases, and replacing a flawed approach to expenses were laid out in our case for reforming General Dental Services (GDS).
We emphasised that goodwill among General Dental Practitioners has run out, evidenced by the move away from Health Service (HS) dentistry underway; also, the imperative of meaningful action by the Department to address significant financial pressures on practices, and to start to rebuild confidence in HS dentistry.
The Minister pointed to the forthcoming Cost-of-Service review, which he said will be followed by negotiations; he also referred to short-term support measures for GDS in 2025-26 which the department says will help to stabilise and maintain HS dentistry. The Minister agreed to instruct officials to look at the approach to determining uplift to expenses which coincides with the Review Body on Doctors' and Dentists' Remuneration (DDRB) process.
We urged the Minister in the context of GDS 2025-26 that he acts to ringfence all underspend within the GDS budget, that it is re-invested into dentistry rather than be lost from the service, thereby maximising GDS activity and spend.
The Minister committed to ‘make it his business’ to look into issues relating to the GDS budget further. He also accepted our ask that a twin-track approach of prioritising financial sustainability of practices alongside maximising patient outcomes should drive forward GDS reform.
Community Dental Services
Our second key ask was around action to grow the Community Dental Service (CDS) workforce, a service which has lost out when compared to 16.4% growth in whole-time-equivalent of Health and Social Care (HSC) staff as a whole since 2018. This is in spite of countless recommendations in various workforce reviews and Oral Health Improvement Plans which point to the need to grow this small but vital service.
The impact of inadequate staffing being manifested by high levels of stress, low morale and high job strain among CDS dentists was emphasised to the Minister.
We asked for both a needs analysis to be undertaken to match CDS workforce capacity with existing and future pressures, and for clearer lines of accountability for how workforce growth in the CDS should practically be taken forward. We emphasised how growth of the CDS will be instrumental in helping to tackle growing oral health inequalities across the population.
Hospital Dental Services
Acknowledging the Minister’s efforts to resolve industrial action for all three Hospital Dental Services (HDS) cohorts, and his actions on DDRB to find funding to award the uplift in full, we asked the Minister to ensure a more timely implementation of DDRB recommendations going forward -which he has accepted.
Existing workforce pressures impacting on HDS staff, the need to improve working conditions to support recruitment and retention of key staff, and the importance of a joined-up approach to dental workforce planning where future workforce needs are factored in was laid out clearly.
In fact, the need to have a joined-up approach towards dental workforce planning was a key theme of the meeting.
Concluding comments
Ultimately, whether dental services in Northern Ireland will be in a better place by March 2027 - the end of this Assembly mandate - remains to be seen.
What is clear is we have pointed out the key areas where reform is needed to move Health Service dentistry forward: a GDS payment model which reflects the true cost to provide care; an enlarged CDS, adequately staffed to meet increased patient demand and to improve morale among staff; a strategic approach towards dental workforce planning; and implementation of Oral Health Improvement Plans recommendations, and all these combining to ensure HS dentistry is sustainable into the future.
Dental system reform is long overdue; we believe it should be an integral part of the Minister’s approach to wider HSC reform.
We hope this constructive meeting translates into a more informed assessment of what dentistry requires, and we soon see tangible outcomes aimed at putting Health Service dentistry across all crafts on the road to a better future.