Following liaison with our Northern Ireland committees we were in a position to produce a succinct yet robust response, having scrutinised aspects of the consultation which raised our concerns. This was particularly in respect of General Dental Services (GDS) and the potential for unintended consequences.
Originally, the framework for safe and effective staffing was solely in respect of nursing and midwifery, but was subsequently expanded to include all health and social care disciplines in Northern Ireland, including dentistry.
This proposed legislation places a statutory duty on the Department, trusts and arms-length bodies regarding workforce planning including, but not restricted to, the Department of Health (DoH), health and social care trusts, organisations providing a service on behalf of the health and social care trusts, the Public Health Agency, and the Regulation and Quality Improvement Authority (RQIA).
For salaried dentists in community and hospital services, we could in principle agree with the proposals in the consultation, which would place full responsibility on statutory employers for effective workforce planning, reporting, accountability, and governance.
Workforce planning for dentistry and dental services
Adequate workforce planning has been severely lacking in recent years, resulting in services and staff being under increasing pressure as a direct result of inadequate staffing complements.
We have pointed out these omissions in workforce planning multiple times over many years, including in successive Doctors’ and Dentists’ Review Body submissions.
A new legal requirement placed upon the DoH to apply evidence-based strategic workforce planning will avoid delay and inaction in discharging their workforce planning responsibilities, in particular to smaller sectors of the workforce such as dentistry.
It is helpful that the legislative proposals set out the functions the DoH have around strategic workforce planning, taking a pre-emptive, forward-looking approach to dentistry’s specific workforce needs instead of reacting from a position of immense difficulty.
We also called for workforce planning at an operational level. We asked that this new duty create an imperative to proactively identify workforce gaps at trust level; effectively, it is such gaps that add to the significant pressure and negative impact on morale which is very apparent at this time.
We wrote that “There must also be opportunities for trusts and the Department to come together on operational and strategic workforce plans, particularly where there may be overlap, such as specialty posts at regional level”.
Workforce Reviews
The Workforce Review for Dental Services in Northern Ireland was carried out in 2018 but the report was only finally published in July 2023. Recommendations are still to be taken forward despite considerable efforts from our side for workforce gaps to be addressed.
In principle, we are supportive of the proposed 10-year formalised workforce reviews on the grounds of full accountability. However, concerns remain that this may not work adequately for small regional and dental specialities. Our position was that such an approach would not be flexible, nimble, or as close to "real time" as required.
General Dental Services
Further detailed scrutiny and reassurance was required here. Before responding to the consultation, our own representatives and those from our committees met with the safe and effective staffing consultation team at the Department to ask specific questions. We needed reassurances and clarification that GDS would not be adversely impacted.
We were concerned initially regarding some terminology which could impact GDS. Could GDS fall within the “independent sector”, or “organisations providing a service on behalf of Health and Social Care (HSC) Trusts”? Alternatively, could it fall within “those wishing to provide services on behalf of the HSC Trusts” or “providers of HSC services”?
In respect of GDS, we questioned if additional burdens would fall upon small dental practices in Northern Ireland, where the vast majority (80%) of dental services are carried out by “independent contractors working within General Dental Services.”
Our response stated “At a time when dental practices are under considerable pressure to deliver Health Service dental care, and when we have considerable access issues because the Health Service contract model is failing, any additional bureaucratic requirements, particularly where disproportionately applied, could have a significant impact.”
A duty is already placed upon General Dental Practices, namely that “there are, at all times, suitably qualified, competent and experienced persons working in the service in such numbers as are appropriate for the health and welfare of service users”, under indicator S1 'Is care safe?' as outlined within the RQIA Provider Guidance for Dental Practices.
No new duties should be placed upon dental practices or practitioners contracted to provide dental services within GDS. Existing requirements inspected by the RQIA should suffice for these purposes, and we were assured that would remain without change.
What next?
We support the overall approach of introducing new legislative duties on the DoH and HSC Trusts or employers aimed at strengthening workforce reviews, workforce planning, implementation, and reporting. Particularly for smaller professions like dentistry, strengthening the onus upon government to discharge its functions to staffing after years of delay, and when colleagues are under immense pressure, is welcome.
We certainly welcome the statutory requirement upon the DoH to consult with trade unions and professional bodies when considering the development of common staffing methods, including where this may be considered for dentistry. The very different operating environments across the range of dental services; the GDS, Community Dental Services and Hospital Dental Services would need to be factored in to this work in co-production with the profession.
In addition to the different areas of professional staff groups, consideration must be given to the different settings in which staff operate, ranging from salaried colleagues working in community and hospital settings, to those who provide General Dental Services as independent contractors. Roles vary considerably, and as such this will have an impact on whatever calculation methods or tools are developed.
We re-emphasised the importance of engaging with staff, including placing a statutory proposal on the DoH to consult with professional bodies and trade unions in relation to all conversations aimed at taking forward the development of a common staffing calculation method or tool.
We voiced our discontent that we were not included along with other trade unions in the pre-consultation engagement phase that led to the development of these new legislative proposals. However, we do trust that we will be an integral part of all future discussions, particularly where aspects of safe and effective staffing within dentistry are concerned.
We raised particular concerns regarding extending the scope of legal duties beyond statutory providers, such as to independent contractors. For dentistry, we are firmly of the view that existing safe staffing obligations inspected by the RQIA are sufficient, and no additional burdens should be placed on struggling practices.
Alongside this safe and effective staffing legislation, adequate funding must be found to effect meaningful improvement to the considerable staffing issues we currently see across dental services. We trust this legislation will ensure much needed progress is made to stopping workforce issues being swept under the carpet.