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Published: Thursday, 20 June 2024 06:50

Written by Peter Ingle

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A recent BBC report used biblical language in a story about NHS dentistry in Northern Ireland. This was not a report on sectarian disputes, but about dentistry, and the terms felt appropriate were of an ‘exodus’ that was ‘coming to pass’. The group seeking freedom from oppression on this occasion, are dentists with NHS contracts. Indeed so many wish to leave the scheme that there is now a waiting list for would be leavers and their soon-to-be former patients. 

Giving evidence to Stormont’s health committee on Thursday, Ciara Gallagher Chair of the Northern Ireland Dental Practice Committee explained how a formula designed to increase pay has actually decreased it. Ms Gallagher said NHS work is down by 30%, describing practices queuing to "unshackle" themselves from the NHS.

The BBC described her as being scathing of the actions of the Department of Health towards the sector, and saying that there had been a complete breakdown in trust.

She explained that most dentists were small businesses who had no power over setting fees and were given little government help. "These fees are set by the Department of Health, who neither know, or have taken any meaningful steps to find out, the true costs to provide dental care," she said.

"Our lived experience has been one of denial, prevarication, lip-service and more recently broken promises," said Ms Gallagher.

Writing for the BDA, with the headline, “Northern Ireland: Planning to leave NHS dentistry? Form an orderly queue,” Ms Gallagher set out the background to what may be the end game for NHS dentistry there.

She described the eventual promise of £9.2 million in selective fee enhancements, made in January 2024 as “crumbs.” While believing the Minister when he said that it was all his department could afford, practice spreadsheets did not lie and it was much too little, way too late. Nor had any of the agreed funding yet been delivered to practices.

Even a promised uplift for 2024 -2025 had been subjected to the Department’s sleight of hand.

A torturous calculation allowed Minister Swann to state that he had ‘implemented the recommended pay uplift of 6%’. This, Dr Gallagher wrote was, “a disingenuous statement.” The DoH interpretation had not been in keeping with either the spirit or the actual wording of the DDRB recommendations.

Dentists were stepping away from a system which exploited the bond they have with their NHS patients. NHS dentistry was being subsidised by private revenue, and the Department had come to expect cheap dentistry. Dr Gallagher expressed the revolutionary view, at least in the world of NHS dentistry, that “the time had come to run our businesses as businesses should be run, where revenue exceeds costs for each and every treatment we provide.”

The exodus was now underway, with 22% less NHS dentistry done last year. Nearly 90% of dentists state that that they intended to do less NHS dentistry going forward. Almost half have said that they expect to go fully private.

One consequence of the shift from the NHS is that the volume of WCA966, NI deregistration forms, being submitted in recent months has grown to the extent that a deregistration spreadsheet had to be created to help process them all. The BSO electronic portal is ‘inundated’ with requests for these forms to the point that there is a wait. So, advised Dr Gallagher: “If you are planning to reduce or leave NHS dentistry then form an orderly queue.”

Looking to those practices and patients that could not go private, there was a possible solution. Dr Gallagher’s proposal may not be welcomed by career politicians: “If the DoH want to have a service then they must ‘cut their coat according to their cloth’. And they must do this quickly.”

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