Amalgam Reprieve
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- Published: Monday, 22 July 2024 09:26
- Written by Peter Ingle
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Concerns about an impending ban on the use of mercury containing amalgam in dentistry have been particularly pressing in Northern Ireland. NHS dentistry there has been having at least as difficult a time as in any of the other four nations, with the familiar challenges of inadequate funding and access problems.
Superimposed upon this, the different post Brexit status of Northern Ireland has led to fears that the approaching loss of amalgam as a restorative option, would deal the final blow to NHS dentistry there.
To deal with the unique problems of a land based UK and EU border, the Windsor Framework was negotiated and came into effect in October 2023. As a result Northern Ireland (NI) remains subject to some EU rules. One result was that it appeared that dental amalgam could not be used in NI after 31 December 2024. The imminent loss of a low cost and familiar material led to dire warnings from NI dentists and their BDA representatives.
In survey evidence presented to Stormont’s Windsor Framework Democratic Scrutiny Committee in March, the BDA warned that 92% of dentists were on track to reduce the amount of NHS activity at their practice in the event of a ban. 92% said it would increase costs for NHS activity at their practice, with 91% reporting this would impact on higher needs patients seen at their practice. As a consequence 88% said that it would lead to their practices reducing or ending their NHS commitments.
To the relief of all parties, provision for a 10-year derogation has now been announced. It is subject to specific conditions being met, including the UK taking the necessary measures to make regular and consistent progress towards phasing down amalgam. Under the new terms Amalgam will not be banned until the end of 2034 or the date agreed under the Minamata Convention on Mercury, whichever is sooner.
Announcing the new agreement, the BDA recognised the considerable efforts made to secure the derogation, not just by the dental profession, but from Department of Health officials working extensively with the UK Cabinet Office, and in their engagement with the European Union. However, it stressed that concerted action is needed from both the Stormont and UK Governments to ensure a seamless transition to an amalgam-free service.
Ciara Gallagher, Chair of the British Dental Association’s Northern Ireland Dental Practice Committee, said: “A ban on dental amalgam in 2025 could have spelled the end for NHS dentistry in Northern Ireland. We sounded the alarm and fought tooth and nail for a workable solution. This delay is a glimmer of hope for a service that’s on its knees and could not have shouldered any further financial pressure.”
She made it clear though, that this alone would not be enough to ensure the survival of NHS dental care: “We have some breathing space, but Stormont and Westminster cannot take their feet off the pedal to affect a seamless transition to amalgam-free dentistry. Any progress will require reform, investment, and concerted action on deep oral health inequalities. When the plug is finally pulled on amalgam, Northern Ireland will need to have a healthier population and a more sustainable service. Otherwise this 10 year derogation is a mere stay of execution for NHS dentistry.”
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