The future of NHS dentistry in Northern Ireland "hangs in the balance" as years of tighter margins and punishing schedules has forced many into the private sector, it has been claimed.
It follows concerns raised by a Stormont MLA that the dentists’ NHS exodus is leaving a mass of patients without care.
Scores of constituents have contacted the office of Independent East Derry MLA Claire Sugden after being unable to find any available dentists to treat them. Of the few who still carried out work for the NHS, no dentists were taking on new patients.
Read more: NI dental patients left in limbo after sudden closure of practices
“The fact is that people literally have nowhere else to turn. Many have tried every dentist for perhaps a 20-mile radius and none have been able to take them on,” Ms Sugden said.
“This applies to people in all sorts of situations – children, the elderly, patients born abroad who are registering for the first time, pregnant women. Many of these people are particularly vulnerable to poor dental health. Pregnancy, for instance, can lead to increased risks of gum disease and cavities, and looking after children’s teeth and ensuring good dental hygiene is of course essential.
“Everyone needs access to timely NHS dentistry, but when people in even higher risk groups don’t have this then you know the situation has become extremely serious. The prospect of the entire privatisation of dentistry gets closer with every dentist who has to turn away an NHS patient. This would be a disaster for everyone on a low to middle income.
“With people already being forced to choose between paying for life’s essentials such as food and heating, there can be no doubt that a widespread deterioration of the country’s dental hygiene would result from even greater, or complete, privatisation.
“The consequences would not just be the occasional missed cavity or untreated gum disease. Related, and much more serious conditions, such as cancers of the head and neck are routinely screened for, and often first detected by, dentists.
“Missing these would be devastating for individuals and create even greater knock-on pressures for our wider health system.”
Ms Sugden said the large-scale abandonment of health service work by dentists had been inevitable but the warnings had gone unheeded.
“I have been urging Northern Ireland’s health ministers for years to secure the future of health service dentistry by adequately funding it,” continued Ms Sugden. “In the absence of a current minister I have directed these appeals to those currently with power in the Department of Health.
“What we are seeing now is the accumulation of all these years of a chipping away of health service dentistry. No-one within the department can say there were no warnings, and no-one should still be ignoring them.
“It is deeply concerning that despite these warnings nothing has been done. It is a tragedy – and a cruel one at that – that the service has been run down to the point where it effectively doesn’t exist for some people.
“I retain some hope that all is not lost and that steps can be taken to rescue this essential part of our health service. But these steps must be significant. They must be taken now, and must be taken with or without a functioning Executive or Assembly, because, sadly, that is the situation we are in.”
Ciara Gallagher, Chair of the British Dental Association’s Northern Ireland Dental Practice Committee has warned that the future of NHS dentistry here hangs in the balance.
She said: “No health professional can be expected to deliver care at a loss. Years of underinvestment and a failure to acknowledge the costs of care, means that this has become the reality for many dentists working under a broken system.
“The future of NHS dentistry in Northern Ireland hangs in the balance. It will take realistic investment and reform to bring this service back from the brink.”
In a statement, a DoH spokesperson said the coronavirus pandemic has had a significant impact on general dental services, with reduced activity, and therefore capacity, across the industry. However they add that there has been considerable improvement in the last 12 months with overall activity increasing from 60% in January 2022 to 84% in January 2023 when compared with the equivalent month prior to the pandemic.
They added: "To sustain practices throughout the pandemic, the Department has provided significant and unprecedented financial support, with approximately £88m being invested to stabilise the cash flow position for health service dentists during the pandemic and to increase levels of health service activity.
"Continuing support is currently available to dentists through the Rebuilding Support Scheme (RSS) that provides eligible practitioners with a 10% enhancement on fees for health service treatments completed. This is in addition to any general pay and expenses uplifts. Combined with the 2022/23 uplift, this will see GDPs receiving 20.2% more per item of service than they were receiving in early 2020, before the pandemic.
"For the past seven years, recommendations on rates of pay for dentists (by the Doctor and Dentist Remuneration Review Body) have been implemented in full in Northern Ireland. Dental expenses have also been uplifted in each of these seven years. The 2022/23 pay uplift and expenses uplift is currently being implemented and will be backdated to April 2022.
"There has also been £6.5m investment in the past two years via the Revenue Grant Schemes. This funding has supported practices in investing in new technologies, such as improved ventilation, digital connectivity and enhancements to practice premises to increase patient throughput and reduce the impact of infection control measures."
According to the DoH, the period 2021/22 saw more invested in dental services than ever before.
"To help address the access issue, the Department commenced a pilot in October 2022 throughout Northern Ireland to provide access to non-registered patients who are experiencing an emergency or urgent dental condition. This will help ensure that irrespective of a patients’ registration status, appropriate treatment is available," the spokesperson added.
"Additional support can be obtained at Emergency Dental Clinics, where the patient will be triaged remotely and appropriate advice given or treatment arranged. These clinics, which provide emergency dental care at weekends and public holidays, are helping to ensure that those patients who need treatment the most are receiving it, despite the ongoing capacity challenges.
"Whilst the Department recognises the challenges that dental practices will be experiencing due to the cost of living increases, the pressures facing the Department’s budget are also considerable and without precedent, leading to difficult financial decisions having to be made to align funding with key priorities.
"The 2022/23 budget provided by the Secretary of State has effectively included funding brought forward from the 23/24 financial year, leading to consequences in the coming years, and it is clear that there will not be funding for all we want or need to do.
"The sustainability of the dental contract is a key objective of the Department and we will continue to monitor dental activity, remuneration and engage with the British Dental Association in the coming months on GDS reform."
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