Northern Ireland: dentists demoralised and undervalued

A dentist has told her MLAs she is ready to quit NHS dentistry but worries about the impact on her patients.

After providing NHS treatment to my patients for the last 36 years, I now feel totally demoralised and undervalued. I have written to my MLAs to call for urgent support for NHS dentistry in Northern Ireland.

I hope you will write to your MLAs too – and tell them our service is facing collapse.

The fees have barely increased over the last 20 years whereas the cost of providing the service has rocketed. The high cost of wages, laboratory fees, materials and utility bills now far exceed the NHS fees for certain treatments.

Patients are regularly shocked when they find out how little they are being charged for NHS treatments such as extractions and dentures. A difficult extraction can take anything from 30 minutes to an hour to complete and the patient charge is little more than £13. The dentist earns 45% of the fee and after tax, this is ridiculously low.

Patients in peril

It is heart-breaking for me to hear stories of patients who cannot find an NHS dentist to take them on and cannot afford private fees. I can't believe how this is happening in the UK in 2023.

I had a conversation with one of my dental colleagues in practice yesterday who was extremely upset after a stressful day in which she saw many emergency patients for absolutely zero fees as there are no NHS fees claimable for certain emergency treatments.

This is one of many young dentists who will more than likely end up moving to a private practice where they will be properly remunerated for their time and will not be forced to work on the treadmill of NHS dentistry.

I fear for my patients as the practice has been trying to recruit NHS dentists for the last 12 months with no success. I am now contemplating retirement due to my low morale and the feeling that I am effectively carrying out charity work for my patients.

I had hoped to carry on looking after my lovely NHS patients for another few years, but I just can't continue in the current system.

Who is going to look after these patients?

A service facing collapse I took my NHS pension in February 2023 under a 24-hour retirement scheme and continued to work. Little did I know that the Seniority Pay which is payable to NHS dentists over the age of 55 was no longer payable to me after taking my pension. This was another "kick in the teeth" to me after serving the NHS almost exclusively for 36 years. I thought the government was encouraging retired health service staff to return to the workplace, clearly not in the case of dentistry.

If the axe falls on dentistry - indeed if there is a failure to provide desperately needed investment - this service faces collapse. The price will be paid by patients across Northern Ireland.

No prevention and no cure

The crisis on the high street is having knock-on effects in our hospitals. Red flag referrals for suspected oral cancers from general dental practitioners to secondary care are set at two weeks. They are now running at 8.5, and we know early detection can save lives. A workforce crisis is fuelling an access crisis. Most colleagues now have plans to increase the amount of private work they undertake. All of this is hardly surprising; high street dentists face skyrocketing costs and the reality of delivering NHS dentistry at a loss. No healthcare professional should ever be in that position.

An exodus is in motion

Morale is on the floor. Clearly Northern Ireland cannot have NHS dentistry without NHS dentists, but the exodus is set to grow. We are now on track to be the only part of the UK unable to deliver pay uplifts. That will have devastating impacts on recruitment and retention in every part of dentistry.

It will only hasten the move to a three-tier system, where those who can't get registered for NHS care but can't afford to pay privately are left with no routine access, short of accessing emergency services. This is a disaster for the oral health of your constituents.

I’ve asked my MLAs to tell the Permanent Secretary that any cuts in dentistry are the wrong cure – if nothing is done, dentists will vote with their feet. An exodus is in motion.

I urge you to do the same and please take the time to write to your MLAs now and explain that the circumstances we are working under cannot continue. It is time for action.

Anonymous