Latest fall in dental earnings must serve as wake-up call to avoid collapse of Health Service dentistry

The British Dental Association (BDA) Northern Ireland has warned new data confirming the continued collapse in pay among Health Service (HS) dentists could jeopardise the recovery of the service as it emerges from the covid pandemic.  
 
Taxable income for all average self-employed dentists in Northern Ireland fell from £68,000 in 2018/19 to £65,100 in 2019/20. Associate dentists have seen their pay fall in real terms by 36 per cent since 2008/09, and by 43 per cent for practice owners. Whilst dentists across the UK have experienced sustained cuts to their real incomes, practitioners in Northern Ireland have seen their pay eroded by the largest proportion.  
 
Of particular concern, says the BDA, is that those dentists who are most committed to the HS have been hit the hardest. The largest dental group, representing associates where HS earnings account for at least 75 per cent of their total gross earnings, have the lowest average taxable income at £49,700. This compares with an average taxable income of £94,500 for associates with 25 per cent or less earnings from HS dentistry and a larger private income.

The stark fall in dentists’ pay is being attributed to wholly inadequate fee uplifts, cuts in the form of removal of Health Service Commitment payments, and private work often effectively cross-subsidising HS activity. Whilst the Northern Irish government has granted capital funding in the wake of the pandemic, dentists have historically relied on their incomes for all investment in improving equipment and facilities in HS practices.  
 
Official figures just published relate to the 2019/20 financial year, and largely pre-date the further massive impact that Covid-19 has had on general dental services and practice finances. They underline the precarious state of the service even prior to the pandemic. 
 
The BDA has stressed that a new General Dental Services (GDS) contract is urgently required which ensures dentists receive fair remuneration for their work, and which makes Health Service dentistry financially viable and an attractive proposition in its own right. They also point to the need to modernise a contract model that is decades old, and which is based on treatment and not prevention. It hopes urgent work on securing a financially viable future for HS dentistry can be meaningfully progressed via the recently established General Dental Services Rebuilding Stakeholder Group over the coming months.

Richard Graham, chair of the BDA’s NI Dental Practice Committee, said, “When post-pandemic, patients across Northern Ireland are already struggling to access dental services, these figures should serve as a wake-up call.  
 
“Before covid struck, Health Service dentistry had been run into the ground. Colleagues are facing the greatest oral health problems in the UK with their hands tied by a decades-old contract model that rewards failure, and chronic underfunding in wholly inadequate fees that no longer make any financial sense.  
 
“We want to avoid a complete collapse of Health Service dentistry. For that to happen, we need a new contract model that works for both the general public and practitioners alike.

"For our patients’ sake, the downward trajectory needs to be reversed before any more dentists conclude there is no future in the Health Service they have been so committed to. If Health Service dentistry is going to survive this pandemic, the time to give practitioners confidence it has a future is now.”