Derry dentist forced to 'restructure' as current NHS model is 'unworkable'

A Derry dentistry practice announced that it would be restructuring its practice. 

Great James Street Dental told patients the decision has come due to rising costs and the impending crisis in the NHS dental care sector. 

Meabh Owens, owner of the practice, lobbied politicians for years, hoping to find a solution to save it, but as things got worse, she felt she had to make this 'very difficult decision’.

Dr. Owens said: “The people of Derry have been really good to me, and I have loved every bit of it, but the last few years have been incredibly challenging.

“I can't work any harder than I am working right now, and three months out of 12 last year, I didn’t break even. I am booked four months in advance, and I have to turn people away every day. I will see between 20 and 30 people per day sometimes.

“This has just become unworkable.”

Confirming the practice would not fully withdraw from the Health Service, patients who are currently undergoing a course of treatment and those who are registered under the exemptions list will not be impacted by the changes. 

The practice confirmed it is not accepting any new exemption patients, which currently includes those aged 18 or under in full-time education, those who are pregnant or have given birth in the last 12 months, and those on benefits or universal credit exemption. 

Those patients who had paid for treatment previously would no longer be subsidised by the health service arrangement. 

Dr. Owens felt forced into the restructuring due to the failure of the Department of Health Northern Ireland to listen to dentists and their warnings that the current model for NHS dentistry does not function practically. 

She said: “There is a huge access crisis, especially for kids. If you have a child between zero and five that was born between Covid and you are trying to get them registered, you will find access difficult because, at the minute, anywhere, it is really difficult to get a dentist; they don’t qualify enough of us. 

“You are given an allowance per month for children that has to cover their examination, their x-rays, and if they had 10 toothaches in a month, that has to cover those 10 appointments.

“To cover all that, we are given £1.77.

“My professional registration, just to call myself a dentist, I have to indemnify myself like car insurance, that is £4,850.16, then I have to pay to be on a General Dental Council register and that is £621 and then I have to do 75 hours of verifiable CPD to keep my knowledge and technique up there. The most recent course that was held in Derry was £1,500 for two days.

That all comes to £6,971.16, that works out as £580.93, that is a mortgage before I turn a key and £1.77 for a child doesn’t even cover a first class stamp for the referral I may have to do. “

The Department of Health NI provided a statement when asked about the restructuring of Great James Street Dental.

The statement read: “The Department is certainly aware of the longer waiting times and access issues facing many dental patients and challenges too faced by the dental practices.

“In response, an unprecedented amount of support has been provided over the last four years. A total of £95 million was provided to dentists to mitigate against the impact of the Covid-19 pandemic and ensure dental practices remained financially viable. To help further support dental practices, in March 2024 the Department announced a £9.2 million investment in General Dental Services for 2024/25.

“A 6% pay uplift for dentists for the current financial year was also announced for dentists in March 2024. This increase will be backdated to April 2023 and is in line with the recommendations from the DDRB (Doctors' and Dentist' Review Body). The uplift comes with a 7.3% uplift to non-staff expenses for 2023/24, with a 3% recurrent award in future years.

“The Department will continue to consider ways to further support dental services in the coming months.”

But Dr. Owens feels the department is being disingenuous when talking about their injection of money. 

She said: “The Department of Health’s most recent injection of funding into NHS dentistry is not extra money. NHS dentistry is allocated a pot of money every year that they have to use in the service, and this money is money unspent in that pot; it is not additional money. The only reason it exists is because people have left the service or reduced what they are delivering.

“It only exists because the system is failing.”

Dr. Owens sees the crisis getting worse in the near future unless something is done now, a shared belief with Tristan Kelso, British Dental Association (BDA) Northern Ireland Director, that the Scottish model is the only way forward. 

He said: “Last year, the Scottish Government stepped in to save NHS dentistry. They engaged with the profession, they did their research, they accepted the utter inadequacy of the fees, and they acted. They created a new, streamlined, more realistically funded payment system. It has been fully costed, it is fully deliverable, it can be implemented at pace, and if applied here, it might just about retain some of those practices who are at present making plans to leave.”

The BDA and Kelso want to save health service dentistry as they recognise many parts of the population can’t afford private care.

He said: “It has reached a critical point in the past couple of years.

“This is the last opportunity to save the dentistry health care service in Northern Ireland.

“Healthcare dentists have been let down after decades of underfunding and inactivity, resulting in the collapse of the health service industry in Northern Ireland.

“We have pushed the department to carry out an objective piece of work. We have provided figures for years and years showing how the fees are not matching the costs to provide care. We pushed them to do a cost-of-service investigation to get someone independent to do that, and they have refused and dragged their heels.

“From our practitioner future intent survey, we know 88 percent say they are going to reduce their NHS commitment and 49 percent say they intend to go fully private next year.

“It is incredibly worrying.”