Morale in the GDS workforce in Northern Ireland is now so low that we have grave concerns about the future sustainability of health service dentistry. That's what we told the DDRB, the body responsible for making a recommendation to government on GDP pay in our written
evidence submitted in December 2017.
According to the government's own figures, over a third (33.6%) of practice owners rate their morale as 'very low' and 29.5% as 'low' - these dangerously low levels are totally unacceptable amongst a profession delivering patient care.
Sadly, however, these figures will not come as a surprise to many dentists.
So what is causing such low levels of morale?
Higher health service commitment = lower morale and pay
According to a recent NHS Digital report, low levels of morale amongst GDPs in Northern Ireland are linked to longer working hours and carrying out more Health Service work.
Essentially, the more time dentists spend on Health Service work, the lower their levels of morale, and the less they earn. The strain of insufficient health service income is evident as figures clearly show that those dentists with the most significant number of health service patients, have the most difficulty in remaining viable.
In 2015/16, dentists whose Health Service earnings accounted for at least 75% of their gross earnings had the lowest taxable income at £55,800, compared to £93,300 for GDPs whose Health Service earnings accounted for between 25-75% of their total gross earnings.
This situation will leave many in the profession with no option but to assess whether their Health Service commitment levels can be retained. It has already negatively affected morale and undoubtedly will impact on retention in the medium term and recruitment in the long term.
Timing and implementation of uplifts
Northern Ireland is up to twelve months behind the rest of the UK on the implementation and delivery of pay awards to the GDS. The 2016/17 award was not implemented until April 2017 and the 2017/18 process has still not concluded, as it was only confirmed in December 2017 that GDPs would receive 1% for 17/18.
This uncertainty and delay creates anxiety and causes great distress. GDPs are independent contractors, and the significant delays in the application of uplifts makes cash-flow management increasingly difficult, and could force many practices into a position of cash loss, negatively reducing the ability of practices to invest in equipment and premises needed to provide patient care.
Rising expenses, falling income
GDS practitioners have seen an increase in their expenses, higher than the increase in their gross earnings, which has meant that their taxable income continues to decline. Taxable income for both associates and practice owners in Northern Ireland has fallen by over a quarter since 2008.
The effect of successive, below inflation pay awards; the impact of the zero percent uplift in 2015/16 and the ceasing of commitment payments in 2016 have led to very considerable erosion of dental incomes in Northern Ireland.
GDPs, more than any other health service professionals, are impacted by wider economic conditions, feeling the effects of the fall in the value of the pound and the rise in the cost of materials, for example, the euro is now worth 89p. Two years ago this was 70 pence. With the currency fluctuation alone that is an increase of almost 20% for all materials and equipment.
What needs to happen
The BDA seeks a recommendation from the DDRB that acknowledges the very difficult environment for practitioners and recognises the full impact of growing costs on maintaining a viable health service dental practice.
Effective care for a population which has the worst oral health in the UK, strongly linked to higher rates of deprivation, requires investment. The costs of servicing a high needs population are high in respect of materials and lab work generated and a motivated and content profession is essential.
Low, inadequate health service fees are unsustainable and will continue to force practitioners to question their commitment to the health service. Negative feelings about the future of the profession cannot be understated and the government can't pretend this problem will just go away of its own accord.
The more that the government neglects to invest in GDS dentistry, the more likely it is that dentists will have no choice but to walk away.
Chair, Northern Ireland Dental Practice Committee
Dentists' pay: What we do for you
Each year we
use our evidence to fight for a fairer pay for associates, practice owners, and community dentists, and we call for pay parity for dental clinical academics.
We work across England, Northern Ireland, Scotland and Wales, and provide evidence to the Governments on your behalf.
We want an end to the public sector pay cap for doctors and dentists – we believe the continued decline in income for dentists is affecting not just the profession, but the access to care dentists can provide for patients.