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Northern Ireland: Contract reform must be expedited

Blog Author Tristen Kelso

Blog Date 11/05/2022

The current GDS contract is not working and hasn't been for some time. We are moving to engage with a contract reform process to ensure that the service is sustainable and delivers for patients and the profession.

 

Following a letter we issued to Chief Dental Officer (CDO) Caroline Lappin confirming our commitment to engage in new contract discussions, we attended a contract reform group meeting on 10 May. In our letter, we also took the opportunity to highlight the issues that need urgent attention, and simply cannot wait.

 

Rising costs of dentistry

The costs of delivery dentistry are rising at a rapid pace due to inflation on materials, lab fees plus difficulties with the recruitment and retention of staff. With no current inflationary mechanism to adequately offset increasing expenses, we are seeing a detrimental impact on independent contractors.


"We are looking to the DoH to address these rising costs now, whilst work to put a new contract in place is prioritised."

The situation is being further compounded by delays in the implementation of the DDRB uplift. We are extremely concerned about what impact the continued exposure to high rates of inflation will have, especially if the contract reform process is likely to take a long time to materialise. We are looking to the DoH to address these rising costs now, whilst work to put a new contract in place is prioritised.

 

We accept there are wider budget uncertainties in play, however we cannot go too far down the path of contract reform without having a clear sense of what funding will be available for GDS. We must be able to deliver the future service within the budget set by the government. The profession is already experiencing significant difficulties recruiting associates because of how financially unattractive HS dentistry has become.

 

Equal treatment for all

"We believe that no practitioner or group of practitioners should be disadvantaged or treated unfairly due to their characteristics."

We believe that no practitioner or group of practitioners should be disadvantaged or treated unfairly due to their characteristics. It is getting harder to guarantee equality when working under a thirty-two-year-old contract that was designed with a very different workforce in mind to what we have today. Early FSS criteria was found to disadvantage those on maternity leave during the reference period.

 

Current examples of this lack of parity include maternity entitlements not being calculated or paid in a timely manner, and significant allowances (including practice allowance) being calculated using a rigid formula which seemingly cannot accommodate the increased part-time and majority female workforce we have today. We need a lawful system that treats everyone fairly and equitably, that is flexible to suit the requirements of the modern workforce.

 

We are deeply uneasy with the way conditions have been imposed on independent practitioners, aimed at binding them into maintaining health service commitments under duress, when they are already under intense pressure. Two years later, conditions are being applied to RSS in relation to unregistered patients, but GDPs are currently unaware of what the GDS financial conditions will look like over the upcoming two-year period.

 

It is important to ensure public funds are properly spent, but due process on potential enforcement actions and complete transparency to the profession must be guaranteed. If practitioners are being compelled to retain HS commitment, that constitutes a failure in the system. We want to see the GDS reformed, to make HS dentistry financially sustainable and attractive for dentists to want to stay committed voluntarily.

 

Securing the future

There is a huge crisis of confidence among dentists regarding the future of HS dentistry. Our surveys have shown many dentists are struggling with low morale. Practitioners are being forced back onto the NHS treadmill, while also being bound by the RSS when the out of hours provision still hasn't been reinstated.

"There is a huge crisis of confidence among dentists regarding the future of HS dentistry."

 

The department must address the underlying reasons behind the collapse in morale and crisis of confidence to begin to transform GDS into an attractive and aspirational option. It is currently unclear what timescales we will be working towards for the ultimate completion of a new GDS contract. Time is against us due to how unworkable the current arrangements have become, but your BDA elected representatives will be doing everything in their power to expedite a new contract that works for everyone.

 

Tristen Kelso

Tristen Kelso
BDA Northern Ireland Director