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Northern Ireland: Orthodontists lacking vital support

Blog Author James Lundy and Sally-Ann Todd

Blog Date 26/04/2022

Over the last two years orthodontists have received less support due to higher levels of activity. Where does this leave the profession now?


During the pandemic, orthodontists were able to adapt their care to maintain higher levels of activity than general dentistry. Whilst this has been greatly beneficial to patients, it has resulted in less support being received from the Financial Support Scheme (FSS). We are questioning where this lack of parity leaves orthodontists now that the new Rebuilding Support Scheme (RSS) is underway, and society is living with Covid.


Why did Orthodontists receive less support?

Over the last two years, Specialist Orthodontic Practices were able to change many of their procedures to be non-aerosol generating. As a result of this, higher levels of activity were possible, and more patients were able to get the treatment they needed, despite the challenging circumstances.


From June 2020, we began adapting to ensure that we could continue to provide the treatment we had already begun with our patients. This was the right thing to do, but inevitably resulted in less support from the FSS, and now many of us are facing a referrals gulf.


"A lack of parity within dentistry has left Specialist Orthodontists feeling disappointed."

Activity levels during the pandemic were largely due to the continuation of treatment that began before Covid. During 2020-21 orthodontic referrals from general dental practice plummeted, reducing the number of new cases started. This will have a delayed impact on practice income, at the same time as the FSS is being wound up and being replaced by the RSS.


A lack of parity within dentistry has left Specialist Orthodontists feeling disappointed. It is grossly unfair that we have not received the same enhancements that were seen in other areas of dentistry throughout the last two years.


Making a case for fair enhancements

In February, we met with the Department of Health (DoH) and the Health and Social Care Board to highlight the delayed impact of the pandemic on Specialist Orthodontic Practices. The Northern Ireland Dental Practice Committee (NIDPC) have been highlighting our concerns and we appealed for much-needed financial support to see us through the next 12-18 months.

"We've made it clear to the DoH that the profession feels a sense of betrayal."


Unfortunately, despite our best efforts, it was decided that orthodontic fees will not receive any enhancement under the new RSS, which replaced the FSS from 8 April. We've made it clear to the DoH that the profession feels a sense of betrayal. Orthodontists worked incredibly hard during the height of the pandemic to deliver vital care to our patients. It is unthinkable that now, when we need support, we are not going to get it.


Colleagues have fed back to us that they feel they are being treated unfairly by the current system. Specialist Orthodontic Practices have always considered themselves to be a part of general dentistry. We cannot understand, after sharing the stress of the last two years with our general dental colleagues, why we are not receiving at least the same support.


Looking ahead

With us all learning to live with Covid, and society reopening, practices are now very active and are beginning to start work on new cases. In the short term, this will entail a lot of extra costs. However, due to the long nature of the treatments we provide, this activity will not generate income until it is completed in 18-36 months. This leaves the profession in a tricky short-term situation as we wonder what direction NHS Orthodontics is going in Northern Ireland.


We will continue to engage with the DoH, sharing our concerns through the NIDPC to fight for parity across general dental services and secure the fairest outcome possible. We have an upcoming meeting to discuss these issues in more detail and are also planning to speak with the Regulation and Quality Improvement Authority to discuss the issues around remote orthodontics. We will keep you updated with any future developments.


James Lundy

Specialist in Orthodontics


Sally-Ann Todd

Specialist in Orthodontics