Delivering Nothern Irish health service dental care costs around £145 per hour while current funding only stretches to £90, according to a new review that warns publicly funded dentistry is approaching a ‘tipping point’.
With a reduction of more than 389,000 patients registered for publicly funded dental care since 2022, the review warns that Northern Irish health service dentistry may be reaching a point of no return.
It says: ‘Given the level of skill and investment required to enter the profession, it is unlikely that current levels of public sector remuneration will remain sufficient to attract and retain practitioners over the longer term.’
Compiled by Professor Ciaran O’Neill of Queen’s University Belfast, the General Dental Services in Northern Ireland: Cost of Service Review was commissioned by the Department of Health (DoH) to assess the financial landscape behind the shift away from publicly funded dental provision towards private practice.
Is more funding available?
The DoH acknowledged the scale of the funding gap but said its current financial position did not allow it to provide all of the investment identified by the review.
Health minister Robbie Butler said: ‘Whilst the current financial position means that the level of investment identified by the review is not currently affordable and difficult choices remain unavoidable, it is imperative we now move forward with a programme of payment reform that will seek to close the gap.’
Butler said officials would work with the British Dental Association and other stakeholders on an options appraisal examining the future of General Dental Services. This will include options to support a rebasing of dental fees and inform a future public consultation.
The review also estimated that private care generated more than £320-£340 per clinical hour, while publicly funded fees generated around £90-£93. Professor O’Neill argues that these figures represent ‘a growing financial incentive to reduce publicly funded activity in favour of private provision’.
Northern Irish dentists earning the least in the UK
The financial prospects for public dentistry in Northern Ireland appear to be worse than in other UK nations, with Northern Irish dentists earning the least on average:
- Northern Ireland – £77,000
- England – £78,200
- Wales – £79,900
- Scotland – £90,600.
The review also concludes that dentists’ income has reduced over time in Northern Ireland. Between 2016/17 and 2023/24, associates’ taxable income fell more sharply, from £74,500 to £65,500, while that of principals fell from £125,000 to £121,200.
According to Professor O’Neill, dentists are ‘highly responsive to financial incentives’ due to their status as independent practitioners responsible for the financial risks of service delivery. This differs from other healthcare practitioners who may be directly employed by the health service.
The findings are reported with the caveat that cost analysis is an ‘evolving situation’. The review says: ‘Changes in case complexity, in staff expectations of working conditions, in technology, among other factors combine to create an uncertain environment for dentistry.’
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