Time for decisive action : Ireland's Dental Magazine

Time for decisive action

Executive financial backing and bold contract reform are needed to prevent the collapse of Health Service dentistry

The most pressing issue in dentistry in Northern Ireland is the collapse of Health Service (HS) dental access, driven by an outdated and underfunded payment model.

The British Dental Association (BDA) has described public dental care in Northern Ireland as a “disappearing service” on the brink of total collapse. As well as issues with the payment model, dentists are increasingly moving to private care. Recently published figures revealed that the average gross earnings for self-employed dentists in the north rose to an estimated £184,700 in 2024/25, an increase of 16.4% on the previous year (after deducting costs, it left self-employed dentists with an average, taxable, income of £87,600 per year).

Key factors contributing to this crisis include:

Plummeting patient registration: levels dropped to 49% of the total population (and an all-time low of 44% for adults); down sharply from around 70%. In some areas, such as Fermanagh and Omagh, adult registration has fallen to just 30%.
Outdated payment structure: high-street dental practices are funded under a outdated payment model that fails to cover the true operational costs of treatment. As inflation and overheads rise, dentists are increasingly forced to deliver HS treatments at a financial loss, leading many to reduce their HS hours or switch entirely to private practice.
The amalgam phase-out: regulations restricting and phasing out the use of dental amalgam (mercury fillings) have placed additional pressure on dentists. Alternative white-filling materials are more expensive and take longer to place, which further squeezes the viability of health service dentistry without fee reform.

While Stormont MLAs and Health Minister Mike Nesbitt have pledged targeted investments, including a £2m Activity Support Payment and targeted fee boosts, and has called for reform, dental bodies continue to press the Department of Health for the publication and implementation of a Cost-of-Service review to create a fair, modern payment model.

But if the Northern Ireland Executive is to prevent public dentistry from vanishing entirely into a private-only model, it must move beyond crisis management and deliver three decisive reforms:

Fast-track and act on the Cost-of-Service Review

For decades, high-street practices have been shackled to an antiquated fee-per-item payment model. Skyrocketing overheads mean practitioners routinely deliver Health Service care at a financial loss. The Department of Health’s long-awaited Cost-of-Service Review must be published and fully funded without delay. The Executive must commit to replacing the current contract with a modernised, sustainable fee structure – drawing inspiration from Scotland’s overhauled model – that reflects real-world operational costs.

Fund the amalgam phase-out transition

The European Union-driven phase-out of dental amalgam has disproportionately squeezed Health Service providers. White filling alternatives require more time and vastly higher material expenses. Asking dentists to absorb these costs under legacy fee tariffs is pure fantasy. Stormont must establish dedicated financial backing for composite materials and longer appointment slots to ensure clinical viability.

Invest in prevention and workforce capacity

Fixing the contract is pointless without the workforce to deliver it. Northern Ireland needs a refreshed, fully funded Oral Health Strategy focused on early intervention and child health. Expanding Dental Foundation Training (DFT) places and improving retention incentives will stabilise the clinical pipeline, preventing newly qualified talent from migrating immediately to private practice or overseas.

Plasters will no longer stop the bleeding. Only Executive financial backing and bold contract reform can ensure that access to a dentist in Northern Ireland remains a public right rather than a private luxury.