EU metallic fillings ban and financially unviable contracts an 'existential threat' to NHS services in NI, dentists warn

Around 700 dentists have expressed grave concern that the additional costs associated with the switch away from the metallic mixture (which includes mercury, silver and tin) to more expensive treatments “represents an existential threat to NHS dentistry”.

In an open letter to Stormont’s Department of Health permanent secretary Peter May, the British Dental Association NI said NHS dentistry in the province is already in a “death spiral” that must be urgently addressed.

The dentists claim that a combination of the looming ban on the least expensive fillings, the Stormont freeze on health budgets and a “financially unviable contractual framework” could “doom the service “.

The association said: “Northern Ireland looks set to be subject to the EU ban on dental amalgam from 1 January 2025, with practices braced for a huge hit from increased costs and time pressures from the shift to alternative materials. NHS dentistry works to a discredited high volume/low margin model, that has already seen practices delivering some treatments at a financial loss, fuelling an exodus to the private sector.”

A call has also been made for the NI health department officials to “urgently follow the lead of the Scottish Government, who rolled out wide ranging changes to a similar contractual framework in November,” and for the department “to reinvest the significant underspend projected for this year’s dental budget to aid struggling practices, who are unable to deliver pre-pandemic levels of activity”.

In the letter to Mr May, the dentists state: “The imminent ban on dental amalgam represents an existential threat to NHS dentistry. In Strasbourg, MEPs backed amendments calling on member states to support practices with the added costs of alternative materials, and to reduce the clear impact this will have on the patients who need us most. We require the Department to do no less.”

The letter adds: “Evidence shows that the move away from Health Service dentistry is well and truly underway. In the continued absence of payment reform proposals, colleagues will be increasingly driven out of Health Service dentistry to keep their practices afloat.

"We are passionate about maintaining a future for Health Service dentistry, and we want to continue providing access to these vital services for our patients.

“But this now hinges on you acting, urgently in the public interest, and investing to stabilise and reform the service. Continued inaction will result in significant detriment to the provision of this vital public service. We cannot wait on if, or when, politicians decide they want to restore a devolved Assembly and Executive.”

It concludes: “This isn’t a matter of the Department finally delivering a late pay rise this year. We need to know what you intend to do to fix the crumbling foundations this service is built on.

"Please share your plan for Health Service dentistry with the profession, and the public.”

The Department of Health at Stormont has not yet responded to a request for comment.