A long-awaited review has confirmed what dentists and patients have known for years: Health Service dentistry in Northern Ireland is underfunded by a significant margin, with the current payment system failing to cover the true cost of providing care. The Department of Health has published the General Dental Services Cost of Service Review in full, acknowledging a “significant funding gap” that has driven practitioners away from NHS contracts and left patients struggling to find affordable treatment.
The review, led by Professor Ciaran O’Neill of Queen’s University Belfast, was commissioned to establish the actual cost per hour of running a dental chair for Health Service work. Its publication comes as registration levels have hit historic lows—just 49% of the Northern Ireland population was registered with a Health Service dentist as of March 2026, with adult registration falling below 44% for the first time.
What the Review Found
The Department’s press release confirms the review “provides important evidence regarding the costs and challenges associated with delivering Health Service dentistry” and explicitly acknowledges “the significant funding gap that currently exists.” However, no specific monetary figure for this gap has been disclosed in the announcement.
The findings reinforce long-standing concerns from the British Dental Association (BDA) that the current system is financially unsustainable. According to BDA data, 114 dentists handed back their Health Service contracts between 2023 and 2024, with more than 53,000 patients removed from practice lists as a result. Just two of Northern Ireland’s 360 dental practices remain fully Health Service.
Health Minister Robbie Butler, who took office in August 2026 following Mike Nesbitt’s resignation, has committed to transparency by publishing the review but admitted the full investment required is not currently affordable.
Minister’s Statement: Reform Without the Funding
Robbie Butler said:
“The Cost of Service Review provides an important and robust assessment of the challenges facing Health Service dentistry in Northern Ireland. I recognise the concerns that have been raised by the profession regarding the sustainability of the current arrangements and the impact this is having on access to care for patients.
“Transparency is important, and I believe it is right that the findings of the review are published. The review provides a valuable evidence base to inform future discussions and decision-making.
“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.
“I am committed to finding a way forward which will aim to ensure practitioners are paid fairly whilst also working to provide a sustainable and accessible dental healthcare model.
“I have therefore agreed that officials should commence an options appraisal, working closely with the British Dental Association and other stakeholders, to consider the future of General Dental Services in Northern Ireland. This work will examine a range of options to support the long-term sustainability of Health Service dentistry and will inform a future public consultation.
“I remain committed to improving patient access to Health Service dentistry and to working constructively with the profession to identify a realistic, sustainable and affordable way forward.”
What Happens Next—And What’s Missing
The Department has outlined a multi-stage process:
- An options appraisal will examine reform possibilities, conducted with BDA and stakeholder input
- This will support a “fee rebasing exercise”—essentially recalculating what dentists are paid to reflect actual costs
- The appraisal will eventually inform a public consultation
However, several critical details remain unclear:
- No timeline has been provided for the options appraisal, consultation, or implementation—despite former Minister Mike Nesbitt’s previous pledge for reform by 2027
- No specific figure for the funding gap has been disclosed in the press release
- No explanation of why the financial position is “exceptionally challenging”—though the Department’s permanent secretary Mike Farrar told Stormont’s health committee in August that the health service is operating with “expenditure currently exceeding available funding by approximately £2 million each day”
The phrase “difficult choices remain unavoidable” suggests dental reform will compete with other pressing health priorities for limited funding.
What is ‘Fee Rebasing’?
The commitment to a “fee rebasing exercise” refers to recalculating the fees paid to dentists based on the actual costs identified in Professor O’Neill’s review. Currently, dentists argue that Health Service fees have failed to keep pace with inflation, staff costs, regulatory requirements, and equipment expenses.
The BDA has previously called for such an exercise to account for “all business-related costs incurred by practices,” including premises, borrowings, laboratory fees, materials, and reasonable profit margins. Without this, the association argues, practices effectively subsidise Health Service work through private fees—or abandon NHS contracts entirely.
Critical Questions
The publication raises several questions that patients, practitioners and policymakers will need answered:
- What is the actual monetary value of the “significant funding gap” identified, and why hasn’t this figure been disclosed alongside the review’s publication?
- Given that 114 dentists have already left Health Service contracts and registration rates continue falling, how long can the current system survive without immediate “bridging” support?
- With the next Assembly election due in May 2027, is there sufficient time to complete options appraisal, consultation, and implementation before a potential change of government?
- How will the Department ensure that “difficult choices” do not disproportionately affect rural areas like Fermanagh and Omagh, where adult registration has fallen to just 30%?
- Does the Minister’s commitment to “realistic, sustainable and affordable” reform mean patients should expect changes to eligibility, charges, or service scope?
Broader Context
The Northern Ireland crisis echoes pressures seen elsewhere in the UK, with England reporting 91% of NHS practices not accepting new adult patients. The BDA has warned that “tweaks at the margins and unfunded gimmicks have barely scratched the surface” of what is needed.
The DDRB (Review Body on Doctors’ and Dentists’ Remuneration) made a rare higher pay recommendation for dentistry in March 2026, noting “substantial reform to the contracts is needed to make NHS dentistry attractive.” Northern Ireland’s 2026-27 pay uplifts remain contingent on Executive budget agreement.
For patients like Joe Friel from Londonderry—who spent months calling 20 practices without finding Health Service treatment—the promises of future reform offer little immediate relief. With two cracked front teeth and no prospect of NHS care, he told the BBC: “There’s not much smiling happening right now.”
The Department’s publication of the Cost of Service Review provides welcome transparency. Whether it leads to meaningful change before Health Service dentistry becomes a historical curiosity rather than a functioning service remains to be seen.