The Association has been in discussions with the Minister for Health and Department of Health officials over the last three weeks on a small number of urgent difficulties facing dentists. In addition to pursuing the provision of PPE and, separately, financial assistance for dentists, we have sought immediate interim changes in the operation of the DTSS (medical card scheme) and a commitment to resume discussions on an entirely new scheme and contract as soon as possible.
Three weeks after the Minister for Health promised the IDA that PPE would be made available to dentists, the HSE says it is still awaiting official direction from the Department of Health to release PPE to dentists. Yesterday, the Department of Health advised us it was still pursuing this matter.
Even though it was the State which abandoned discussions on a new medical card scheme in 2008, we have yet again been faced with further procrastination and delaying tactics as well as a litany of excuses as to why no proposals for urgent, interim changes cannot be tabled at this stage. The Association understands that many members take the view that pre-existing difficulties and inadequacies of the scheme and contract have been exacerbated with the advent of the Covid-19 pandemic.
Members are advised that the HSE insists that there can be no additional co-payments levied on medical card patients to meet additional costs a dentists may incur in providing care to medical card patients, that dentists are not entitled to limit the number of eligible patients each dentist holding a DTSS contract is obliged to see, that dentists cannot opt-out of providing treatments covered by the scheme and that no increases in professional fees are to be paid by the State even though there have been no fee increases since 2007 and in fact fee cuts were introduced from 2011 onwards. In spite of the significant extra costs being incurred by dentists treating patients, no alleviating changes in the operation of the DTSS are likely to be sufficient or to be presented anytime soon by the State based on the responses we have received to date.
The State’s interpretation of competition law precludes the Association, a registered trade union, from engaging in any form of collective bargaining or collective action on the part of self-employed members holding individual contracts with the state. The same applies to other trade unions such as the Irish Medical Organisation, Irish Pharmacy Union and the Irish Hospital Consultants Association where they are representing self-employed members.
It is therefore a matter for each individual member holding a contract with the State to decide on their participation in such schemes. Naturally, the State takes careful note of the numbers of dentists who decide to apply for or to remain as contract holders. While the IDA cannot and will not direct, recommend, signal or induce members to act as regards their holding of State contracts, we are entitled to advise our members of the need to regularly review their participation in third party schemes and contracts and, acting individually, to consider whether their membership of schemes is in their best interests having regard to the economic viability of their practices, the best interests of their patients and the professional and ethical obligations they owe to their profession and patients, including the guidance on ethical conduct published by the Dental Council.
Our legal advisers have also asked that we remind all dentists that they should not consult others in deciding on their participation or otherwise in the medical card scheme or any other third party scheme in order to avoid the possibility of criminal prosecution. Commentary on social media is also subject to competition law restrictions and members are asked to ensure they avoid making any comments on any media platform which could be construed as constituting anti-competitive behaviour.
For the reasons we state above, and particularly the increased costs of providing care and treatments to medical card patients in the post-Covid-19 world, each member may wish to conduct an independent review of their participation in the DTSS to ensure it makes commercial sense for their particular practice. The Association reiterates that any decision should be taken on an individual basis and that no form of concerted or collective action should be contemplated or pursued in order to avoid any risk of legal prosecution. Members are advised to ensure that they are fully conversant with the full contractual provisions of the DTSS and to ensure they comply with those terms if they choose to continue to participate in the scheme or to honour their obligation to complete treatment plans they have commenced and to give 90 days’ notice of resignation if they choose to leave the scheme.
The Association will continue to pursue immediate changes in the operation of the DTSS and, with the establishment of a new Government, a permanent replacement of the medical card scheme which is clearly unfit for purpose and has been for many years, as we have repeatedly advised successive Ministers for Health.
Issued on behalf of the Irish Dental Association’s Management Committee