Running smoothly

Dr Clodagh McAllister has many things on her agenda as IDA President, including the DTSS contract and Covid-19, but says her number one aim is to continue the steady governance of the IDA.

It was Clodagh McAllister’s mother who first impressed upon her the benefits of being part of a collective, she says: “My mother was a pharmacist, and she was very involved in the Irish Pharmacy Union. She kept telling me I should join the IDA because it’s good to be part of a professional group – many voices are better than one voice”.
Prior to becoming President-Elect last year, Clodagh really got involved in the work of the IDA about five years ago, when she was asked to join the GP Committee. It was not something she ever saw herself doing but found that once she started, she got a lot out of helping her fellow dentists: “I had never had any desire to be involved in the actual politics of the IDA but once I got on that committee, I really enjoyed it”.

Aims and ambitions
Clodagh believes the IDA is governed well and aims to keep that going for her year as President. Other important goals for her include representing members to the best of her ability and hopefully increasing membership.
When it comes to the DTSS, Clodagh believes it is time the Government offered dentists and patients something new: “It’s not a sticking plaster we want on the contract now. We need a new contract for the current climate because I think the medical card contract was originally initiated in 1994, so that’s nearly 30 years ago”.

It’s not a scheme Clodagh operates in her practice in Fairview in Dublin, and one thing she is keen to promote is independent practice: “I was always very into being independent, so that’s another one of my goals, to promote independent practice. It probably would have been a great thing to do, the medical card scheme, in the beginning because it would have got you busy fairly quickly but I decided that I wanted to be fully private, so initially I did neither the PRSI nor the medical card schemes, but in the past couple of years, we’ve started doing the PRSI scheme”.
Part of the reason Clodagh decided to take on the PRSI scheme is the supports that were introduced after the successful negotiations between the IDA and the Department of Social Protection, she says: “They weren’t trying to cover everything because I didn’t want a third party running my business or being in control of my business. Also, it meant that a lot of my patients who were self-employed were now going to be covered, so I felt it was important to offer them the opportunity, particularly when the cost to me was more or less the same as my private fees”.
The problems with the DTSS contract run deep and Clodagh says it remains the biggest challenge for dentists in Ireland right now. It is not just the low level of fees that is a problem, but also the two-tier way it forces dentists to treat patients: “It has limited treatments that you can offer the patients, so you’re not treating people equally. You don’t have the same choice to treat your medical card patients with the same options as private patients. The second thing is that the contract is outdated. I don’t want to labour the point of the fees too much, but they are totally at odds with private practice fees. I think the final straw that broke the camel’s back was when [the Department of Health] didn’t honour their agreement to give PPE to practitioners. Last June it was promised for practitioners who do the medical card scheme, because the cost of the PPE is making dentistry very expensive”.
The way the scheme forces dentists to treat patients is completely at odds with how dentists are trained, explains Clodagh: “It covers as many extractions as you like but only two fillings in a year, so there’s no preventive element to it whatsoever. It puts patients and dentists in a position where they have no alternative but to be extracting teeth when they should be saving them. They’re just postponing the problem. In the future, there will be an issue with people who have no teeth. They promote as many extractions as you like, but they don’t allow for the making of dentures, except in special circumstances. They’re not offering a modern-day service to the public and that goes against what dentists are trained to do. The main thing they’re trained to do is apply prevention first and foremost. The same services should be available to everybody, regardless of your socioeconomic group”.

Pandemic strain
During the pandemic, dentists have had to extend appointment times or put more time between patients, which means they can see fewer patients per day and this adds to the pressure of stressed practice finances, explains Clodagh: “We’re doing that as well but we’re quite lucky in that I took on an extra member of staff to have somebody to clean up so that we could work between a couple of different surgeries. We’ve kind of weathered that storm but that is an issue where you don’t want too many people in the waiting room, so you’re doing longer appointments, the turnaround is not as quick as it was, so that definitely will have an impact on finances”.
Staffing of the entire dental team is becoming harder for practices as well, says Clodagh: “Another difficulty in private practice is employing dentists. It’s very hard to get staff as everyone seems to be in full employment. It’s really hard to get younger dentists. They are really shying away from the medical card scheme. There’s definitely a shortage of support staff, like nurses, and hygienists are very thin on the ground”.

Not equipped
Clodagh says the Public Dental Service is currently not equipped to do the job it is supposed to be doing. The dentists are committed and willing, but there simply aren’t enough of them. Covid has only exacerbated this, she explains: “A lot of them have been redeployed to Covid services; previously they were testing and now they’re vaccinating. There’s a whole cohort of children not being seen. And quite a number of private practitioners have come out of the medical card scheme, so now there’s a whole cohort of adult patients who are finding it difficult to access care. I think the Government has let them down in that it hasn’t funded the public service to the level that it should in order to provide cover and proper care for medical card patients”.
In comes the new national oral health policy, with its ambition of moving much of the public service’s work onto private practitioners, despite there being no meaningful engagement with the IDA: “I don’t see the capacity in private practice to do that. They’re literally abandoning patients. What they’re doing is giving the problem to another group whereas they fund a public health service, but they’re not willing to properly fund a public dental service. Without having consultation, to think that dentists are going to take on a whole load of new patients and children, there definitely isn’t the capacity in private practice to do it”.
If the IDA had been involved in the formulation of the new policy, Clodagh says what was published could have formed the basis for a discussion on what needs to be done: “Yet again it’s the same problem in that there’s a lack of consultation. It’s very hard to get the Department of Health to actually discuss things with you. Perhaps the only saving grace would be if they used it as a stepping stone to further discussions to come up with a plan that would actually work for everybody – for dentists, for the public service and the patients”.

Clodagh speaks a lot about the need for the IDA to continue to communicate well with its members, and cites the continuing efforts to improve this, such as the Association’s new customer relationship management (CRM) system, which should help the IDA to liaise with members better. She wishes the Department of Health would take on board an attitude of improving communication when it comes to discussions with dentists: “First of all if they would reply to us in a reasonable length of time and actually engage in meaningful consultation … It is hard to engage them”.
Another long overdue piece of dental work for the Government is the introduction of a new Dental Act to replace the current Dentists Act 1985: “In fairness to the Government, things have come in their way and they’ve been dealing with Covid this past year, but there seems to be no will to want to move [the Dental Act] along. They don’t seem to rate dentistry as something important, despite the fact that lots of dental issues impact on medical issues, and they should view medicine and dentistry as a whole rather than as separate entities”.
Clodagh advises dentists to stay strong and be part of the collective that is the IDA, as a group is always heard better than an individual: “I would encourage non-members to join the IDA. There are many advantages but the main one is being part of a group, where you have colleagues to help you out. We do have a mentoring service. We also have a mental health service, the Practitioner Health Matters Programme, and apart from that I would advise dentists to have hobbies and interests that take them away from the day-to-day strain of the job, and particularly if you’re a practice owner, the day-to-day strain of running a business”.

Clodagh is originally from Co. Mayo and did her Leaving Cert and dental training in Dublin, qualifying in 1992. She then took what was a familiar path to those that qualified around that time, she says: “When I left college, like everyone else at the time, I went to work in the NHS, in Northern Ireland. I worked there for four years and then I went off travelling for two years. When I came back in 1999, I did a few locums and then I bought a practice in November 1999 in Fairview”.
Around 2001, she took a job in the DDUH as a clinical supervisor and teaches in the Advanced Restorative Department. She also has a postgraduate diploma in conscious sedation in dentistry from King’s College London.
She has a ten-month-old shih tzu named Ferdi, and in her spare times enjoys ballet, yoga, bridge, and playing piano.

Colm Quinn
Journalist with Think Media