Primary oral healthcare in Ireland: a health systems analysis of publicly funded contracted services delivered by the general dental practitioner workforce.

BACKGROUND: In recent years, Ireland has seen a decline in the number of private general dental practitioner (GDP) contractors delivering state funded dental care. Meanwhile, the National Oral Health Policy - Smile agus Slainte, proposes contracting more state funded care to private GDPs including care for all children and vulnerable adults. Understanding Irish GDP workforce characteristics will be key in evaluating services and informing workforce planning into the future. This study describes the primary oral healthcare system and GDP workforce indicators in Ireland and compares private GDPs by current state dental scheme participation. METHODS: Documentary analysis was used to describe and trace the origins of Ireland's current primary oral healthcare services. Secondary analysis of publicly available data was undertaken to map GDP workforce indicators to critical dimensions of the World Health Organization (WHO) 'Dimensions of Universal Health Coverage (UHC) relating to Human Resources for Health' framework. Private GDPs were compared by state dental scheme participation utilising available demographics. Descriptive statistics were computed using STATA/SE 17 software. RESULTS: Private GDP contractors have participated in the delivery of state-funded dental care in Ireland since the early 1950s. The number of private GDPs holding Dental Treatment Services Scheme (DTSS) contracts fell from 1,664 in 2016 to 787 in August 2023, while the number holding Dental Treatment Benefit Scheme (DTBS) contracts increased from 1,959 in 2016 to 2,384 in 2023. The number of private GDPs submitting claims on the DTSS has also declined from 1,318 in 2016 to 831 in 2022. DTSS contractors are more likely to be male and qualified longer (> 20 years) than GDPs holding only DTBS contracts. CONCLUSION: These findings are very relevant and timely to the planned policy implementation given that Smile agus Slainte is reliant on the greater provision of publicly funded care by private GDPs. There is a potential lack of GDP supply into the public system as the Irish Government seeks to implement Smile agus Slainte and meet its WHO obligations on developing UHC for oral health.