Sir, I would like to congratulate Nairn Wilson CBE, Chairman, Oral Surgery Services and training Review Group and his team for the excellent MEE report on Oral Surgery Services and Training. Although this report looked at this situation in England, its findings can be equally applied to all of the UK including Northern Ireland. Indeed, an important part of the evidence behind the report was gathered in Northern Ireland.

Northern Ireland has had 'high street' OS (oral surgery) practices for nearly 25 years. Currently there are four OS practices with two satellite practices, employing 12 OS specialists. In the East of the province, home of the majority of the population, there is good provision of OS services in primary care. If the Department of Health Social Services and Public Safety (DHSSPS) is supportive of high street OS practice then the West will also benefit from similar services.

In 2009, the OS practices treated over 12,000 health service patients. Patients are primary referrals directly from general medical and dental practitioners. Not every patient can be treated in the primary care sector and the OS specialists refer appropriate cases to their colleagues in secondary care. None of us would deny that hospitals need OS specialists with appropriate facilities to manage difficult patients. Unfortunately, practitioners without access to OS specialists in practice refer patients to secondary care who could easily be treated in an OS practice. If the recommendations in the report are implemented the problem could be solved.

Last year the Western Trust in Northern Ireland awarded a waiting list initiative contact to one of the high street oral surgery practices. These were patients that general medical and dental practitioners had already sent to the secondary care sector. Of 181, 180 patients were examined and treated without even setting foot in a hospital. One patient due to age was referred back to the hospital sector. The cost to treat these patients was just less than £30,000. Using the National Tariff figures the minimum cost per patient would have been £558. The total cost to a health authority would have amounted to £100k. Surely this must be attractive to any health authority in today's climate of financial pressures.

However, not everything is perfect even in Northern Ireland. The current 'fee per item' remuneration for OS specialists is totally outdated. It was designed for general dental practitioners. No OS practice could survive without cross-subsidising NHS practice with a significant number of private patients. The DHSSPS is currently negotiating with the BDA to design a pilot scheme for OS specialist practice. I sincerely hope the DHSSPS use this as a golden opportunity to create a new contract and thus cement high street OS practices across Northern Ireland for the benefit of all patients.

No system of care can survive and improve unless new young enthusiastic talent is developed and trained to take over from us 'oldies'. In Northern Ireland the training of OS trainees takes place in primary and secondary care. Trainees learn how to perform the surgery and run a practice. If the remuneration of specialists was addressed the system could be expanded to give the opportunity to specialise in OS to more trainees.

In life we cannot progress without change. This is one change I personally have been advocating for years and I look forward to when the recommendations of the report been implemented.