What's the issue?
Health Education England (HEE), through a project team with input from the Committee of Postgraduate Dental Deans and Directors (COPDEND), is currently conducting a review of the dental workforce and the way training is delivered for dentists and the dental team in England.
The review – called 'Advancing dental care' – explores the possibility of introducing a common point of entry to shared undergraduate courses for dentists, dental therapists, hygienists and nurses, with opportunities to progress to more advanced learning for different roles based upon projected demand for those roles.
HEE believes this has the potential to:
- increase flexibility for trainees – allowing students to only decide their profession further down the line based on their progression and the opportunities available, and allowing them to step on and off the training ladder as they wish
- increase flexibility for the service – making it easier to tweak output opportunities from the common entry baseline depending on projected numbers required in each profession
- ensure a more effective use of taxpayers' money.
They are also suggesting a modular approach to dental training for all groups, in place of the current 'spiral' curriculum (i.e a layer upon layer of training, repeatedly covering key aspects) that is in place in the dental degree.
What is the BDA doing?
We don't believe that there is currently a demonstrable need to change the existing training model and we don't think this review has been based on sufficient or appropriate evidence. We have serious concerns that these changes could potentially destabilise dental schools, and have a negative impact on both the workforce and on patient care.
We believe the project fails to consider the fundamental question of the future shape of NHS dental services in England, the issues with the current dental contract and its reform, and the changing shape of demographics, most notably, an ageing population. While the latter problem is mentioned, the proposed solutions by HEE during the project do not make much sense.
We have raised concerned about the extremely rushed nature of this process , as well as lack of meaningful engagement with stakeholders and patients, including the way feedback has been requested.
The General Dental Council and a number of other major dental organisations have also noted concerns about the project.
What is happening next?
Across the BDA committee structures we asked for feedback on the project's ideas and our proposed response. We submitted a detailed response to HEE at the end of March 2018, outlining our concerns – see a summary of our key points below.
HEE published its final report on 16 May 2018 and the BDA is currently considering how its feedback has been taken into account.
What can you do?
Be aware of the issue and please let us know if you receive any communications about the project from HEE.
We continue to welcome your views and feedback as this can be collated for further work and responses as this project might continue for some time, if HEE accepts the report from the project group.
If you would like to let us have your comments, please get in touch.
Our response to HEE on Advancing Dental Care
Our full response to HEE is available here.
Some of our key points included:
- Recruitment issues: We already see a looming and fast approaching crisis in recruitment of NHS primary care dentists in the UK. Of the practices in England who sought to recruit in 2016/17, two thirds (66%) reported experiencing difficulty filling the vacancy.
- Workforce structure: Dentists who have been trained in EEA countries currently constitute about 17% of the dental workforce in the UK, and deliver up to 20% of NHS dentistry. Following Brexit, the UK may no longer be an attractive country for EU dentists to come to for some time, increasing the need for home-trained dentists.
- NHS dental contract reform: the review appears to ignore the fact that the NHS contract is currently under reform and whatever the outcome of these reforms, may have an impact on the structure of the workforce. We believe this training review should wait until the new contracting arrangements have been put in place.
- Dentists morale: Our research shows that morale amongst UK dentists is at an all-time low, 58% of NHS dentists have said they are looking to leave in the next five years – either to move to fully private practice, move abroad, or to quit dentistry altogether.
- DCP roles: The assumption that DCPs could take over a large proportion of the work currently carried out by dentists, appears to ignore the current NHS regulations, which state that dentists have to give a diagnosis before DCPs carry out any treatment. If the regulations were to change, patient safety could be compromised and cases of litigation may rise.
- Savings to taxpayers: the review makes claims that the changes would bring savings to the taxpayer. We believe the changes could add significant costs to the NHS, which do not appear to have been considered.
- Quality of training: the suggested changes to dental education would destabilise dental schools, bring UK dental education out of sync with Europe and the rest of the world, and make the dental profession in England a less attractive profession to work in, meaning we can't attract the top talent to work in dentistry.
- Locality: the review's remit is England-only; the effects on the other UK nations have not been considered publicly in any detail.
- Feedback/representation: It has not been possible to raise concerns in any open forum setting, only in small working groups; we felt any questions and answers after presentations were positively being discouraged.