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Dental workforce challenges in 2022

Roz McMullan, NI Council Chair, on the key challenges facing the dental workforce in Northern Ireland over the next three years.

Roz McMullan
Roz McMullan Chair of Probing Stress in Dentistry in Northern Ireland

The start of the year is always a good point for reflection and setting goals. This has been difficult over the last two years, given the need to navigate the acute stages of a global pandemic and manage future uncertainty. Here is how we are focusing our efforts, to support our members and the profession over the next three years and beyond.

Reform is overdue

Although it is often referred to as "recovery", the COVID-19 response has changed how we operate to such an extent that we cannot go back to how we were.

The GDS contract was broken before the pandemic, and the viability of NHS dentistry in general practice has, for some considerable time, depended on the private income of practices balancing the books. The contract in Northern Ireland (NI) remains a fee per item model, where the importance of prevention is not recognised and patients with greater care needs are not prioritised.

The elderly population with complex co-morbidities is a growing patient base and the pandemic response has caused a worrying reduction in oral cancer diagnosis. Going back to full waiting rooms and insufficient time with patients cannot be an option for GDPs.

Around half of associates and practice owners confirmed they intend to increase their proportion of private work over the next five years.

These problems are now widely recognised by everyone, from individual dentists and their teams, to those responsible for commissioning the services and training the workforce.

This is clear from the most recent BDA survey which showed associates' reluctance to work in the NHS as one of the main reasons (40%) practice owners are finding it difficult to recruit.

The survey also revealed a collapse of morale in dentistry, with 0% of associates and just 12% of practice owners in NI describing their morale as 'high' or 'very high'. Respondents indicated that financial uncertainty is one of the major causes of stress. Around half of associates and practice owners confirmed they intend to increase their proportion of private work over the next five years.

These startling statistics illustrate the urgency of a sweeping reform programme to make Health Service dentistry sustainable and attractive for the profession. It simply must serve as a wake-up call if there is to be a future for Health Service dentistry.

Workforce struggles

Care backlogs in the CDS are having a real impact on oral health. However, the CDS dentist workforce also has a potential crisis looming, with one third due to retire in the next eight years. It is hard to see that, even if they could start tomorrow, they will be able to recruit and train at sufficient pace to replace the potential loss of skills and experience and avoid some service disruption.

The success of specialist services, depends on attracting the brightest and best to training pathways. Offering trainees lower salaries than those provided in the rest of the UK, places NI and our patients at a disadvantage now and for many years to come. This continues at consultant level, where hard-working dentists are without mitigation for adverse pension penalties or Clinical Excellence awards, both of which are enjoyed by their counterparts elsewhere in the UK.

A new service delivery model to deliver targeted, preventative and evidenced-based care to the population, will influence the workforce we need. The present fee per item model does not support the business case for dental therapists in the GDS and we have had no dental hygienists trained in Northern Ireland for some years. Both groups provide an invaluable part of the workforce in the CDS, where the service can arguably use the right skills, in the right place, and at the right time. However, our CDS colleagues tell us that recruiting to these grades is increasingly difficult.

Dental nurse training has been a problem in Northern Ireland for many years, and there are significant barriers to valuing what nurses can offer in the dental workplace. Many are leaving for similarly or better paid jobs with a better work/life balance.

The challenge ahead

Workforce planning is not easy. But for the sake of NHS dentistry and the patients who rely on it, the profession and government must use all their skills and knowledge to secure a highly skilled and valued workforce. Our patients need and deserve quality and timely dental care.

The next three years will be pivotal for the future of dentistry in Northern Ireland.

We are clear that the time for bold reform in dentistry is now. In the next three years, I believe we can build a solid foundation for dentists and their teams and secure the care our NHS patients so desperately need. The BDA will continue to challenge those charged with leadership in dentistry and support our members – whether working in NHS, mixed or private practice, or in the Community, Hospital and Academic services.

The next three years will be pivotal for the future of dentistry in Northern Ireland. Your committee representatives, supported by the BDA Northern Ireland office, will continue to ensure your voice is heard. Together we are stronger.