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Hospital dentistry: The looming crisis has arrived

An overview of the challenges facing all grades of dentists working in Scotland.

John Ho-A-Yun BDA SAS representative Scotland; Lead, SHDRG

Covid backlogs aside, the looming existential crisis in hospital dental services is now affecting all staff levels. Through training grades, specialty doctor and specialist (SAS) grades and consultants there are problems both now and stored up for the future.

Pay cuts and cancelled awards

The most recent 4.5% pay offer is a disappointment to put it mildly. It is another effective pay cut. With current inflation expected to hit 11% this year, it will not address pay erosion. Adding insult to injury, consultants in Scotland were told in June that once again the distinction awards have been frozen in value and that no new awards or progressions are permitted.

The most recent 4.5% pay offer is another effective pay cut.

The Scottish Advisory Committee on Distinction Awards (SACDA) website meanwhile says that any new applications will be “immediately rejected”. These funds are apparently ring-fenced. With this freeze having been in place since 2010, we would ask where have the monies saved by natural wastage gone? Are new awards going to be available and if so when?

We, along with the BMA, DDRB, medical schools and Scottish Academy of Royal Colleges, are concerned by this. As it stifles innovative activity at the top levels of the hospital-based profession and will, it is contended, lead to the migration of staff elsewhere.

Staffing crisis is worsening

The NHS staffing crisis in England has been reported on extensively, but is in fact UK-wide. There are staff vacancies here in Scotland which persist in being unfilled despite multiple adverts. Numbers vary by specialty and location. There is also concern that where posts are unfilled, the local specialist services are severely attenuated or simply withdrawn.

The local specialist services are severely attenuated or simply withdrawn.

Alarmingly, Dental and Maxillofacial Radiology trainees are very thin on the ground, compounding a lack of future consultants in this specialty. In dental microbiology, there is a complete lack of trainees UK-wide. With the Covid pandemic highlighting the need for adjustments in cross infection management, where will future research and advice come from?

What about trainees and succession of consultants? The significant pay disparity that exists between training grades in England and Wales, and those in Northern Ireland and Scotland is of major concern. It undervalues their work and is an active disincentive to take up training in these countries.

The BDA has called for a strategic approach to dental workforce planning and will pursue this with the Scottish Government.

Some progress for SAS grade dentists

In Scotland, negotiations are at an advanced stage for the new SAS contracts, and BDA SAS members should be prepared to exercise their voting rights. Whilst SAS dentists are a minority in Scotland our numbers may be influential in accepting or rejecting the proposed offer, if the vote is close run.

BDA SAS members should be prepared to exercise their voting rights.

All SAS dentists in the UK are disadvantaged in career progression and in specialty educational opportunities. However, I am pleased to say that a new committee has been set up by the Dental Faculty, Royal College of Surgeons, England looking at education specifically for SAS grades.

I attended its inaugural meeting last month and look forward to representing members’ views, and the exciting developments to come.

I am hopeful for eventual clarity on the GDC Specialist List Assessed Application (SLAA) route and potentially access to specialist exit exams, without a training number, via the royal colleges’ dental faculties.

In the meantime, I’d also remind you to engage with your local SAS educational advisor. They will be able to advise on SAS funding for many existing educational courses – the SAS development fund is a use it or lose it central pot of money!

Looking ahead

We face Covid backlogs, staffing pressures, a moribund consultant award scheme, pay offers which do not attempt to address real terms cuts resulting from over a decade of decline, and UK nations trainee pay disparities which will erode the future of specialist services if not addressed.

We face a lot of challenges and despite the rather gloomy outlook, I promise you that we are working hard on your behalf to monitor and highlight these issues and hold governments to account.