Over the past six months, Health Education England (HEE) and the Office of the Chief Dental Officer for England have been undertaking a review of dental education and training, known as Advancing Dental Care. The ideas that have been raised in this review could have profound and long-lasting impacts on the working lives of today's young dentists and current dental students.
The review is looking across the board at undergraduate dental training, postgraduate training, scopes of practice and how training is funded.
Radical changes to the dental profession?
The key initial ideas that HEE have set out would represent a radical change to our profession, with common-entry for dental and DCP students to joint dental science degrees or, alternatively, a modular-approach to dental training with professionals gaining groups of skills based on current treatment need that can be topped up at a later stage.
It is clear that the ideas on the table could have an enormous impact on the working lives of young dentists and current dental students. Yet this major review has been rushed through in just six months. That's why I've now written to Nicholas Taylor, who is leading this review, to set out the concerns and comments of the Young Dentists Committee on behalf of our colleagues.
On the few occasions when young dentists have been specifically engaged with, the opportunity for discussion and for HEE representatives to listen to our feedback has been curtailed. It just doesn't feel like the voices of young dentists have been properly heard or taken into account.
Fundamentally, it is not really clear what HEE are seeking to achieve with this review. We all know that there are many problems within dentistry, but it's not clear how the proposals being considered as part of this review are the solution to an overbearing regulator, a failed NHS contract, the rising stress levels dentists are experiencing and falling morale.
In fact, this project has explicitly ruled out discussion of the current or future reformed NHS contract. When 28 per cent of associates are planning to increase the proportion of private work they do, and many others are planning to work part-time or leave dentistry altogether, the priorities in relieving any workforce pressures must be reforming the NHS contract and improving working conditions and pay.
A reformed NHS contract?
A reformed contract that works for dentists and our patients would likely lead to many more colleagues looking to work for the NHS than is currently the case. It's concerning that neither HEE nor the Government appear concerned about the potential for destabilising NHS dental care if the workforce doesn't see the NHS as a good place to work.
It seems nonsensical that this review is being conducted with the intention to shape dental education and training for generations to come without any consideration as to what the contract will be in the future and what workforce that contract will require.
If this review is, as has been stated, solely about the NHS dental workforce then it follows that the NHS contract must be at the heart of these discussions.
Changing dental patient demographic: challenges ahead
There are also serious questions about the evidence base and assumptions HEE are making with this review. We have an increasingly ageing population and a larger cohort of older patients, with complex needs - especially in care homes and treatment for those with dementia. They will require a large number of highly-trained dentists to meet their oral health needs.
Are reforms that could lead to fewer dentists really the answer? I think, if anything, we are going to need more dentists in the future to meet the increasingly complex oral health needs of the population.
The proposal that has been floated to create a common-entry degree programme for all dental professionals is particularly troubling and there are serious questions about how it would work in practice, how entry requirements would be set and whether, with no clear career outcome, this would remain attractive to the most academically able students.
This has also been linked to proposals to change the structure of dental degrees, for example, leaving the training to be a dentist until the final two years of the degree. This would place significant pressure on students during the final period of a degree and would leave training and experience on key clinical skills to be gained in a short period, rather than gradually built up over the course of the BDS.
All of this would take England out of line with not only the rest of the UK but the European regulatory framework for the training of dentists – and indeed with that of the rest of the world.
A confused system of dental training?
There is a risk that all this will create a confused system of dental training with England out of line with Northern Ireland, Scotland and Wales, and a workforce in England that has been trained under two distinct and divergent systems of training.
How all this would work in practice is totally unclear and would likely cause many more problems that it could ever hope to solve.
This sort of comprehensive review should be a long-term project with the profession and other key stakeholders – in particular patients - properly engaged and consulted throughout. Instead, we've seen a rushed process that I fear most dentists aren't even aware of.
It is particularly disappointing that more has not been done over the last six months to engage with young dentists and to listen to the concerns that have been raised. The changes HEE are considering would have profound and career-long impacts on the working lives of young dentists and current dental students, and it is vital that they are at the heart of shaping the future of the dental workforce.
Nikki Patel, Chair
BDA Young Dentists Committee
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