NHS People's Plan: Good ideas on workforce, but funding remains elephant in room
3 June 2019
The BDA has welcomed much of the overall approach to workforce planning set out in the Interim NHS People Plan: the future dental workforce published today by the Future Dental Workforce Group, as part of the NHS Long Term Plan.
The document covers contracts, training of dental professionals and workforce integration. It makes a clear link between contract reform and workforce planning, which had been overlooked in the first phase of the Advancing Dental Care project (ADC) run by Health Education England (HEE).
Dentist leaders have also welcomed recognition of the importance of the Adult Oral Health Survey in workforce planning and commissioning, and the pledge to support the business case for future work. The future of the survey has long been in doubt, despite being a hugely important tool to show and forecast trends in the state of oral health and the oral health needs of the population.
The BDA has however expressed concern, and called for more detail on changes to training pathways for dentists and DCPs. The Association has been concerned that models championed in the ADC plans raise the risk of deskilling the dentist workforce, while ideas for more skill mix in NHS general dental practice are not underpinned by any workable model. The 2018 report on the first phase of ADC was in the main an outline of the need for actual evidence-gathering of workforce numbers, distribution and intentions, rather than a firm policy commitment into any given direction. While there are some positive ideas in ADC Phase 2, there are aspects of the project that are not supported by the profession, and information sharing with stakeholders has been lacking from some of the work streams.
The NHS Long Term Plan received criticism for failing to outline a coherent strategy for dental services when it was published in January. Despite the headline focus on prevention, no tangible commitments or investment were offered to NHS dentistry. Budgets for NHS dental care have failed to keep pace with inflation and population growth, with government spend per head on dental care falling by 29% in real terms since 2010.
A recent national survey of dentists conducted by the BDA suggested nearly 3 in 5 practitioners (59%) based in England are now planning to scale down or leave NHS work entirely in the next 5 years. Those with higher NHS commitments are the most likely to leave - 67% of dentists seeing more than 75% NHS patients expressed their intentions to move on – falling to 51% among those doing less NHS work.
BDA Chair Mick Armstrong said:
"Officials have finally recognised that you can't talk workforce planning without addressing the NHS contract. It is only right that a reformed contract and retention are front and centre of this document.
"Decent planning rests on decent data. So, we are delighted to see real support for the Adult Oral Health Surveys, that looked like falling prey to cost cutting.
"Dentists will still approach terms like 'flexible training models' and references to 'optimising scope of practice' with scepticism. This smacks of deskilling dentists, and parcelling off responsibilities to an extended DCP workforce.
"But the elephant in the room remains funding. 'Do more with less' remains the official mantra, thanks to a budget that's failed to keep pace with both inflation and rising demand.
"Warm words on the workforce are not compatible with cuts by stealth; the powers that be must be aware that significant extra funding will be necessary for any of the decisions to be taken with regard to dental workforce training and retention issues."
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