Dentistry Census – what does the cost of living crisis mean for dental nurses?

Dentistry Census – what does the cost of living crisis mean for dental nurses?We recently shared the Dentistry Census statistics on pay and earnings within the profession. Here, we look at what this means for dental nurses in the context of rising costs and high inflation.

Dental nurses are the lowest paid member of the dental team. With 99% of dental nurses made up of women, feedback in the Dentistry Census reveals that 88% are earning less than £25,000.

At the start of the year, Dentistry – in collaboration with DD – published its first ever Dentistry Census, the biggest ever survey of dental professionals in the UK.

Many dental nurses are expected to pay their own GDC annual retention fee (ARF) and indemnity cover as well as pay for their CPD and meet the regulator’s expectations outside of working hours. Amid a cost of living crisis, this is hugely challenging.

Coping with the squeeze

Fiona Ellwood is president of the Society of British Dental nurses.

With a lack of dental nurses in the profession and an exodus to better-paid jobs, she says she is also hearing of golden handshakes and dental nurses taking up agency and locum work because salaries are higher.

So how are dental nurses who remain in the industry coping with the squeeze on their budgets?

Fiona says: ‘It is difficult for many; some are already stretched, and some have more than one job to make ends meet. Many have taken additional qualifications and courses in the hope it will enhance their salaries, only to find out that employers do not value those skills.

‘Student dental nurses are in a more challenging place. Some are perhaps on minimum wage in some cases and many on an apprenticeship wage which currently is:

  • £4.81 per hour (under 18)
  • £ 6.83 per hour (18-20 years old)
  • £9.18 per hour (21-22 years old)
  • £9.50 per hour (23 years and over).

Historic attitudes

‘Some apprentices are fortunate that employers pay an additional fee. Those not on the apprenticeship training pathway have no set salary guide other than the National Minimum Wage,’ she says.

‘Many expect a recognised salary increase when transitioning from being a dental nurse student to a registered dental nurse. This happens in some cases, but many receive an increase that is unlikely to make a noticeable difference at the best of times, without the huge rise in the cost of living.’

Fiona laments historic attitudes that have failed to recognise and reward accomplished dental nurses.

She says: ‘What was enormously sad this year was that established and competent dental nurses were being given a wage rise so that they were above the minimum wage. Some corporate groups have bandings that reward and recognise additional duties and qualifications, others don’t. A survey carried out in 2020 showed that the salaries in the corporate settings varied.

‘Dental nurses’ salaries are not always higher because they work in the private sector. What will come as no surprise is that in community, secondary care and secure settings, salaries are different again. As are salaries in the armed forces.

‘There are quite clear pay disparities. Those dental nurses in primary care were never considered in the discussion for Agenda for Change in 2004. Despite many dental practices holding NHS contracts. Many years ago, the NHS Whitley Council pay scale for general nurses was used by some as a guide, but it was only a recommendation and rarely adhered to.’

Adaptability and flexibility

Fiona is also concerned that those dental nurses who wish to progress often end up having to move away from being patient facing.

‘Those who have undertaken undergraduate degrees, masters’ degrees and doctorates and return to the clinical field are not guaranteed either the financial or academic recognition.

‘Year-on-year salary surveys are undertaken but nothing comes of them. The picture and trends hardly alter and the pandemic has exacerbated the issue.

‘But this is not a new problem. Salary always scores very highly when asking dental nurses why they are leaving the profession. Let’s not forget the hard work undertaken throughout the pandemic. This includes the adaptability, the flexibility and the willingness to step up when needed.’

Fiona has yet to see any move within the profession to increase dental nurses’ pay in order to retain their expertise.

‘What we have seen is a change in how dental nurses are working. There has been a huge uptake in dental nurses either going to work for agencies or becoming self-employed. We are also seeing social media being utilised to ask for clinical cover – and at short notice. This is a concern.

‘Training and adjustments are unlikely to be as in-depth or exist, cohesive team working may well be challenged and the smooth running of clinics, too. When planned and carried out in a professional manner, it is very different but could still be disruptive.

‘We are hearing of dentists having to pay agency dental nurses far more than they would have been paying if they had given their dental nurse the salary increase that she/he may have asked for.’

Negotiating better terms

Whilst Fiona recognises not all dental nurses feel they are underpaid, her and SBDN colleagues are seeing incentives rather than salary increases. But where once this may have been appealing, currently with the cost of living salary increases are appreciated.

Fiona says: ‘This perhaps folds into a further point, that there are very few professional groups who are vocationally trained at a level 3 or the equivalent and who are registered with a regulator. Dental nurses in the last survey talked about being valued, respected and listened to’.

So, would she advise dental nurses to try negotiating better terms and conditions?

‘There is no “one size fits all” answer to this question, simply because dental nurses work across different settings and in very simple terms, are paid from different pots.

‘Those working in primary care are really working in an independent business. Negotiations are quite simple, if these conversations are deemed to be appropriate. But many do not feel able to ask.

‘I recall supporting one dental nurse who asked the question and who had presented a very good rationale to her employer. The answer was an instant “yes” – no discussions, no arguments. She asked why she hadn’t had a raise before if it was that easy. He said because you never asked.

‘The truth is many do not find those conversations easy. In the corporate settings, the decisions tend to be business-wide and individual cases can be challenging to address. As noted previously, the banding systems in the secondary care systems set out a framework which is mapped to pay grades.’

Marked difference

Unlike general nursing, dental nurses do not have a trade union to tackle matters of pay and conditions head on, or that has driven any noticeable change when it comes to dental nursing salaries.

Fiona says: ‘This has long been a bone of contention. We are a million miles off the likes of the Royal College of Nursing and the Nursing and Midwifery Council. But we have the same workforce supply and demand issues, even if there is a marked difference in patient need.’

SBDN provides support, guidance and advice and can provide mentoring and coaching on a 1-2-1 basis. They offer this free to members as membership benefits, these services can be accessed by non-members too, they are part of the chargeable offers. They can signpost dental nurses to support teams outside of SBDN who they work with.

SBDN also supports career advice and help members to consider their options, we offer support to structure their CV and offer help in preparing for interviews.

Dentistry Census acknowledgement

From August to September 2021, we carried out the first ever Dentistry Census. This is the most comprehensive survey the UK dental profession has seen.
Dentistry, in collaboration with DD, undertook the extensive survey to explore the current state of the profession and the future implications for dentistry.

We would like to thank all the dental professionals who took part in the Dentistry Census. We would also like to thank DD for their support.

*The Dentistry Census is based on a survey of 816 dental professionals from across the four nations. It was undertaken from August – September 2021, in collaboration with DD using Surveymonkey to collect the data.

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