International Dentists’ Day falls on 9 February, but there’s not much that NHS dentists are celebrating. Tamara Milanovic speaks with Eddie Crouch about his experiences fighting for the profession.
Could you please introduce yourself?
I’m Eddie Crouch, a dentist working in south Birmingham, providing orthodontic care. I’m the chair of the British Dental Association (BDA) Principal Executive Committee. It’s a board of directors of the BDA that deal with policy, with many committees under them.
My background is in dental politics. I’ve been a part of the General Dental Practice Committee (GDPC) in the past and I’ve chaired the Local Dental Committee conference. So since 2007, I’ve been very active in dental politics.
How would you describe the current climate in the profession and how everyone’s feeling?
It depends on what service you’re working in. Many of my private colleagues are seeing very busy appointment books. They’re very happy with the way that they’re delivering care.
Sadly, my NHS counterparts aren’t very happy and there is a significant shift in the way that the profession is moving. There is an exit from the NHS.
Many colleagues seem to be reducing their commitment to the NHS, if not handing back contracts. Many of them seem as though they’re planning for a future career outside of the NHS. And many have given up hoping that reform of NHS dental contracts is over the horizon.
Certainly throughout the pandemic, a lot of people saw what it was like to take their foot off the treadmill of NHS dentistry. They were able to provide a different quality of service for their patients. And when it started to ramp up after the pandemic and go back to hitting targets within an NHS system that seemed impossible to do, they re-evaluated their career and started thinking elsewhere.
Many younger colleagues aren’t even seeing their future entering the NHS system. They’re going straight out of dental school into private practice.
What changes might the profession need to see to feel appreciated again?
At the moment, industrial action is very popular across the health service. Many people who are taking industrial action – nurses, junior doctors etc – have seen significant reductions in their pay in the last decade. But probably at the top of any league table are NHS dentists.
We’ve seen a 30% decrease in real-term income in the last decade. And the latest Doctors’ and Dentists’ Review Body (DDRB) recommendations for a 4.5% pay uplift, when it’s translated into a 4.75% uplift in contracts, will not give dentists a pay uplift.
Many people are working in a dental practice where dental inflation is 11% or more, so the long-term future of the NHS certainly needs more funding. I’m sad to say that in my two years as chair of the BDA, I’ve engaged with five ministers responsible for dentistry, which in itself is a significant problem.
If you haven’t got consistency in the people that you’re talking to, you can’t make progress. I met Steve Barclay a few weeks ago. I’m probably the first chair of the BDA to meet the secretary of state for probably more than 20 years.
It shows the significance that the government is putting on this. But we need to see more action. They tell me that there is no more money to put into the system.
If there is no more money, I think we need to have an open and honest discussion about what level of service they want to buy from dental practices to maybe provide an urgent and emergency service only for the population.
Do you see that as one of the more realistic solutions going forward?
To retain the profession, I think we need terms and conditions in a contract that encourages people to work in the NHS. The recent tinkering and marginal changes that have happened with the contract, I think even the politicians accept that it isn’t going to be sufficient to retain a workforce.
We’re losing people daily. They’re either reducing the amount of time that they’re working in the NHS or they’re considering leaving, so we need contractual reform. We need it more rapidly than the politicians believe is necessary.
And I believe we need more funding. When other areas of the NHS have needed money in the past, money has been found. So, I don’t accept that there is no more money to improve dentistry. But if it is their only answer, then we have to look at the pot of money that we’ve got, and what service we can deliver with that.
We can’t deliver a comprehensive dental service. We only ever had sufficient funding for 50% of the population going back to 2006. So, we’ve had a problem that’s been building for a long time.
How is the BDA helping to put these changes in motion?
The GDPC is negotiating with NHS England on future reforms of the NHS contract. And my colleagues around the UK in Scotland, Northern Ireland and Wales are engaging with their local governments to improve the situation for colleagues in those areas.
It’s frustrating. We’ve been calling for changes to the 2006 contract since it was introduced. And we’ve had nine debates in Parliament in the last 12 months, which is unprecedented coverage in the Houses of Parliament.
We even had two questions recently in Prime Minister’s Questions, so dentistry is at the highest profile that I think it’s ever been at in my career. If we can’t secure improvements for patients and dentists working in the UK in this current climate, then I don’t think we’ve got any chance at all.
I’d like to thank all the colleagues that have lobbied and educated their MPs. I think the BDA has been very successful recently in working alongside patient groups, with Healthwatch and other campaign groups, so that they understand that this problem is not the making of greedy dentists. It’s the problem of the politicians.
We are seeing an improvement in the overseas registration system for dentists. Do you think that will help them feel more appreciated? Is this a potential solution?
Every politician that I speak to – and I’ve spoken to about 120 in my two years as chair of the BDA – starts off the conversation believing that this is a workforce issue. So if we get more dentists delivering the service, the problem will go away.
Certainly, the changes that are being made by the General Dental Council to improve a very inefficient and poor overseas registration examination entry system will improve the situation for a lot of colleagues who are wanting to come and work in the UK.
But my worry is that they will come and work in the UK, potentially initially in the NHS. I can’t see why anyone would think that this is a system they’d want to stay in. My concern is that they will come and work in the UK, stay a very short time in the NHS and leave to work in the private sector where they can deliver the type of dentistry that my colleagues tell me they are able to do outside the NHS.
We need a new system
If you fill a bucket with a workforce, and you’ve got holes in that bucket and dentists are leaving, no matter how quickly you fill it with other people coming in from abroad, you’re not going to solve the problem. You have to solve the conditions and working environment for those people irrespective of where they’ve qualified. Whether they’ve qualified in the UK or elsewhere.
You need a system that encourages people to deliver quality care for their patients. A system they’re happy to work in and is conducive for them to provide good dentistry.
The other thing that I think politicians believe is that the situation will improve if they build a dental training establishment in their area. I think it might for skill mix. If they recruit from the local area, they may get those people to deliver services in that area. Skill mix is part of the solution, but it’s not the whole solution.
How can patients and the rest of the dental team help show their appreciation for dentists?
I think many patients do appreciate their dentist. Every survey that’s carried out and every patient group that I talk to highlight that they value their dentists. So, I think colleagues do feel appreciated.
There’s nothing better than getting someone out of pain. Dental pain is the worst and to be able to solve people’s problems within a short phase of treatment is very rewarding to colleagues.
There are some patients that are getting incredibly frustrated about not being able to access services, and I think people at the front desk of dental practices are getting far more abuse than they got during the pandemic.
Many people at the end of the pandemic were very appreciative of a dental service. They saw what it looked like without a dental service. So when it started again, they were very appreciative. But I think some of my colleagues are getting the backlash now of people being frustrated about not being able to get into services.
There have been schemes developed with the local commissioners to improve access for urgent and emergency care. They’ve been commissioned outside of the unit of dental activity, which has been incredibly popular with colleagues in some parts of England.
‘We have significant problems across the whole of the UK’
I believe there are ways to deal with some of the problems of access for urgent and emergency care, and the population understands the problems that dentistry is having. There are far fewer headlines of greedy dentists leaving the NHS.
Many people understand that this is a business viability issue and that working in a system where the NHS pays you less than the costs you are incurring, isn’t a business model that’s sustainable. I’m happy that we’re working hard on behalf of the profession. The BDA is doing its utmost to improve the situation. Not only for dentists who are members, but also for dentists who aren’t members.
And for the dental population out there asking, ‘Why isn’t the BDA doing such things?’ The BDA needs your voice. The BDA needs your resources to work on your behalf. So, if you can become a member of the BDA, it will become more effective.
From a patient’s point of view, we are their advocates. We’ve been dealing with groups across the country, such as Healthwatch and an established campaigning group called Toothless. There are no longer just isolated dental deserts. We have significant problems across the whole of the UK and the recent BBC research showing only one in 10 dental practices taking on new patients is a serious concern for the population.
Do you see an optimistic future for dentistry?
I do. We have very qualified, experienced and capable dentists working in the UK. There will always be a demand for the quality services that colleagues provide. So, from that point of view, I’m extremely optimistic.
Am I optimistic for an NHS system being sustainable in the long term? No, I’m not confident. I think we may be past the tipping point where NHS dentistry may not exist for the whole of the population in the future, so I’m not optimistic at all.
I hope that the politicians realise where we are with that and work more urgently to solve that. The recent meeting I had with Steve Barclay should be a series of meetings. Those meetings need to be more frequent, more urgent, more high profile, with a plan that the profession can see is going to deliver in a short time.
Because if they haven’t got any of that, then I’m not optimistic for an NHS dental service in the future.
Is there anything else that you’d like to add?
I’d like to thank all the colleagues out there that have been through an incredibly difficult time working through the pandemic. We sadly have a real recruitment problem for not only dentists, but also the dental team members.
We need remuneration packages for NHS dental practices that allow us to employ quality dental nurses, dental hygienists and dental therapists as well as practice managers and all the other people in the team. Unless we get contracts that allow that to happen, I’m sorry for the exodus of people with great skills who have trained to work in dental teams that don’t see their future in dentistry.
It’s a real shame.
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