‘I feel like I’m drowning’ – can NHS dentistry actually change?

Nishma Sharma opens up about her views of the NHS Long Term Workforce Plan and why attitudes towards NHS dentistry need to desperately change.

What were your first thoughts of the NHS Long Term Workforce Plan?

If you look at the overview in the summary, the first thing that was apparent is there wasn’t a single mention of dentistry or dental. So straightaway, I feel that tells you a lot about where we stand within the NHS and the plan in general.

Why was there no mention? Why are people’s views not being taken on board? Patients are desperate for dentists.

When you look at the actual data, it’s great that this plan states it is supporting advances in dental care. This is great, but we’ve heard it all before.

It says, ‘we’re going to get more dentists on board, we’re going to get more dental schools open’ – again, that’s really  great, but we can’t even sort out a contract.

When they talk about a long-term plan, I didn’t realise it was that long term. What do I say to Mrs X? I’m sorry about your pain, but if you could just wait 25 years for someone to help you?

Or there’s the suggestion of getting a load of dentists over from another country. But then they can see how corrupt the system is here and then they won’t want to work in it either. I don’t see how that’s an alternative.

I also have a moral issue with getting people from overseas. Certain developing nations need to keep the talent within their country – we shouldn’t be going out there and exploiting the system for its talent and bringing it over here.

But even then, if the contract is that rubbish that we don’t want to work in it, why would people from overseas want to work in it?

So what are we doing right now? That’s the issue that I have with the plan.

The plan suggests encouraging newly-graduated dentists to work in the NHS with a ‘tie in’ period. What are your thoughts on that?

This suggestion went straight to the ‘Daily Fail’, which led with the headline that dentists will be forced to stay in the NHS. This is just catastrophising and it’s absolute nonsense.

What needs to happen is the narrative needs to change. I do a lot of work with foundation dentists and the younger generation. Often they do feel that when they qualify, they would like mentoring and support. Some don’t feel it – and that’s fine, go and do your thing.

But for those who do feel they need more support, it shouldn’t be seen as a tie in, but rather more time spent on foundation training or mentorship within an NHS environment. What’s wrong with that? I do think that should be more by way of keeping them within the NHS – it’s not ‘practising’, and then do it privately on ‘real patients’.

You should always maintain your integrity when carrying out treatments. When I’m seeing NHS patients, I am quicker than I was as that comes with time. Asking dental graduates to work at the same rate is akin to saying you’ve learned the theory in piano, now go and play a bit of Gershwin.

Surely my work will be of a certain skill compared to someone who’s just graduated? Yet, within this system, you’re all playing the same. We need common sense in dentistry. And that might mean that people stay within the NHS because it’s incentivised and because it’s a really great place to work. That’s what will make us stay in there – not because we’re being ‘tied in’. That’s the wrong narrative.

How can NHS dentistry survive the next 12 months?

Without sensationalising, it’s really hard right now.

Like I said, for 20 years I’ve put into this and it’s just not fun. I work in a fully private practice, and I work in mixed practice. The private work is in a very affluent area. But when I’m working on the NHS, I am treading water, I’m treading water, I’m treading water – and I feel like I’m drowning.

I’m seeing 30 plus patients a day. It’s great banter, I like to talk a lot and it’s lovely getting to know them and all the rest of it. But I’ve still got to hit a target. How do I hit a target? They don’t need anything. I’ve taken care of them for the last 10 years. They don’t need anything. So, where am I supposed to pull this target out from?

So you’re treading water and it’s exhausting. You feel overwhelmed at the end of the day. I’m shattered, demoralised, and I’m devalued by the system that I work under. You can’t help but compare and contrast.

At the fully private practice, I am able to choose which stroke I want to swim. I’m doing lengths, I’m going back and forth. It’s good for me and it’s good for my mental health and I’m really enjoying it. It doesn’t come without its own stresses. I’m still exhausted but that’s the nature of the beast.

What is it about the NHS that will make people want to stay in it?

Personally, I think that ship has sailed. I think it’s just too little too late. I’ve been waiting 17 years for change.

I don’t want to use the term lightly, but it’s gaslighting. We’re slowly being chipped away, demoralised and devalued, thinking, ‘change is coming, change is coming. It’s all in your head, this is fine’.

But the system doesn’t work for anybody. It’s mental trauma – the guilt it gives me when I’m dealing with patients on a day to day basis, knowing that I could be offering them something else or I could actually be taking longer on it.

I think one of the biggest issues to patient safety at the moment is the current system that we work under, by far, and something needs to be done with that system.

I think the regulators are aware of this – I do think their hands are tied in some ways. Something drastic – incredibly drastic – has to happen right now.

If there isn’t a solution, stop gaslighting and let’s try to figure out how we can help people reduce inequalities. Maybe it is time to think about a core service.

I don’t see how we’re going to get around this.

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