Following on from last month’s part one of their review of the dental landscape in 2023, Nigel Jones continues his discussion with BDA chair Eddie Crouch.
Nigel Jones (NJ): For me, the fundamental problem is the supply constraints of dentistry. That’s not necessarily a bad thing. It puts the profession in a position of control because they’re in short supply. But I’m still struggling to understand how we address those supply constraints within the NHS Long-term Workforce Plan. I can’t see how it’s funded or practical.
The government talks about 500 extra hygienists and therapists in 2030/31. But we don’t have anything like that much time to solve things. So that points towards importing overseas dentists. Do you think that the loosening of the legislation relating to the GDC will help?
‘We don’t know if we have enough dentists’
Eddie Crouch (EC): The problem is we don’t know if we have enough dentists. The initiatives to find out how much work dentists are doing in the NHS will provide useful data to help formulate how we develop the workforce in the future.
We’ve seen from the marginal changes that the amount of work therapists and hygienists are doing is tiny. It’s probably 5% of the courses of treatment. For them, it’s still more attractive to work outside the NHS than within it. In meetings with hygienist and therapist organisations, they tell me they don’t want to be regarded as a cheap workforce. They won’t receive pensions and other NHS benefits so they don’t want to become a cheaper associate model for the NHS.
The BDA has done some work on the workforce plan and it’s clear that a lot of it is soundbites that make it look good. We’re under-resourced with teaching staff within dental hospitals as it is. Many students are struggling to get clinical experience because of the lack of staff to supervise on clinics and a nurse shortage to support students, meaning they end up nursing for other colleagues.
‘We’ll probably need a doubling of the NHS dentistry budget’
And if there’s a sudden expansion by 40%, we’ll need a workforce and buildings to deliver that training. If you then tied graduates into the NHS afterwards, we’ll probably need a doubling of the NHS dentistry budget to accommodate all those people who would want activity within the NHS. None of it adds up.
Also, a big factor within the workforce plan was increasing the amount of NHS dentistry performed by dentists with low levels of activity. That’s unlikely to happen as people don’t want to do as much NHS dentistry, but the plan includes a significant amount of increased productivity with more people working full-time in the NHS.
‘That will never be enough’
NJ: That’s what I don’t understand because Practice Plan had a bumper year with record numbers of people signing up to plans. We had one practice that went from zero to 5,000 private patients on plan in two months.
The speed at which people can make this change now, I can’t see why anyone would want to go back. They’re now in control of their own destiny and have more patients than they need. I can’t see how they can make the NHS attractive enough to appeal to people. I appreciate there’s a social conscience element to it they could tap into, but that will never be enough.
‘Patients get it now too’
EC: I agree. But the point you’re making about 5,000 people signing up shows that patients get it now too. The British Dental Association (BDA) has been successful at highlighting to the population where the blame for the problems lies.
When I started in this role, I had several difficult interviews about greedy dentists making the most of not allowing people to be seen on the NHS, but they could get an appointment the following day privately. I didn’t have an interview like that at all last year.
But I sense the budget to increase the training of 40% more dental professionals isn’t there, and a simpler option for any government will be to recruit from abroad. And that’s where the GDC changes come in. The GDC has been put under huge political pressure and stood firm on its remit, which is to protect the population. You can’t relax standards to allow just anyone to come in. It is important that overseas dentists are assessed.
So, the changes to the overseas registration exam (ORE) are welcome, but they aren’t going to be quick enough. I hear people complaining at meetings about how difficult it is for them to survive with their NHS contract because they advertise vacancies and no one applies.
‘I don’t see how an NHS practice can compete’
NJ: That seems to be the big challenge. When there aren’t enough dentists, then their price goes up. And I don’t see how an NHS practice can compete with a private one that can pass on additional costs to patients.
Moving onto funding for NHS dentistry: I’m dismayed the integrated care boards (ICBs) may not have to ring fence it. I saw a fabulous opportunity to redirect funds to people that need it most, but now I’m wondering if the ICBs are just being realistic? It doesn’t matter if the funds are there, as the dentists won’t be.
‘It’s hard to put that genie back in the bottle’
EC: I think it’s down to the shocking way the government dealt with industrial action. I met Steve Barclay (former Health Secretary) in January last year before any industrial action and laid out strongly what the government needed to do about pay restoration. We wanted an indication that they recognised the argument that in dentistry, pay had diminished significantly by possibly 30%.
It’s been handled appallingly. They didn’t adhere to the Doctors and Dentists Review Body’s recommendations that there should be proper negotiation with the BDA about expense elements to ensure dentists got a 6% pay uplift.
Dentists won’t see a 6% pay uplift because of the way they’ve negotiated things. Industrial action has cost the NHS huge amounts to bring in support from locums. The overspend is greater than the amount they would’ve paid if they’d negotiated to pay restoration, and now they’re looking to the ICBs to bail them out.
NJ: I’m concerned this is the thin end of the wedge. They take the money to compensate for the industrial action, but then as stresses increase, the precedent has been set where you can redirect those funds. It’s hard to put that genie back in the bottle again and it worries me.
Read part one here:
If you are looking to gain more independence from the NHS, call 01691 684165 or visit nhs.practiceplan.co.uk/.
