Dental Leadership Network: addressing the dental workforce crisis

November’s Dental Leadership Network event tackled the problem of building and maintaining the UK’s dental workforce.

On 12 November, the General Dental Council (GDC) hosted the Dental Leadership Network (DLN) event. Bringing together influential figures from across the UK profession, the meetings aim to build relationships, share information, develop understanding of the regulator’s remit and set priorities for the future.

The DLN meetings have been taking place each quarter since November 2023. Previous topics have included helping the public to understand the dental system, developing and motivating an effective workforce, and health and wellbeing of dental professionals. November 2024’s event centred around the question: how many dental professionals are enough?

Work-life balance

Speakers at the event were keen to emphasise that unemployment is one issue that the dental workforce is relatively free from. Chief dental officer (CDO) for England Jason Wong shared updated workforce statistics which suggest that only 0.7% of dental professionals are seeking work.

As Bupa’s director of dentistry Neil Sikka pointed out, this creates a ‘buyer’s market’ with dental professionals able to pick and choose between vacancies. Roles that allow for a better work-life balance are therefore more likely to attract top quality talent, according to Neil.

However, consultant in dental public health Paul Brocklehurst noted that a greater emphasis on work-life balance could lead to fewer hours of dentistry delivered. He said: ‘We’re only just starting to see the impact on productivity.’

Stefan Czerniawski, executive director of strategy at the GDC, discussed the results of a recent survey into dental workforce patterns. The data showed that 42% of dentists and 45% of dental care professionals (CDPs) work less than 30 hours per week. Around one third of each group (33% of dentists and 36% if DCPs) are also working entirely in private practice.

Dental dean James Spencer commented: ‘We have an increase overall in the number of professionals – the issue is what they’re doing and how much.’

British Dental Association (BDA) chief executive Martin Woodrow said: ‘There are important consequences of the drift to private dentistry. Generally private practices take fewer patients.’

Regional differences

Jason Wong said that the UK has one of the lowest dentists per capita of any European country. However, he also stressed that the number of dentists does not necessarily correlate to oral health outcomes.

One problem facing the dental workforce is an uneven geographical distribution of dental professionals. For example, James Spencer said that while UDA levels are largely returning to pre-pandemic levels, areas such as the south west have seen a decline.

He said: ‘We are going backwards in rural areas – this is all due to the number of dentists willing to work in the NHS.’

James Neilson, president of the British Association of Clinical Dental Technology, added that ‘geographical deserts’ are also a crucial issue for dental technicians.

Neil Carmichael, chair of the Association of Dental Groups, said that the answer to distribution problems was ‘thinking more broadly and widely’. For example, by implementing ‘a different model of commissioning for rural and coastal communities’.

According to Stefan Czerniawski, Scotland is the region most skewed towards NHS work. Fiona Sandom, chair of the British Association of Dental Therapists (BADT), added that Scotland had the highest proportion of dental therapists working to their full scope. She said this was likely due to increased demand, undergraduate training opportunities and regional NHS contract variations.

Scope of practice

Job scope was raised as a key factor in the output of the dental workforce on a wider scale. Fiona Sandom went into greater detail on the continuing issue of dental therapists being underutilised in practice, often working to the scope of a dental hygienist.

Paul Brocklehurst said that public opinion around the role of dental therapists and dental hygienists is changing, with data suggesting that most patients support greater use of them in their care.

Many of the dental leaders in the room agreed that greater skill mix was ‘the way forward’. Simon Thackeray, president of the British Association of Private Dentistry, said: ‘Some dentists will have a chip on their shoulder that they are the best person to do everything but that’s not necessarily the case. If I’m going to delegate a task to someone else, it’s because they are going to do it better.’

In tackling this problem, outgoing British Society of Dental Hygiene and Therapy (BSDHT) president Miranda Steeples emphasised the need to involve dental hygienists and dental therapists in change-making conversations.

She said: ‘Don’t talk about us, talk to us. I’m grateful for the representation of dental therapists and dental hygienists at this event, though it is not proportional.’

Jason Wong also touched on the changing scope of dentists as increasing numbers of dental practitioners incorporate facial aesthetics into their offering. He said: ‘I don’t think Botox is dentistry. Even Invisalign, I’m not sure about it.’

The CDO suggested that a role in wider healthcare was a more profitable broadening of dentists’ scope, as improved overall health also takes pressure off oral healthcare provision. He pointed to measures such as a trial of delivering blood pressure checks at NHS dental appointments as encouraging a more holistic attitude to the delivery of oral care.

What workforce issues are affecting dental technicians?

Experts representing the different groups within the dental profession provided insight into the workforce struggles within each sector. For example, James Neilsen drew attention to a growing shortage of dental technicians.

He said: ‘There are insufficient dental technicians for the vacancies available. We are at risk of not having enough dental technicians to carry out the work demanded by the NHS.’

This was corroborated by the workforce data shared by Stefan Czerniawski. He said that as most dental technicians are small business owners, there are ‘not enough employees to go round’.

James called for dental technology to be declared an ‘endangered profession’. However, this highlighted a wider issue of dental technicians and clinical dental technicians falling under the wider bracket of dental care professionals.

Kirstie Moons, postgraduate dental dean for Health Education and Improvement Wales, said: ‘The term DCP is not helpful. It’s not one homogenous group, it’s six professions. A plea to dentists in the room: stop using the term DCP.’

Miranda Steeples added: ‘Our titles are hard fought for and won. We need to be using them.’

The panel concluded that dental technology would have to be recognised as a separate profession to be declared at risk.

Another issue is the aging demographic of dental technology. Speakers suggested that making more young people aware of the opportunities available in the dental profession was crucial to maintaining the workforce.

Miranda Steeples encouraged any dentists going into schools to discuss careers in dentistry to draw attention to the entire dental team. She said: ‘Someone might not have the grades to be a dentist, but they could be a dental therapist. If they’re business minded they could be a practice manager. Those who are creative and technical could be dental technicians.’

Retaining dental nurses

The dental nurse workforce was also the subject of significant discussion. Fiona Ellwood, executive director of the Society of British Dental Nurses, shed some light on the unique issues facing dental nurses.

She said: ‘Dental nurses are the biggest workforce in dentistry but also the most transient and hard to track.’

She expressed frustration at the continued problem of recruiting and retaining dental nurses, saying: ‘This is an ongoing issue. We hear “we need X amount of dental nurses by 2025”. And guess what? We’re still talking about it.’

Neil Sikka said that Bupa observes a ‘mass exodus of dental nurses before the summer holidays’. Fiona also touched on this, stating that GDC figures represent a snapshot taken in July. This does not account for the loss of 2,500 dental nurses come August.

Neil emphasised the importance of increasing flexibility and benefits for dental nurses to encourage them to stay within the profession throughout the holidays.

He said: ‘Our nurses are the lifeblood of the dental practice. Without them we cannot operate.’

Fiona Ellwood also called for the GDC to ‘explore the red tape and bureaucracy that stops us from progressing’.

Supply and demand

A major purpose of the day’s discussion was to identify the level of need for dentistry that the UK dental workforce must cater to.

The difficulty of this task was underlined by Kirstie Moons, who said: ‘We have an opportunity to galvanise and work towards a goal – the issue is identifying that goal.’

Paul Brocklehurst recognised the aging population as a significant factor heightening demand for dental services. He cited research which found that care home residents have two to three times greater dental needs than average.

Simon Thackeray said that increased uptake of dental implants would likely compound the problem. He said: ‘We have increasing numbers of implants being placed and an increasing inability to care for them in older patients.’

The remaining backlog from the COVID-19 pandemic was also considered a continuing factor for heightened demand for dental care. Paul said: ‘We could see another pandemic in our lifetimes. Change happens – we need a workforce that’s able to respond to that change.’

Many speakers also highlighted that while the pandemic had certainly exacerbated workforce challenges, the problem was not a new one. Jason Wong said: ‘We’ve been here before, dental workforce issues continue to reoccur.’

Are overseas professionals the answer to workforce issues?

One of the processes which was raised as contributing to the growth of the dental workforce is international registration of professionals who qualified outside of the UK.

Jason Wong said that the percentage of the dental workforce who qualified overseas is increasing year on year, now approaching 50% of the total.

Martin Woodrow highlighted the need to be aware of the needs of this ‘growing non-UK workforce who are unfamiliar with the UK system’.

In September, the GDC announced that it was working to increase capacity for the Overseas Registration Exam (ORE), including an extra sitting of both parts of the exam in 2025.

Speaking at the DLN event, GDC CEO Tom Whiting confirmed that the regulator has now ‘expanded capacity to the maximum capacity possible under the current contract’.

He also shared the results of the GDC’s attempts to reduce the backlog of international registration, which has fallen to 259 professionals at the last data collection.

Increasing ORE capacity and discussions around provisional registration have proved controversial as measures to combat dental workforce shortages. Delegate Laura Cross, a member of the BDA’s Principal Executive Committee, said: ‘Everyone needs to meet a certain standard to work in the UK. Opening up UK dentistry to more overseas professionals without analysing the need first seems like back-to-front thinking.’

Fiona Sandom said that overseas dentists often register as dental therapists while they wait to sit the ORE. This means that many professionals who trained as dentists internationally are not working to their full scope in the UK, reducing the range of dentistry they are able to perform.

Is government intervention working?

The CDO discussed several measures introduced by the government to target dental workforce problems. For example, innovative commissioning models such as plans to implement free dental checks for children in residential special schools announced in October.

James Spencer added that the NHS’s workforce planning strategy would include ‘focusing on areas of concern’ going forwards. For example, graduate retention in under-served areas would be prioritised by expanding the number of specialist training posts in these areas.

Another measure to reduce geographical disparities touched on by Jason Wong was the ‘golden hellos’ introduced as part of the Conservative government’s dental recovery plan. These offer dentists a one-off payment of £20,000 to relocate to an under-served area.

However, many of the delegates and speakers spoke out against this measure. David Felix, director of dentistry for NHS Education for Scotland, said: ‘There are some areas where you can give people all the tea in China and it won’t make a difference.’

Caroline Lappin, CDO for Northern Ireland, added that the golden hellos ‘seem like a short-term solution’. She suggested that ‘making the workplace attractive is the answer instead of shackling people, albeit with gold’.

Contract reform – the elephant in the room

Dubbed the ‘woolly mammoth in the room’ by Simon Thackeray, contract reform reoccurred as the solution to dental workforce problems.

For example, BDA chair Eddie Crouch said that skill mix was incompatible with the UDA system. He added: ‘That’s why contract reform is so important.’

Eddie also concluded that more robust data was needed to inform such reforms. He said: ‘The level of data we have is shockingly bad – we need better data to come up with solutions to the problems.’

This sentiment was echoed by many of the event’s speakers. Martin Woodrow said: ‘We don’t have a good handle on workforce data and what our workforce needs.’

Stefan Czerniawski acknowledged a ‘previous struggle with not having granular and robust data’. However he said that the newest survey results were a great leap forward in providing this insight, as 55% of GDC-registered dentists and 58% of DCPs had responded to the survey.

James Neilsen commented: ‘Finally we have meaningful data to back up what we’ve been observing. This is not new information but now we have evidence to assist us in lobbying for change.’

Simon Thornton-Wood, chief executive of the College of General Dentistry, pledged: ‘We’re going to get our act together and make sure we’ve got enough data to make the important decisions we all have to make.’

GDC priorities

Tom Whiting thanked the speakers and delegates for their contribution, pointing to the positive outcomes from previous events.

For example, he said that the wellbeing impact of fitness to practise proceedings was a strong theme that the GDC was working to address. He cited ‘significant changes including initial enquiries’. This refers to a new procedure adopted by the GDC, aiming to ‘improve timeliness’ of fitness to practise processes.

The CEO also said there was ‘more to do’, laying out the GDC’s priorities for 2025.

However, many delegates questioned the efficacy of the Dental Leadership Network events as mechanisms for dental reform.

Local Dental Committee Confederation director Rita Bagga said: ‘Information sharing and networking are great but we need to come up with an action plan based on what was discussed and pass it on to the relevant stakeholders to start enacting real change.’

Positivity

Overall, there was a strong sense among the assembled dental leaders that the frustrations expressed throughout the day should not get in the way of attracting new recruits into the profession.

Simon Thornton-Wood said: ‘We need to think about the kinds of people who are entering the profession. We’re going to get the people we want if we’re optimistic about the benefits of this wonderful vocation.’

Neil Carmichael added: ‘What we should do is make it clear that of you’re a student, you should be thinking about dentistry. If you’re working abroad, you should be welcome. We need to speak up loudly and clearly for the entire profession.’

However, Eddie Crouch raised the difficulty of achieving this when so many issues are on the minds of the dental workforce. He said: ‘We need to do something urgently to bring morale up.’

Simon Thornton-Wood concluded: ‘It is the duty of this network to somehow distil out a positive view of the world, to come up with a constructive approach to these problems.’

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