During a recent Practice Plan webinar, director Nigel Jones hosted a discussion with dental practice owners, Chris Groombridge and Simon Thackeray, about the reform of the NHS contract in England.
Inevitably, the conversation turned to the workforce issue. Here are some of their thoughts.
Nigel Jones (NJ): Something I’m struggling with, although this is a position of strength for the profession, is that there aren’t enough clinicians. I know we’re trying to address it, but there aren’t enough clinicians.
Simon, when you went private, you would’ve significantly reduced the number of patients you were seeing. Chris, I’m sure when you are assessing the risks involved in gradually moving your practice over to private, you’ll know you don’t need as many patients to remain economically viable.
So, if we don’t have enough clinicians already and lots of people feel compelled to go private and reduce the number of patients and increase the amount of time per patient, the GDC is going to have to work extremely hard on the ORE to keep up with that.
Chris Groombridge (CG): I think the current chief exec and chair of the GDC is moving things in a positive direction. Yes, I think they could do more, but they are definitely doing something positive. I do know that the Royal College of Surgeons is going to bring something online in June, and that obviously will also help. But the simple fact is the government is looking at overseas dentists.
I understand why pre-Brexit, we needed approximately 650 overseas dentists a year just to stay still. That comes down to us never having trained enough of our own. We have 980 training places for 2026/27 for dentists, which takes five years. If you look at the comparative population sizes of France or Germany and then look at how many dentists they train, it’s about 2,000-2,500.
So, we simply do not train enough of our own. Frankly, we never have. We’ve been dependent for a long time on overseas dentists and now we’re looking to bring in more. That’s fine, but they’re doing it primarily because the government doesn’t want to pay the cost to train another 1,000 or 1,500 dentists in the United Kingdom.
A top heavy profession
Simon Thackeray (ST): One of the solutions to that could be an increase in the scope of practise for dental hygienists and therapists. One of the admirable aims is that there would be more therapy-led dentistry within an NHS practice. But the problem is you’ve got upside down training. In that respect, there still aren’t enough therapists being trained in proportion to the number of dentists.
We’re still a top-heavy profession. We can’t solve the access problem immediately because you need the people to do that level of treatment. The big issue there is the fact that therapists can’t extract adult teeth. If there were a scope of practise change that therapists could extract adult teeth of a certain nature, then you might find that a core service could be run effectively by therapists.
There’s a shorter training pathway for dental therapists. But where are they training? Are they training 980 therapists a year like they’re training 980 dentists? I don’t think they are. This potential skill mix is a good skill mix because there are some things that dentists don’t need to be doing as they should be treatment planning with complex cases. So, with skill mix you can have a team that’s therapy-led dealing with the treatment that they can do within their core competencies.
‘I don’t see the finances stacking up’
ST: There aren’t enough dentists. It’s multifactorial, but I probably now see a third of the number of patients that I saw when I was NHS versus private. If every dentist did that, access would go down from 50% to less than 25%. This is because you’d lose so many people who’d then be working at a lower capacity because they’d be working at the speed of their choosing rather than the speed they’re forced to work at to hit their targets. They’d also be doing the dentistry that is not constrained by the things that can’t be done on the NHS, which takes more time to do. So, you’d have a shortfall of dentists of probably 50%.
NJ: Which is why somebody like Chris doesn’t necessarily have to fear going private because the supply/demand imbalance means that you’re in a strong position. The hard thing will be keeping hold of people like Chris in the NHS at the moment.
CG: I have managed to move a significant percentage of my business to the private sector while still delivering the sixth largest NHS dental contract in the country. But obviously there comes a point where that is no longer viable. The difference is that because of the way I view things going, I’m not in a quandary about what I will do. At the appropriate time, I will make that transition and cross the Rubicon where in the past it would’ve troubled me.
Am I leaving the NHS completely? No. Am I significantly increasing my private commitment versus my NHS? Yes. Because I don’t see the finances stacking up. And I think therefore, to be as heavily involved as we used to be in the NHS as an overall business would be foolish to be in that position. I don’t think it’d be sensible to remain in that position. And I don’t think any practice should be because the money simply isn’t coming through.
Limited and licensed
ST: We must remember, no matter how much we want to support those less fortunate, it’s not our business responsibility. It might be a moral and ethical responsibility, but the moral that doesn’t pay any ever-increasing bills that the chancellor is dumping on us all the time.
As a dentist you must remember that you have a skill that is limited and licensed. Not everybody can do this. It’s not your fault that the government isn’t putting enough funding in to be able to look after all those people. And while you might feel morally and ethically obliged to do it, that doesn’t pay your overdraft. Chris has got to have a business head on him to survive to care for some patients. There’s no point in him going bust because then he can’t care for any of them.
I don’t look after anywhere near the number of patients Chris does, but if I’m not there, my patients will not be looked after. So, it’s important to look at your own morals as to why you’re doing this. The NHS shouldn’t be a trap with no escape.
There’s never been a safer time to leave NHS dentistry. If you’re looking for a provider to be by your side through the transition then, with over 300 years’ dental experience in our field team, you’re in safe hands with Practice Plan… Be Practice Plan and get in touch. Come and visit stand G50 at Dentistry Show Birmingham on 15 and 16 May, call 01691 684165 or visit www.practiceplan.co.uk/be-practice-plan/.
This article is sponsored by Practice Plan.
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