Nigel Jones tackles the everlasting question of workforce planning in light of recent developments in the dental sector.
From budgets to potential CMA inquiries and from GDC strategies to consumer media appearances, it’s clear we still need to talk seriously about workforce issues in UK dentistry.
There has been a lot of talk for many years so there is at least a superficial understanding. However, a little knowledge can be a dangerous thing and there is a continuing obsession with headcount while placing insufficient emphasis on other factors such as productivity, patient throughput or the trend for part time working.
This matters. In my opinion workforce issues are the biggest driver of change in UK dentistry and the biggest threat to any efforts to reduce oral health inequality.
Remuneration or psychological safety?
Take, for example, the oft repeated claim that we have more than enough dentists in the UK, just not enough willing to work in the NHS. According to Professor Chris Whitty, this situation arises because it is more ‘lucrative’ to work in the private sector.
Whether or not you agree with Professor Whitty could depend on which definition of ‘lucrative’ you think he meant when he made that statement. If it’s the traditional view about producing a great deal of profit, then that’s a massive oversimplification of the reasons why dentists turn to the private sector.
However, if you take the definition used in civil law that something is lucrative if it is ‘acquired without accepting burdensome conditions’, then I agree with him. Indeed, nearly all the hundreds of dentists I’ve personally helped in the last three decades to ‘go private’, have done so not to increase their taxable income, but to escape what they have viewed as the burdensome conditions of working in the NHS.
Many cited the demands of NHS administration, bureaucracy and contract management as being contributory factors to their decision to leave the NHS. However, of greater significance to the workforce issue is the fact that nearly all wanted to lengthen appointments and see fewer patients per clinical session.
Working patten trends
A fear of complaints, litigation and the GDC lie beneath this desire as the perception is that longer appointments allow for the mitigation of the risks of patient misunderstandings as well as clinical errors. The CDO for England, Jason Wong, highlighted when appearing in front of a committee of MPs earlier this year that the NHS dental workforce needs to feel able to provide safe care and feel safe doing so. Most of the dentists I have helped did not feel sufficiently safe within the NHS, so opted for the private sector and a less intense way of working.
This issue of safety and the intensity of working under the NHS has further implications for the workforce because there is also the risk of burnout. Mitigation of that risk is part of what leads so many dentists to go part time.
There are wider drivers than just mental health considerations that lie behind the trend for part-time work. Society responded to the pandemic by re-evaluating the part work played in our lives. The ability to blend career and family in a different way is part of the attraction of dentistry for many. With frozen tax thresholds extended to 2031, the temptation to reduce clinical hours rather than increase a tax bill is likely to endure for years to come.
What are the implications of more part-time dentists?
The implications are obvious. If a private dentist sees fewer patients, the more dentists that go private, the more we need. Likewise, with dentists going part time. The increases in headcount on the register, whether that’s homegrown dentists, overseas dentists, therapists or hygienists, will struggle to keep pace with the reductions in clinical hours and patient throughput. The result will be continuing restrictions in the supply of the clinical services that can be made available to meet patient demand.
That demand will almost certainly soften as the continuing cost of living crisis will undoubtedly affect the spending decisions and attendance patterns of patients. However, that softening in demand could well be less than reductions in supply and is also likely to be temporary. Given priority being attached to health and appearance by members of the (ageing) population, demand looks set to outstrip supply for many years to come.
Supply and demand
Perhaps it’s that supply and demand imbalance that brings us to the potential inquiry into private dentistry by the Competition and Markets Authority (CMA). The basic law of supply and demand dictates that prices will rise when supply of goods or services decreases so it can be no surprise that this is what we have seen in private dentistry.
In a world where providers of clinical services can become price makers rather than price takers, a question for the CMA will be whether this position of strength is being abused. However, while there will inevitably be exceptions, the response of the BDA to the Chancellor’s call for an inquiry evidenced that increases in private fees over the last four years have been an average of 13.8%, while cumulative inflation over the same period stands at 24.5%.
Although the chancellor outlined her motivation for requesting an inquiry in her letter to the CMA, it is hard to escape the feeling that this is the first of a sequence of moves in the political game of chess in which NHS dentistry is embroiled. Trying to guess the end game in such circumstances could be considered a waste of valuable energy.
Perhaps it is a genuine response to consumer concern, fueled by isolated incidents of unfairness. Maybe it’s a prelude to a rapid expansion in the private dental market that could appear because of the fundamental reform of the NHS dental contract we’ve been promised will be announced this parliamentary term.
Sharp focus
Whether it’s an intended or unintended consequence, what such an inquiry should do is bring into sharp focus the supply issues caused by a lack of detailed sophisticated workforce planning on the part of successive governments over decades.
If, as an increasing number of people believe, we are moving towards a core service for NHS dentistry and with it an exacerbation of those issues of part-time work and patient throughput, that can only be a good thing.
If you’re considering your options away from the NHS and are looking for a plan provider who will hold your hand through the process at a pace that’s right for you, you can start the conversation with Practice Plan today by calling 01691 684165 or to book your one-to-one NHS to private conversation at a date and time that suits you, just visit practiceplan.co.uk/nhsvirtual.
To find out more about introducing a plan, and how Practice Plan can help you, visit practiceplan.co.uk/nhs.
This article is sponsored by Practice Plan.
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