Practice Plan Director, Nigel Jones, offers his take on potential solutions to the workforce problem.
Patient access has been an issue that has worsened post-COVID. Despite having around 45,000 dentists on the register, part-time working and dentists choosing to offer longer appointments by moving to private dentistry are fuelling a shortage of dentists. In search of a quick fix, adding overseas dentists to the register has been a solution touted by many. However, is this really the panacea they think it is?
I have little doubt that overseas dentists could make a significant difference to the access problem, especially if, by some miracle, the government, the General Dental Council (GDC) and the Department of Health and Social Care are able to deliver the numbers they have pledged. However, I’m dubious as to whether they’re able to do that.
There are a whole host of considerations that need to be taken into account. One of which is financial. Often, overseas dentists arrive with very little money and the costs of going through the Overseas Registration Examination (ORE) have now increased substantially which could become a barrier to registration.
There are also possible cultural and quality assurance barriers. While there are some excellent dentists from the Subcontinent, there are so many dental schools in India that to quality assure all of them and be confident about the equivalence of their qualifications versus what we would expect as a minimum here, would be arduous and time consuming.
Ongoing support
To ensure overseas dentists are trained and confident to work within the NHS they would also need supervising and mentoring, something which I am uncertain has been factored into all the planning. Supervising an overseas dentist would require time and commitment from the UK mentor which would distract them away from their own delivery of care. Yes, there’s an argument that this might only be temporary, but, in some cases, it could take quite some time before people gain sufficient confidence and experience to be allowed to ‘fly solo’.
Aside from assessing clinical competence, there’s also the need for overseas clinicians to understand how to work within the confines of their NHS contract, understand their obligations with regards to the CQC, HIW, HIS or RQIA, depending on where they’re based in the UK, as well as the workings of the GDC and the standards to which everyone is expected to work. The intricacies of the NHS contract are such that the potential to be tripped up are legion, placing the unwary at huge risk. To equip an overseas dentist to be able to navigate all these hazards safely would take a great deal of time and input from others.
It’s imperative that the workforce problem is solved as the split between NHS and private dentistry appears to be gathering momentum. While I find it difficult to imagine that there will ever come a time when an NHS dental service for the most vulnerable in society doesn’t exist, there is a grey area between those in need and the category of people well off enough to be able to afford private dentistry. I worry for those caught between these two categories as, in the absence of a sufficiently large workforce, there’s a danger they could fall between the cracks and be left with no provision.
While there is certainly a need to explore solutions, I remain unconvinced that the ones that have been put forward so far are the answer. However, I believe greater use of skill mix does have the potential to alleviate some of the workforce problems.
A perceived barrier relevant to both greater use of skill mix and overseas dentists is who would carry the can for anything that went wrong? The prospect of being held vicariously liable for someone else’s error may be too big a price to pay for some principals simply to be able to expand their team. That is a view currently held by some practitioners who choose not to make the most of skill mix.
Skill mix is a solution that could bear fruit over a much shorter time span than some of the other suggestions put forward and is the one which I feel most optimistic about as I have already seen some very successful therapy-led models in action. Perhaps this is where we need to focus more of our attention than we have done?
No quick fix
The difficulty is that these workforce problems have been decades in the making. I can remember writing and talking about this issue 10 years ago. Sadly, I cannot see that there can be a quick fix to a problem that has been brewing for so long.
Which leads me to my main fear which is that successive governments have left it too late to start addressing this problem. The various initiatives suggested are likely only to yield results in five to 10 years, which is a long time for the current dental service to struggle on.
The supply and demand imbalance means overseas dentists are likely to take the opportunity to get on the register in the UK. Having made a commitment to the NHS initially, they will not want to remain in the NHS system. Thanks to the imbalance of supply and demand, dentists prepared to travel to areas less well served will be able to set up successful squat practices or find a position at a purely private practice that suits the way they want to work better than working on an NHS contract.
While, on the face of it, there are ways of filling the NHS workforce bucket, the leaks will continue until such time as there’s either a significant improvement in funding, a significant improvement in contractual arrangements or, preferably, both.
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This article is sponsored by Practice Plan.
About Nigel
Nigel Jones is a Director at Practice Plan. He has been working in the dental sector for more than 35 years and has a special interest in the development and future of NHS dentistry in the UK. His knowledge and passion for dentistry have led him to become a trusted voice, offering invaluable advice on how to strategically and successfully run a practice.
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