Are new dental school places a realistic answer to the workforce crisis?

Nigel Jones offers his views on the recent announcement of 50 new dental school places to be divided between the Universities of East Anglia and Portsmouth and whether they will solve the workforce issue in UK dentistry.

Despite having more than 40,000 on the register, we do not have enough dentists in the UK. This can be attributed to the fact that dentists, in many cases, are working fewer hours on average resulting in the full-time (or whole time) equivalent reducing. Although it may settle down, there appear to be no signs of a prospect of meaningful change to this trend. So, it seems that the part-time working dentist is here to stay.

This is probably due in part to the demographics of the profession. Dentistry is a supremely flexible profession. This flexibility appeals to people who want to combine a career with caring for a family which may account, in part for the reason that there are more female than male dentists on the register, currently roughly 53% versus 47%.

As well as this, the pandemic prompted everyone, both men and women, to consider stepping back and working part time to avoid burnout. This has also contributed to a reduction in clinical hours. Being able to work part time is likely to ensure that the appeal of dentistry as a profession will endure but will we get to the point where we have enough dentists?

The productivity challenge

As well as the part-time working challenge, dentistry also has an issue around productivity. Dentists who are retiring or approaching retirement work at a much faster pace than those entering the system at the moment. It’s tempting to say: ‘It was ever thus.’ To a certain extent that statement would be valid, as after 30 or 40 years of practise, clinicians would have honed their skills so they would be more efficient and therefore more productive.

However, my sense is that those graduating from dental schools now are doing so with less confidence and clinical experience than their predecessors. The result is they’re already slower. When we add into the mix the fear of litigation, complaints and the General Dental Council, these encourage clinicians to work more slowly, take fewer risks, and spend valuable time writing excessive patient notes to protect themselves from anything that might come down the line at a later date. All of which hamper productivity.

In summary, there is a huge issue with workforce as there are too few dentists working too few hours while being less productive when they are working. The fee per item system in place 30 years ago meant the same number of dentists delivered much more patient care than would be provided by the same number of dentists now who are paid in UDAs.

These are issues that most certainly need to be solved.

Supply and demand

However, ironically, they put the profession in a position of strength because of the laws of supply and demand. The supply of dental services is restricted and the demand, partly because of cosmetic dentistry and partly because of general dentistry, has increased.

This, to a certain extent, can be pegged to the rising popularity of cosmetic procedures and the desire for straighter whiter teeth. However, within general dentistry, demand has also increased thanks to an aging population many of whom have been able to retain their natural dentition which needs maintaining.

This increased demand coupled with reduced clinical hours and productivity put the profession in a strong position. Consequently, some dentists who may previously have been hesitant to leave the NHS for private dentistry for fear of failure, now feel confident that such a move could work for them.

Most dentists who choose to make the move away from NHS dentistry do so, not out of a desire to make more money, but rather to be able to work at a slower pace and see fewer patients for longer appointments for the same money. However, every dentist who chooses to leave the NHS to see fewer patients, creates the need for another dentist to handle the 50% of patients no longer being seen by the newly private dentist. So, there is no sign of the shortage easing.

A drop in the ocean

There have been calls, often from MPs in areas known as dental deserts, for new dental schools. Their suggestion is that dental students will stay and practise in the area once they have qualified. However, they seem to overlook the fact that dental deserts are characterised by being areas with little or no access to NHS dental services usually with high levels of deprivation.

If there is a shortage of NHS contract holders in these areas, what would be the employment prospects for the new graduates from their proposed dental schools? Also, how likely is it that a recent graduate wanting to make the most of their career would want to remain in an area of high deprivation?

The dental school suggestion to me feels like a token gesture which would take a number of years to bear fruit. Not only because of the length of time it takes for students to complete a dental degree, but also because of the lengthy processes involved in obtaining the relevant permissions and so on to be able to set up new dental schools to train the additional students.

Are there enough teachers to support new dental school places?

The recent announcement of the additional 25 places at the University of East Anglia and Portsmouth dental schools also brings into question whether there are sufficient educators able to deal with these increases. Perhaps because the increase is slight, it may be manageable. However, my sense is dental schools are already struggling to stay on top of the workload they have already and that retaining educators is a difficult task. To begin increasing the workload at a time when dental schools are already struggling to keep up could be problematic.

The British Dental Association (BDA) estimates that the unmet need for dental services currently stands at 14 million adults. Adding 50 new places a year to a register that is between 40,000 and 50,000 strong is a drop in the ocean which is why I have little faith it will make a material difference. The only possible way forward is meaningful reform of the contract that comes with additional funding. As the new Prime Minister settles in, it remains to be seen whether it will make good on its promise to bring about dental contract reform within the life of this parliament.

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