18 Feb 2019  •  NHS Dental Landscape  •  8min read By  • Nigel Jones

A potential workforce crisis in dentistry

Nigel Jones discusses the issues surrounding dentist recruitment and retention with Eddie Crouch, Simon Thackeray and Ros Keeton…

Recruitment and retention are two sides of the same troubling coin for the future of dentistry, particularly within the NHS. Anecdotally, there is much discussion about the difficulty of filling roles in practices. When you add this to surveys* that show NHS dentists don’t see themselves in the NHS within the next five years, it feels like a potential crisis. 

In a profession like dentistry where you have the capacity to radically improve the lives of others every day, how can the level of job satisfaction that this surely brings be diminished to the point where 86% of NHS dentists don’t see themselves in the NHS by 2023? And, of those, 24% don’t see themselves remaining dentists at all?

To discuss this issue, I met with some of dentistry’s well-known faces – Eddie Crouch, Simon Thackeray, and Ros Keeton – to find out their thoughts on how it can be tackled.

Eddie Crouch, Vice-Chair of the Principal Executive Committee at the BDA, suggested there was a lack of understanding and urgency at NHS England about the problem: ‘This year the evidence that was submitted by NHS England to the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) about recruitment and retention was completely oblivious to the fact that (or tried to confuse the DDRB into thinking) there isn’t a manpower or morale issue in the profession.

‘Yet a few months later, after the DDRB reported, NHS England was scurrying around trying to get the BDA around a table to discuss what to do about recruitment and retention. They’ve had a completely blinkered approach to what we and others have been saying about this for a long time. Whoever does a survey about the state of the profession, whether it’s us as the BDA or organisations like Practice Plan and NHS Digital, the results are the same – so the figures cannot be lying.

‘It’s frustrating as you feel like you’re banging your head against a wall. There’s no urgency from NHS England to understand how imminent some of these problems are as a crisis. There’s no desire to want to change things, or even just tweak them in the short term, to make it easier for people to deliver good care for patients.’

“There’s no urgency from NHS England to understand how imminent some of these problems are as a crisis.” – Eddie Crouch

Simon Thackeray, a private dentist and practice owner, agreed that Government and other organisations are unlikely to drive change – in large part due to a lack of funding across the wider NHS. He said: ‘Talking about NHS dentistry is like a bunch of frogs in a pot of boiling water trying to negotiate how fast the temperature is being turned up. It isn’t going to get better, and that’s because the Government has come to terms with what the profession can’t – that there probably isn’t the money to spend on NHS dentistry the way we want to do it.

‘All they’re trying to do is gradually make it more difficult to do dentistry the way we want to. It’s their way of saying to us, “Can you not see the writing on the wall? We don’t want you, we haven’t got enough money, there’s a recession and Brexit is looming, you’re the least of our worries”.

‘I think sometimes as a profession we need to realise how important, or unimportant, we are when you’re talking about NHS funding for cancer and other life-threatening things. I think sometimes we need to realise where we stand and actually jump out the pot of boiling water.’

This under-funding of the NHS – and the pressures it can bring when any profession tries to keep doing the same (or even more) with less – is no doubt a contributing and exacerbating factor to the recruitment and retention challenges dentistry is facing.

In the likely event that dentistry won’t see much of the £20.5bn a year for the NHS that Teresa May has pledged by 2023, it seems that an injection of funding shouldn’t be relied upon to solve these challenges. So, what should?

It’s not an easy question to answer, and there is doubtless no single fix. However, Eddie was firm in what wasn’t the answer: ‘The whole idea of setting up a dental school in Plymouth to solve a recruitment problem has worked really well, hasn’t it? And you get the CDO at the BDA recruitment and retention day saying, “If we set up a post-graduate centre in Lincolnshire where people can go and upskill – that would encourage everyone to work in Lincolnshire.” But not if the NHS contracts that they’re working in are unattractive.

‘The BDA is accused by the CDO of being relentlessly negative, which is so sad… you’ve just got to open your eyes to the real problems.’

Ros Keeton, from the BDA Benevolent Fund, added: ‘The CDO does not appear to be worried about young dentists leaving the profession at all. At an event I was at recently, Sara Hurley said she thought it was perfectly acceptable for us to train people only for them to work just one or two days a week and then leave altogether.

“We’re bringing talented young people into this profession, spending a vast amount of money training them, but we’re not hanging onto them and that’s a desperate waste.” – Ros Keeton

‘But the reality is that this is absolutely the wrong thing to do. We’re bringing talented young people into this profession, spending a vast amount of money training them, but we’re not hanging onto them and that’s a desperate waste.’

Simon suggested that no real change will take place until there is a shift in the ‘fear culture’ the profession operates in: ‘There is a fear culture that either the GDC has decided we should have in order to know our place, or it has occurred because of the system that’s been put in place. Either way, as soon as we can get rid of this fear of losing your career over some spurious or stupid mistake or difference of opinion, you will take the shackles off dentistry – you’ll get younger practitioners who are prepared to push themselves appropriately, and you’ll get older practitioners who aren’t going to sell out because of the regulation. This is where the fundamental changes need to happen in order to get some morale back in the profession and have NHS practitioners who don’t feel quite so scared.’

Ros also called for the cultivation of a more positive community among dental professionals as a way of feeling more in control of their own destiny. She said: ‘When I first qualified, many dentists worked on their own, compared to now when they’re in much bigger practices and you would expect to see much more mutual support and community spirit – but that’s not being delivered. People just end up feeling trapped, and don’t know how to get out of that trap, which is really sad because we’re losing great people from the profession.

‘We need to build more of a community where we celebrate each other as dentists. The sorts of things that my generation had for support just aren’t there any more, possibly because they’re no longer appropriate or relevant, but we need to work out how we recreate that feeling? How do we give that support to each other?

‘We do that at the BDA Benevolent Fund but for many of the people we help, we’re the end of their journey and we’ll get as many as we can back into dentistry, but it’s still a really tough journey back.’

Implementing a cultural change that swaps fear for positivity across an entire profession is no mean feat. Doing that against a backdrop of many years of low morale, under-resourcing and uncertainty around what impact the new contract that’s due in 2020 will have, makes it even harder.

Whether that level of change can be delivered quickly enough to – to use Simon’s earlier analogy – turn the temperature down so low that the frogs will stay in the pot, remains to be seen. Indeed, there is a question whether that change can, or will, be delivered at all, especially when the status quo in dentistry seems to suit government as a source of income that can be redistributed to prop up the more headline-grabbing issues in the wider NHS.

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