Zoe Close asks some well-known figures in dentistry what key questions they think need addressing in 2020…
At the start of the year, thoughts turn to what may lie ahead.
And in times of uncertainty such as we are in, both politically and in the dental profession, it got me thinking about what unresolved issues dentists think need tackling in 2020.
In short, what big questions do they want answering?
Throughout 2019, Practice Plan has held a series of events for NHS dentists to hear from, and speak to, those involved with contract reform. On these occasions delegates were not shy about posing their questions to the panel of experts and leading figures from within dentistry.
“Throughout 2019, Practice Plan has held a series of events for NHS dentists to hear from, and speak to, those involved with contract reform.”
Some of those questions included things like: how can the level of skill mixing that seems to be required in the reformed contract be carried out in a two-surgery practice? How can I best prepare for rollout of the contract? What would be the most ideal way for capitation values to be assessed? Will current contract values remain the same? Will the self-employment status of associates be affected?
Clearly, dentists feel there are a lot of questions still to be answered when it comes to contract reform.
To delve deeper into this, I asked two well-known dentists, Joe Hendron and Ian Gordon, what their big questions are that they think need addressing in 2020.
It was striking that they were along a similar theme but perhaps unsurprising that the theme was around workforce issues – the retention and recruitment of dentists.
Many agree that this is a big challenge facing the profession.
The latest Dentistry Confidence Monitor survey shows that 77% of NHS dentists don’t see themselves working in the NHS in five years’ time. Of those, 34% intend to retire (24% earlier than planned) and 20% intend to leave dentistry altogether, meaning 54% will be lost from the profession entirely.
Below are Joe and Ian’s thoughts and their key questions they want answering:
Joe Hendron, Chair of the Wakefield LDC and member of the BDA’s General Dental Practice Committee:
For me, the one big question that needs addressing is: what will it take to make a career in NHS dentistry attractive and fulfilling?
Recruiting dentists to work in NHS practices is becoming increasingly challenging and then expecting them to stay until retirement age, increasingly remote. We continually receive reports and surveys stating that dentists feel undervalued and that they find it more difficult to deliver the care which is expected of them.
Increasing regulation, intensive monitoring, and targets to achieve through perverse incentives can sap the motivation of a professional with the best intentions.
Reform of the dental contract must reward good practice and take account of the additional time it takes to see and treat a patient. It should not be based on work that was carried out in 2004/5 which gave the basis to the UDA and its value, which has changed very little since.
Reform must find an alternative to the UDA so that one is rewarded properly for the work that is provided and this must be accompanied by a thorough oral health needs assessment, necessary for future effective commissioning.
Flexible commissioning may provide a new approach which can take some of the work we do out of the surgery and into the community and help to find a much-needed alternative to the UDA, which could be incorporated into the dental reforms.
More experienced dentists view the future as becoming increasingly difficult and are keen to take early retirement. New graduates are reported to look to a career in NHS dentistry as a short-term commitment before moving into private practice once they have honed their skills.
There is talk of a portfolio career whereby new graduates work part-time in different aspects of the profession or even outside it. Surely this means we are going to have to train a lot more dentists very quickly.
General dental practice is seen by some to be undermined by the clinical pathways and tiering of specialties of endodontics and minor oral surgery. Orthodontics was taken out of the armoury in 2006 and increasing risk of litigation and lack of training experience leave younger dentists scared to do anything other than refer these treatments.
This is deskilling the general dental professional. Progressively restricting the scope of work we do will inevitably make it less attractive.
Ian Gordon, Managing Director Alpha Vitality Group, Chair of Yorkshire Council of LDCs and a Director of the Association of Dental Groups:
For me, there are three main issues, all of which are interlinked, that are affecting the dental profession: recruitment, retention and morale. As such, I think there is more than one big question facing the profession.
I am an almost rabid opponent of Brexit and feel I am yet to see any upside from the process not only for the country but for the profession.
17% of GDC registrants are EU nationals delivering 22% of NHS dentistry – far more in hard to reach areas. How is this workforce to be replaced as too many inevitably return home? And this isn’t just about dentists but specialists and dental nurses as well.
Those challenging my concern point to the need to train our own dentists – I of course agree completely, but this process takes a minimum of six years
So how are we going to convince EU dentists and DCPs that they are welcome in the UK – not just welcome to stay here but also welcome to come here in the first place?
Alternatively, or in conjunction, how are we going to make the registration and inclusion on performer lists easier for dentists from the rest of the world?
How do we ensure the adequate training of new graduates and how do we stop young graduates leaving the NHS and joining private practices or leaving the profession altogether?
Only by providing a dental contract that’s fit for purpose, one which pays for prevention, registration and treatment, can we begin to address the retention crisis.
That contract is not the present one nor the prototype being tested through reform. This leads to my final question which is: when will the penny drop that the prototypes contract is not fit for purpose and cannot be upscaled and rolled out as an alternative, even to the flawed system we now have?