A turning point

Let’s get the next wave of professionals trained and ready to upgrade our profession

13 December, 2021 / insider

We are near a critical mass. People I talked to have concerns about what is coming and a certainty there will be change. I’m not going to continue harping on about COVID and its effect, but it plays a role here.

Dental professionals’ working patterns have changed. For some a little, for many very dramatically. In the last 20 months, many of us have worked in a more flexible and, perhaps, less time pressured way. Albeit, without financial incentives to work faster or longer and without performing our usual level of activity. While there are many reasons for this and reasons that may not change, I want to explore what’s likely to happen and the impact on the profession in the next five to 10 years. I see huge challenges to our ability to cater for the demand.

Firstly, we have a backlog. This will lead to increased volumes of work, increased complexity and increased time required to treat people. This is not a new concept.  We won’t know the magnitude until we start really addressing it and we don’t know how long it’ll take to get through. What we do know is that it’s coming, and it will be very challenging to our workforce.

Secondly, free dentistry on the NHS will increase demand. Again, it’s not certain how this will affect things. However, I suspect the effect will only really be felt after the first wave of the backlog is dealt with and the second phase of more advanced treatment (rather than stabilisation) begins. I think this will be two to three years down the line, when we’ve done the basics and the Scottish Government has let more age groups access free care.

The final and most complex point is workforce. We’ve already lost a lot of DCPs. Registration with the GDC is at an all-time low. Many will be concerned about the risk of further disruption to normal dental work and feel their jobs may be at risk. The inflationary pressures on wages and a continued agenda to lift the Living Wage bring enormous pressure to bear on practices to pay top rates, reducing the workforce further. Simpler, less stressful jobs paying similar money will attract people from the profession.  

A younger cohort of dentists, keen to strike a more reasonable work/life balance, will not fill the shoes of older workaholics. The pressures, in terms of increased volume and complexity, and inflation-squeezed margins are likely to promote the ‘life’ and decrease the ‘work’ quotient of their week. Furthermore, there’s a huge drive towards speciality in younger dentists. While benefitting the skills of the profession, the time taken to learn and perfect them, and the inherent decrease in overall productivity, adds to the tension.

Then there’s the rest of us. As long as the financial support measures are in place, people will stick. We now know this will end in April. Time to twist. Anyone waiting to retire will do so. This will have been delayed (if they have any sense) and I suspect anyone who has been swithering will see the workload and difficulties coming and jump ship. Anyone who has enjoyed a more relaxed pace and fewer hours and who can afford not to go back, will work part-time.

The privatisation of dentistry is rearing its head again, too. Some practitioners will not wish to return to NHS care, particularly with the SDR and its inevitable ‘hamster’s wheel’. They may even change their whole practice business model to private care. Thereby, not only a ‘person power’ reduction but a loss of NHS dental infrastructure. This will be a huge challenge to the workforce. We will need to adapt to overcome it. Supply and demand economics dictate that, if the Scottish Government wants NHS dentistry, they’re going to have to fund it. If we suffer, what I fear could be a 20 per cent plus reduction in the workforce available to perform NHS care, we are going to need to change the way we work.

We will need more people: most likely in the form of therapists. They’re quicker to train. Quicker to fill the void: should I say cavity?  If this is the way forward, we’re going to need to adapt our style. More consultant-led care with other providers involved on prescription. The funding model will need to shift too. Therapists can’t perform enough care using the SDR to make them viable. If we need many more of them, we’ll need bigger infrastructure. Investment in infrastructure is expensive and risky without a well-established system and funding model.

How do we get that? We have to adapt what weíve got to suit. In my opinion, a whole new model will create too many risks. Practices (whether independent or corporate) wonít invest until they get a handle on the system and banks will make lending more difficult without a track record of profits. There could be a decade of delayed care in dealing with the backlog; loss of staff and dentists; and a new system to get used to before thereís any reasonable benefit to the patients and the profession.

It was not my intention in this article to create a doomsday scenario. I’m simply expressing what I think is about to happen to our profession. I don’t even have much of an answer. What I would urge is that we think seriously about what will need to happen and invest in people and our infrastructure. Many of these changes were happening in the wider society, not just dentistry.  However, Covid has pushed it to the fore and accelerated our change. We must be proactive to ensure the best care for our patients and that we don’t burn out trying to wade through the next decade. Turn on the training tap now. Get the next wave of professionals trained and ready to upgrade our profession.

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