We need more people
That is certain. But who, and how will they be funded, trained and recruited?
For the longest while, I’ve been bleating on about COVID and its associated struggles. One of my hobby horses is workforce planning. This has been an issue for a number of years. COVID has caused healthcare to lose a significant proportion of its workforce and dentistry is no different. Many have left the profession entirely and there is certainly a drive towards privatisation.
If we need more people, which people do we need?
Nurses: to replace the ones we’ve lost to other sectors or professions. There are training places in colleges and dental hospitals. However, it’s apparent when we come to recruit, there just aren’t enough. I don’t know if there’s capacity to increase training levels. With all things, especially at the moment, budget will be the most important factor.
Do practices look for trainees and hope to get them into a college course at some point? Do practices fund this? Can we tie trainees into longer contracts, or must we take the risk and the expense? Can the Government actually do something pro-active to help us?
Earlier this year, a training programme started to allow existing nurses to train as hygienists. The training had to involve a VT training practice. We had a couple of potential trainees call us for a place. However, when we tried to find out more details about the time it would take, what was involved and how it was funded, we didn’t have much luck. It is evident that the CDO’s office is trying to do something helpful, but it seems – unsurprisingly – that communicating the detail has not been easy for them. How do they actually get hands-on training? If this is to happen in-practice, who has the surgery space, staff and spare time to do that training? It seems well intentioned but, ultimately, a little ill-conceived. Not to mention the failure to bring anyone new into the profession; just robbing Peter to pay Paul.
For years we have not trained hygienists but, instead, insisted upon only training therapists. I have always thought that a mistake. Once upon a time, we had a therapist who worked for us, and it was a great system. The problem was paying for it. While a therapist requires the same resource as a dentist (nurse, surgery, equipment, materials) they didn’t have the earning capacity. However, there was an extremely high expectation when it came to their hourly rate. Practices are, effectively, taking on an employee at a loss. If you work in private practice and have a vacancy for a dentist you can’t fill, then this is probably a great option; as you can pass the cost onto the patient. However, in a mainly NHS practice, it might be better, economically, to have an empty surgery rather than one which loses money.
A dentist is going to be preferable to a therapist, if at all possible. They tend to generate more income, are more likely to be self-employed (with all the benefits and pitfalls that brings; especially the ‘need to earn’) and will have a greater perceived value to practice owners and patients. These are not insurmountable problems, though. Therapists are quicker to train. The biggest problem is how the NHS funds dentistry and the lack of viability for a therapist in NHS care.
The funding system would have to recognise the difference. However, how can you pay a therapist more to do a filling than a dentist? That’s what you’d need to do. Unless you raise the fees to make therapists viable and dentists better paid. You could, let’s say, do something like have a multiplier on treatment costs. Where have we heard that? And with two weeks to go until the next incarnation of the multiplier, we still don’t know what’s going to happen. Will it go down and by how much?
If we are to use the therapists that are in the system, but are currently working as hygienists, would we need to introduce a training programme to get them back to the level they were at when they transitioned to hygienists? Would we need to create more hygienists to fill that gap? They are even quicker and cheaper to train than the therapists who trump the dentists in those stakes. So, that might be the quickest option of all.
We all know we need more dentists. Training places must be opened up for that. However, we also know it will take seven to 10 years to get a reasonable number of productive dentists into the system. Ten years of training hygienists would boost that sector significantly and allow dentists to shift their working methods to incorporate more advanced trained DCPs. This would give a more blended level of workforce in communities. The funding model has to change a bit to support this.
More importantly, if practices are to change their methods of working, there needs to be serious commitment to changing the funding and then guaranteeing it without significant change for maybe five to 10 years. If the Scottish Government does not do that, practices will hold position and not recruit anything other than dentists and nurses.
A change in the model of business will require a change in our methods. Or, like orthodontists, who seem to have embraced therapists, will we have a workforce epiphany?
If we continue to have a dentist problem, can we move to a more consultant-style model like the US and Canada? One dentist and several therapists carrying out the plans conceived? Would this work for us? Can we make it work?
I fear that the restrictions of NHS pricing and the ubiquitous ‘hamster’s wheel’ mean it’s quite a hurdle. Do we leap or will we get a helpful push from the Government?
Arthur Dent is a practising NHS dentist in Scotland
Got a comment or question for Arthur? Email firstname.lastname@example.org