Reflections on our profession
We are in a better place than we were in 2018.
I thought I should reflect on the travails of the profession and how they have changed since I started writing this column in 2018. Obviously, there has been a global pandemic in that time which created a shift in the ability of the profession to deal with the day-to-day in a way never experienced. At the beginning of my writing this column, I did a trilogy of articles on the stresses faced by the profession. I focused on finance, expectations and regulation.
Finance is the one thing which has changed the most in our favour. The change in Determination 1 in November 2023 shifted the financial goalposts, especially with respect to laboratory fees. NHS dentistry is now more viable. Private care is much more prominent in the marketplace, especially following COVID-19.
Do I think things are perfect? Definitely not. The Scottish Government should look at the allowances, how they are paid, remove caps and ensure parity by making all fee increases inclusive of all the elements in the Statement of Dental Remuneration (SDR). I would also like them to commit to funding security in terms of a parliament-by-parliament continuity of the funding level. This would allow practitioners, and in particular practice owners, to plan and invest with some security over the five years and not worry that their investments become untenable at the whim of government ministers and civil servants.
I would suggest that we need to continue a viable Scottish Dental Access Initiative (SDAI) system to ensure continued expansion or improvement of services with suitable tie-ins to NHS care. Long-term investment by individuals or corporates is risky, especially with interest rates higher than in the previous 15 years. The profession must have security to invest. The profession also needs investment to push the digital workflow, where efficiencies in time and cost will help support more basic care.
That leads onto the next pillar: expectations, which are ever increasing in both patients and professionals. The drive towards one-off plans, primarily to answer aesthetic desires, is a double-edged sword. Sure, there are big wins to be made in better margins and turnover improvements. However, changing these wins takes time, especially away from routine (NHS) care. It also leads to the ‘asset’ of registered patients being less well supported and may make them look elsewhere. If you do not have a patient base, it is even harder to get the leads to generate big plans. Your practice becomes less valuable at point of sale and that value is more tied to the practitioner than the entity. Dentists’ own expectations of the type of work and the hours they do has shifted significantly. Dental influencers push transactional dentistry, and its financial benefits and young professionals follow. They have less desire to work long hours; certainly not five days, weekends or evenings – while wishing to receive higher remuneration and maintain holidays and lifestyle expectations. Understandable, but it creates pressure on service provision. How can practices and health boards maintain good coverage across daytime and out-of-hours services when whole time equivalents (WTE) are greatly reduced? All that is offset by the expectations of patients being higher than ever before.
With respect to regulation, I do feel that the Practitioner Services Division (PSD) and the General Dental Council (GDC) are better than they were. I wonder how long that will last? If the shift in treatment trends continues, we are much more likely to receive more regulation and deal with more litigious patients. High value treatments combined with high expectations will create this. The indemnity providers have already shifted their emphasis by asking less about whether you place implants and more about clear aligners and composite bonding.
Being that they are primarily financial institutions rather than ‘defence’ organisations, that should tell you everything you need to know. So, the question is whether our profession is more or less stressed than in 2018? I think there is a significant proportion of the profession which has chosen to do less, in many cases for the same or more money by becoming more private focussed. Whether that equals less stress is another question. Does this desire simply create another problem for another day?
If we shift our workload and basic ethos away from routine general dentistry and NHS care, we will remove much of the stability our regular patients enjoy. This will create a paucity of access and care which, in turn, creates more basic work and a poorer foundation that advanced care is built on. It will also be highly likely that younger professionals will have to work longer to achieve the funds they need to retire. Maybe that fills the gap over time? However, I doubt it will be enough to stop things getting worse before, and if, they get better.
If I was a young practitioner now, I would think the profession is a better place to be than in 2018. It has more of an upside for professionals and the advances in AI and digital workflow should help to mitigate some of the reduction in WTE.
If I was a patient, I would see the landscape becoming more challenging in terms of decreased access and increased costs. That, in turn, creates poorer goodwill and more tension in the patient/dentist and patient/practice dynamic. I am for a quiet life. Work a bit more to keep patients happy and have a less stressful working life? Self-sacrifice is not trending…
About the author
Arthur Dent is a practising NHS dentist in Scotland. If you have a comment or question for Arthur, you can email them to arthurdent@sdmag.co.uk.
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