Time to invest in the NHS
We might not have the money to spend on upgraded NHS services, but can we afford not to invest?
I believe dentistry is a worthwhile profession. It has been more than three decades since I started my dental journey, and I cannot imagine another profession or career that would have served me better. What made it work for me? I think I’m a generalist at heart. Never the best at any given thing; I never experienced true excellence in one facet of education or ability. I am decent at most things. I am willing to reflect on my own performance and have tried to improve. I have a logical brain which helps me refine processes; clinical and managerial. While I am not the life and soul of the party, I can communicate well and have enough interest in people that I enjoy seeing them time and again. I enjoy caring for people. I am also interested in business; learning about it and running one. It is a range of skills many have, but they suit the life of a dentist.
What does strike me is that, other than finding helpful people, I have not had a clear career path through my profession. When I started, it was straightforward. You qualified, either specialised and moved into a specialist practice, or ‘Community’ (as was), hospital, teaching or research or you became an Associate. Maybe bought into a practice? Maybe did a bit of work for a health board, limited teaching, public dental service (PDS), vocational training (VT) and so on. The range of small roles was, and is, huge and offers a great degree of flexibility and interest to keep from being cooped up in a surgery. However, there did not seem to be much of a pathway for most of that other than the effort and exams for specialism. More like happenstance.
I am not sure our profession has moved on that much in that respect. There is not a clear pathway, and it seems that younger professionals are not terribly keen on the PDS or OMFS (Oral and Maxillofacial Surgery) route either. In my youth, these were prized posts – but now there are vacancies. That is disappointing, and I think younger professionals would like to have clearer support structures. Perhaps that is why there is less drive to NHS dentistry? Although most new graduates will do some form of vocational or foundation training in a broadly NHS based practice, fewer are taking that path and going straight to private practice. Many move that way soon after.
From the patient’s point of view, this has led to a dearth of NHS provision and, therefore, choice. It is hard to say whether the increase in desire for aesthetic treatment (bonding, aligners, botox and so on) drives this or whether the focus on aesthetics in the professional and general social media is creating the market. One of my main reasons for continuing with high levels of NHS care is my belief that it is a good, noble option. I do not believe I am alone in that thought, but younger professionals are not following suit. I see the resident doctors’ strike at the expense of patient care and wonder whether that is a virtuous stance? I would not strike; I would be thinking of the people I have cared for over decades and could not see them left without. However, is that my personification of patients based on my life? How does that translate to someone at the start of their profession?
I have read a bit about what younger professionals would like, and it suggests they would like a more defined support network or career path. Mentors; slightly more experienced colleagues to lean on and tap for knowledge and ideas. Not so much really defined pathways; more networks and role models. A direction of travel. As dentists, we must find our own way. Choose our interests or specialism. Find the courses, find those mentors, find the practices that suit our ideals or desires. We must set our boundaries, in terms of working patterns and work/life balance.
However, I wonder whether, with the difficulties of provision of care and, in particular NHS care, could the NHS or NHS Education Scotland be working harder to help? Could this be the source of an NHS dental care redemption and reinvigoration? Could the NHS develop a series of steps after VT? A more coordinated approach to the first five to 10 years of our careers, not just for a specialism? A broader education that helps people develop their natural and learned skills? There would obviously be tie-ins, but would the process itself create a more NHS-minded profession without handcuffs?
I would like to see this investment made. The creation of an educational and developmental pathway that includes clinical and managerial elements. Let young dentists learn and assess where their abilities lie. Create financial and investment knowledge to encourage practice ownership. High street dentistry does not work without owner-operators. Look at the decline, or at least the stasis, of the corporates. That model is not working, but there must be one or more that does.
Perhaps if the NHS were to invest in this, it would encourage more NHS care? Peer learning and development that is more relevant to young people. Create a trajectory which allows intellectual stimulation and professional qualifications to enhance our system. Management teaching and information on legislation and governance that helps the profession with a focus on improving the patient experience on all levels. We might not have the money to spend, but can we afford not to?
About the author
Arthur Dent is a practising NHS dentist in Scotland. Leave a comment about this article below or, if you have a question for Arthur email arthurdent@sdmag.co.uk