What’s in a number?
Figures surrounding the number of dentists entering the profession must be scrutinised
I read, with interest, the British Dental Association’s (BDA) recent statement regarding the UK Government’s decision to increase the numbers of potential dentists joining the register from 2,100 to 4,200 per year from 2028. There has also been a commitment to increase the LDS and ORE examination processes to accommodate overseas dentists who do not automatically qualify for UK registration. The BDA says this process is a “quick fix” and may not lead to more NHS provision, as those entering have no requirement to work in the health service. They blame the underfunded NHS system.
The statement is primarily about the English system of NHS care and, based on the usual pattern of immigration, most will end up in England. However, there is likely to be migration into the Scottish system too. Perhaps the NHS system up here may be more appealing, even if the weather is less so? The Scottish Government has also looked at the entry or return-to-work process, with the introduction of Mandatory Testing, use of Test of Knowledge and the ability for dentists to register in areas and work for up to six months before fully demonstrating their competence through that testing.
There are potential issues, however, it appears clear that governments are taking the lack of dentists seriously. They are targeting foreign-trained individuals as a ready source of workforce to address our lack of whole-time equivalents (WTE). I am glad they are paying attention. Arguably, it is very little too late and does not easily sort the real issues surrounding the lack of dental availability. But it is a start.
After doing some basic maths, if you consider 2,100 being the historic norm based on mostly full-time working, i.e. five days as a WTE, that results in around 2,000 full-time dentists entering the system annually. Based on rudimentary assumptions, let us say those 2,000 dentists now work three-and-a-half days as a WTE. It would need 3,000 registrants a year to keep the status quo.
There is also a commitment to a ‘modest’ increase in UK-based graduates being allowed too. Universities may have to put in place more resource to accommodate this commitment. This brings its own problems in terms of staffing and adaptation to larger numbers of students. The universities certainly do not have capacity to train many more people and I would say that the governments do not have the cash to train that many homegrown graduates.
The rise to 4,200 registrants would mean that, in less than 10 years, the change in working patterns could be entirely reversed. These assumptions are rough, but that is a very compressed timeline and could result in a huge shift in the availability of care to the people of the UK. The BDA’s assertion that those new registrants do not have to work in the NHS, and may not want to, is entirely true. This weight of numbers would be a paradigm shift in supply and demand. It is unlikely that a mostly private model could support that many more dentists without a significant reduction in fees and earnings.
What is more, the UK culture across professions leading to working a four-day week or less may not be replicated by those migrating. The shift could be even greater and clinics, especially corporate ones, may look at the benefit of a five-day worker in terms of consistency and availability and start to hire more overseas dentists than UK graduates. The BDA says these overseas dentists could be exploited. However, if they were willing to work five days, that availability could be a premium.
An increase of dentists by that many would almost certainly lead to more NHS care whether the system is as broken as the BDA claims, or not. Perhaps the UK Government is betting on attracting migrant dentists over any need to change the system at all? Even if it is broke, do not fix it? Just get more people? If dental availability increases and tax receipts go up, very few MPs will be complaining about more dentists.
In Scotland, the tax system may not help but the NHS fee system might. If we have a more considered Mandatory Training system and VT equivalence, then we may be the most attractive UK area. A mentoring system to ensure that VT equivalence and quality would reassure patients and clinic owners and manage the governance requirements for health boards. Surely that would be the next step to manage the process and maintain dental quality? If that were to be organised and paid for by the Scottish Government and the NHS, then it would only be reasonable to create tie-ins. At approaching £100,000 per VDP, a pretty long tie-in would be reasonable. Possibly up to the seven-year tie-in associated with Simplified Disease Activity Index (SDAI) grants?
There are ethical concerns with taking highly trained professionals from other nations. This is something to be debated, but if we have need then are our own interests paramount? There are questions about quality control, governance and whether migrants stay in the long term. It certainly is not the case for most of the foreign students currently being taught in UK dental schools. Perhaps that offsets this process? Public opinion around immigration and the whole Brexit process is making it more difficult to come to our shores. It will be interesting to see if professionals feel that process insurmountable.
In the end, the 4,200 per year is not a guarantee, merely a possibility. Does the UK dental profession hold enough of a draw for overseas dentists? I suspect any difficulties of opinion or fact, NHS or private, will not stop a huge number trying. The reality of the system’s ability to test, register and monitor is probably a much greater barrier than the rest.
About the author
Arthur Dent is a practising NHS dentist in Scotland. Leave a comment or question below on this article, or if you have another question for Arthur email, arthurdent@sdmag.co.uk