Just hours before firing the starting gun on the 2024 election, the last government opened a consultation on proposals to force those who start training as dentists in England to work on the NHS, or face paying up to an additional £200,000 in fees.
More specifically, now departed Ministers set out to explore a ‘tie-in’ period during which a newly qualified dentist would be required to work in a particular place delivering NHS dentistry for an as yet unspecified amount of time.
I’m all for bold solutions to the access crisis in dentistry, but handcuffing health professionals to NHS dentistry through the threat of unmanageable debt simply isn’t a sensible approach to building a resilient workforce.
Any attempt to solve the workforce crisis in dentistry that doesn’t include fundamental reform of the contract for NHS dentistry is doomed to failure.
These proposals would, in effect, ask a 17-year-old student to commit to working on an NHS system they cannot possibly understand, and that may look wildly different in the six years that will pass between their decision to study dentistry and their graduation.
What’s more, there is every chance that the former Government’s current proposals on a ‘tie-in’ for NHS dentistry are completely counterproductive, and reduce both the number of students entering dentistry, and the amount of NHS dentistry those working on the NHS deliver.
Any attempt to solve the workforce crisis in dentistry that doesn’t include fundamental reform of the contract for NHS dentistry is doomed to failure.
Given the understandable strength of feeling on the idea of an NHS dentistry ‘tie-in’, you won’t be surprised to learn that it has been discussed in detail across several of the BDA’s Committees, including the Young Dentists Committee, which I chair, and the BDA Student Committee.
Alongside those discussions, more than eight hundred of the BDA’s student and graduate members responded to a recent survey on the topic.
Any tie-in that reduces the flexibility of dentists will likely disproportionately affect women and pregnant women.
40% of respondents to our survey told us that they would not have chosen to study dentistry if a tie in requirement been in place when they were deciding whether to study dentistry.
That’s a stark, but not surprising, result; research published in the BDJ in 2023 found that the mean total debt dental students had on graduation was £52,922.12. Dental students already carry the burden of very significant debt into their careers, and the prospect of paying up to an additional £200,000 is of course likely to reduce the number of those wishing to study dentistry.
As well as reducing the overall number of entrants to the profession, any increase in fees will likely disproportionately affect those from lower socioeconomic backgrounds. Similarly, any tie-in that reduces the flexibility of dentists will likely disproportionately affect women and pregnant women given those groups greater use of part-time working.
93% of respondents to the survey said that the ‘tie-in’ for NHS dentistry presented in the consultation would have a negative or significantly negative impact on their feelings toward NHS dentistry, with the rest saying that it would have no impact.
Again, this should come as no surprise to anyone who has been paying attention to NHS dentistry over recent years. Dentists are already experiencing historically low levels of morale and wellbeing because of the long-term underfunding of NHS dentistry. Rather than focusing on short-sighted measures like forcing dentists to work in a broken system, the new Government should focus its efforts on making delivering NHS dentistry more attractive to dentists.
It's abundantly clear that people continue to struggle to get access to the dentistry they need.
A proportionate package of incentives and obligations, including fundamental contract reform, that fairly rewards dentists and allows them to deliver more NHS dentistry to their local communities would be warmly welcomed by the profession, and we continue to stand ready to negotiate with the new administration at a critical juncture for dentistry in England.
It's unfortunate, then, that the last government’s consultation on a tie-in for NHS dentistry made no mention of, for example, loan forgiveness schemes, where a dentist delivering NHS activity would have their debt reduced, or bursary schemes to incentivise dentists to work in the areas where it is most difficult for the public to access dentistry. Both these measures are tried and tested policy mechanisms for adjusting workforce supply toward underserved populations. There is no evidence, on the other hand, that the proposals as they stand would make it easier for the public to access dentistry.
31% of dentists responding to our survey on an NHS ‘tie-in’ for dentistry told us that they believed that, should such an arrangement have existed when they graduated, they would deliver less NHS activity than they do currently, while 61% told us that the volume of NHS activity they currently deliver would be unchanged.
It's abundantly clear that people continue to struggle to get access to the dentistry they need, and it was heartening to see the degree of attention dentistry received in the General Election campaign, thanks in no small part to the BDA’s campaigning work over several years. But dentists and the public deserve a smart, long-term approach to dental workforce planning, not an approach that threatens to be completely counterproductive.
A new government must urgently develop comprehensive proposals for the dental workforce that fairly balance incentives and obligations. That is the only sure path to a sustainable, resilient future for NHS dentistry in England.
