What will a Labour Government mean for private dentistry?

Much of the talk inevitably centred around NHS dentistry and the lack of access to NHS provision in many parts of the country. The incumbent Conservatives focused on their existing recovery plan, while the Liberal Democrats and the Greens both promised additional investment.

In their manifesto, the Labour Party committed to rebuilding dentistry for the long term, reforming the dental contract, shifting focus towards prevention, and the retention of NHS dentists. There is plenty of scope for interpretation about what these words end up meaning, but the intention seems clear.

But what does this all mean for dentists and their teams relying on private income, or those in a mixed economy?

Impact of public health measures

The profile of the oral health agenda had already seen an unusually high level of activity in terms of policy development at the tail end of the previous Conservative administration. Some of that will now fall away, but certainly not all of it. And plenty of it has implications for private and NHS dentistry alike.

Public health measures are, by their nature, likely to impact on whole populations however individual patients’ care is funded. Given Labour manifesto commitments, we would hope to see emphasis on prevention and public health measures. Specifically, the new government committed to introducing a supervised tooth-brushing scheme for three- to five-year-olds, targeting areas of highest need.

The former Conservative government introduced legislation designed to encourage new community water fluoridation schemes, with a consultation on fluoridation in the northeast of England extended across the election campaign and closed at the end of July. The new administration will need to decide whether to take that scheme forward, and then determine its perspective on any further new proposals.

Another public health measure the new government has picked up from their predecessors is the restriction on the sale of cigarettes to those born in or after 2009, effectively introducing an eventual ban on smoking in the UK. This measure ran out of time because of the election, but the recent King’s speech signalled its reintroduction.

The future of the workforce plan

The Conservatives introduced a workforce plan in the middle of 2023 which pledged significant growth in the domestic supply of dentist, and dental therapy and dental hygiene, undergraduate places. That plan received broad cross-party support so we would expect some degree of continuity, although hopefully with a refresh of some neglected areas such as dental nurse training.

This was labelled an NHS workforce plan, but one of the points we have made is that any workforce planning in the UK must recognise dentistry’s mixed economy. While not to the same extent as NHS-focused practices, our own data indicates that private dentistry has also increasingly seen recruitment difficulties over recent years. Growth in the domestic supply of clinicians may change that dynamic, but probably not in the short-term.

The bulk of the planned 40% growth in dentist undergraduate numbers is back ended towards the end of this decade, so it is going to be another 10 years or so until we see a significant impact on graduate numbers. Alongside the focus on domestic workforce supply, the previous government had also just completed its consultation on the concept of provisional registration – the idea to enable dentists with overseas qualifications to work under supervision as a route to registration with the GDC.

Although the policy focus here has been on increasing the supply of NHS workforce, that cannot be seen in isolation. The consultation raised more questions than answers, including what role private dentistry will be able to play in any eventual provisional registration scheme. The Labour government will need to decide if the idea is the best way to improve registration processes and we will of course continue to hold them, and then potentially the GDC, to account should they move ahead.

NHS tie-ins and increases in provision

The previous government’s consultation on tie-ins to NHS work for undergraduates from UK dental schools was launched as the election campaign began. There are clear implications for private dentistry. If we see restrictions on where early career dentists can work, there will be a direct consequence for workforce supply to the private sector. There could also be an indirect impact if the policy is ultimately successful in increasing NHS provision.

We know from our own survey work with the public that while many see private dentistry as a positive choice, there is also a significant cohort of patients accessing private care because they cannot see an NHS dentist. A growth in NHS dentistry could impact that dynamic. It is a policy that is many years away given that it cannot apply to those who have already started their undergraduate course, if it comes at all. We have raised significant concerns, and we hope the new administration will be more attracted to measures that incentivise rather than impose NHS commitment on new graduates.

The extended role of the wider dental team will also feature in the new world, with the workforce plan including growth in dental hygienist and dental therapy undergraduate places. Alongside that, legislation on prescribing exemptions for dental care professionals finally made the cut as the former parliamentary term ended. Dental hygienists and dental therapists will soon be able to supply and administer specific medicines without the need for a prescription, Patient Specific Direction, or Patient Group Direction from a dentist.

The official line on all of this is again to increase NHS provision, but there’s no obvious reason at present why this cohort of professionals will not end up in private dentistry. That’s particularly the case as any concept of NHS tie-ins is not currently intended for hygienists and therapists.

Contract reform

In relation to NHS care, perhaps the most important unknown is how the new Government will honour its commitment to reforming the NHS dental contract. It has started from a place of at least recognising that the NHS is broken and has talked about the need for short, and then longer-term measures to rescue and reform NHS dentistry.

But what are the implications for private dentistry? Are we to see an NHS sector that becomes more attractive to clinicians? Can the new Government encourage retention, or even a return of some dentists to the public sector? There is a sense that following several years of declining provision, the level of NHS activity has somewhat stabilised as contractual interventions start to have an impact. Will bolder initiatives shift the narrative further? A return to the time when spend on NHS dentistry outstripped private care still seems a long way off.

One of two things need to happen (or a combination of both). Firstly, a fundamental shift in how attractive the government is willing and able to make NHS dentistry relative to the private sector.

That means a reshaping of the contractual framework away from the current treadmill, but also wider practical measures to make dentists feel welcome and supported. Secondly, successfully increasing the workforce supply so that professional choice becomes more restricted. Both have implications for private dentistry.

The first of these options feels much more positive, both for professionals and for patients. It is in everyone’s interest that those working in public sector dentistry are there because they want to be, not because they are forced to do so. But significantly, both options require investment. Growing the workforce is expensive, both in terms of training and then in ultimately paying for more care to be provided. In current circumstances, that doesn’t feel entirely realistic.

What else might have an impact?

It is important to recognise that there are wider policy initiatives on the horizon, away from the direct world of health and dental policy, that may end up impacting on dentists and dental practices such as these from the recent King’s speech:

• A Pension Schemes Bill introducing new rules and requirements for private-sector pension schemes
• An Employment Rights Bill focused on the use of zero-hours contracts and introducing various new workers’ rights which we will need to consider through the lens of self-employed status in dentistry and for the employment of practice staff
• A Race Equality Bill which will extend the right to make equal pay claims under the Equality Act to ethnic minority workers and disabled people and bring in new pay reporting requirements for bigger firms.

With parliament in summer recess, it offers an appropriate time for reflection but as always, we will closely monitor these and other developments, ensuring your interests are represented, regardless of the sector you work in.