Health Education England (HEE) has recently launched a review of dental training that aims to reform dental education to respond to the changing treatment need of patients, to improve the quality of care and to deliver a larger workforce within the same budget.
As part of this, HEE are considering reforms that would introduce common entry to shared degree courses for dentists and dental care professionals. This may mean degree programmes in which students start on a shared courses with the same entry requirements and then exit at different points, with a limited number being allowed to progress to complete a BDS and become dentists. Alternatively, HEE are also considering a ‘modular’-based approach, in which students are trained in a particular group of skills based on workforce demand, with the ability to expand this skillset through their career as needed.
The clear aim in this review is to train more dental therapists and hygienists and fewer dentists. HEE has cited evidence that this will improve workforce efficiency and claims BSA data shows that 24 million courses of treatment (the majority of NHS work) could have been completed, at least in part, by a DCP.
So far, HEE have held a stakeholder engagement event with around 140 attendees and will now be taking forward proposals in five workstreams. It is vital that the profession engages with this major review and that dentists contribute their views and comments. The review has a very short timeframe, with a report to be produced by March 2018 and submitted to HEE’s Executive who will then set the ‘overall direction of travel’.
These proposals have raised serious concerns about the future of dentistry when presented to the profession. A push to create a less qualified workforce will inevitably lead to lower pay for all and runs contrary to the stated objective of improving the quality of care. Introducing many more DCPs, with expanded scopes of practice and, perhaps, the ability to diagnose and prescribe, poses fundamental questions about the future role of dentists.
There are basic questions as to whether a general dental degree, without clarity on whether you would graduate as a dentist or a DCP, would still be appealing to applicants and continue to attract the most academically talented. This is a particular concern given the personal investment and debt that university study now involves. Will applicants be willing to risk tens of thousands on such uncertainty?
Moreover, there are concerns about the evidence base and assumptions from which HEE is proceeding. The changing treatment need, in particular an ageing population requiring complex care, might, in fact, mean there is a need for more highly-qualified and skilled dentists, not fewer. In addition to this, the BSA data may hide more than it reveals; it is not clear how much of the work within these 24 million courses of treatment could be completed by a DCP and it may be the case that a lot of it already is.
HEE have stated that this review will not be based on the NHS contract or on any future reforms that might emerge from the current prototypes. Yet it is difficult to see how robust workforce planning can take place without a clear sense of the needs of NHS dentistry as determined by the contractual arrangements. Moreover, many of the problems with NHS dentistry that HEE have identified could be solved far better with a prevention-focused, capitation-based contract.
Also, given HEE’s remit, this review will only be based on the needs of the NHS dental workforce, but will clearly have significant implications for the workforce available for the private sector too. It is also worth noting that HEE, as the name suggests, has a remit only for England, but it is difficult to see how such radical change to dental training would not have an impact throughout the UK. There will also likely be consequences for post-graduate training and the career pathways open to graduates, which will need serious consideration.
More information on the review can befound on HEE’s website and all dentists are encourage to contribute via email.
BDA Policy Adviser