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Is Government serious about the survival of NHS dentistry?

Blog Author Eddie Crouch

Blog Date 21/03/2019

It’s a simple idea, but UK governments are only just waking up to it: you can’t have NHS dentistry without NHS dentists.
The sustainability of any service depends on its workforce. And it’s why we asked our members for detailed feedback on their pay and morale. 
We have submitted your evidence to the Review Body on Doctors' and Dentists' Remuneration (DDRB), the body tasked with providing recommendations on pay. 

We want NHS dental services to have a future. But on the basis of your feedback, that future is now in doubt. 

We have a crisis in recruitment.
We’ve given up on language describing the situation as an ‘emerging’ crisis. A crisis is with us, and is impacting on practices from London to the Lake District.

In England, 75% of NHS practices struggled to fill vacancies last year – a leap from 50% in 2016. We are seeing the same story in all four nations

In Cumbria we’ve spoken to recruitment agencies unable to fill a single post in the last 12 months. It’s not just rural communities – even in the capital golden handshakes are not getting applications in for associate vacancies.

And it’s also hitting the Community Dental Services. In the last two years we’ve found the combined CDS’ of the UK have not even sought to recruit to all of the vacancies that have arisen. 

Despite a selective advertising process, for every three posts that have been made vacant less than two appointments have been made in return. 

And for academics the vacancy rate is up, at 11.1% - with universities failing to recruit for more than one in every ten jobs for readers or senior lecturers.

More NHS = Lower morale 

It’s perverse, but colleagues showing the most commitment to NHS services are not being rewarded for it. 

Now 59% of NHS dentists in England say they intend to leave the NHS in the next five years – and that raises to 67% among those doing the most NHS work.

Whether it’s working to tick boxes or targets, or failure to arrest the collapse in practitioner incomes, the profession is now being squeezed on both sides. 

The long-term sustainability of NHS services depends on dentists wanting to work in it, and choosing to stay the course. 

But across the whole of the UK dentists are being forced into choices that will leave those services in jeopardy.

Scaling back, retiring early, or simply jumping ship are looking more and more attractive. 

And colleagues in CDS face distinct challenges, despite an ingrained loyalty towards the service they work for. Now, 66% of CDS dentists have hit the top of their salary scale with no opportunity for progression unless they move on. 

Access for dental patients patients is a growing problem

And so to the consequences - access problems for dental patients are back, with a vengeance.

We’ve found a million new patients tried, and failed, to secure access to an NHS dentist in England last year. Queues have even returned to parts of Wales. We’ve used the data you’ve given us to this argument across the media. 

Failed contracts and underfunding have seen patients from Aberystwyth to Barrow face 90 mile journeys. The Health Secretary found himself in trouble for endorsing affordable private options as a solution for his own constituents, left without access. 

We know dentistry is a mixed economy, and that our patients value choice. But now patients across England are being left with no choices at all – and we’re ensuring the media and MPs keep picking up on that fact

Is there hope?

We finally have what looks like a glimmer of recognition from government. Health Minister Baroness Blackwood acknowledged to parliament this month that "…there is a level of concern about recruitment and retaining dentists". 

Given what we’ve got used to hearing on official claims on 'record breaking' numbers of NHS dentists it looks like progress. Officials have been all too happy counting heads when they need to focus on time actually committed to actually doing NHS dentistry

And it’s why we need to keep pressing. 

Austerity pay is over, or so the theory goes. But pay uplifts that amount to pay cuts are still with us. We cannot be expected to smile and nod at below inflation uplifts, or when clawback is lost to services in the face of mounting demand. 

Are they serious about the survival of NHS dentistry? We hope so. Yet evidence submitted to DDRB by the UK governments still appears to fly in the face of reality. NHS England's suggestion that the workforce remains robust with a good supply of dentists who are well remunerated, doesn't just grate, it's at odds with the lived experience of colleagues working the length and breadth of the country.

The simple facts are, if practices can't fill NHS vacancies then we can't treat NHS patients. 

We know patients will travel further or wait longer for care until this government stops punishing colleagues who commit themselves to the NHS.

In England and Wales, dentists are calling for a dental contract that really puts prevention at its heart. The cost of ignoring this is too high, and we will continue to make the case to Governments, and ask for real commitment, backed by real investment.

Eddie Crouch, Vice-Chair BDA Principal Executive Committee

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