Last updated: April 2024

Aims of the Workforce Plan

According to the Plan’s estimates, NHS dental services are currently provided by 8,800 full time equivalent (FTE) dentists. Long-term estimated demand in England would require 23,000 FTE dentists. The Plan does not state this explicitly, but this refers only to the NHS GDS workforce. The Workforce Plan aims to bridge the gap by:

Assessing the key areas of recruitment and retention needs within the health service in England
Identifying where growth in employment is required to meet the needs of the service long term
Creating targets for every profession based on a mixture of current workforce needs and future expectations regarding population growth and demographic shifts
Cover the broad sweep of the NHS in England and set out specific numbers for the English NHS dental service.

Shortfalls of the Workforce Plan - What questions still need to be answered?

Investment

The plans will require substantial investment, but currently, neither the Conservative Government nor the opposition has committed to funding the Plan in full. Estimates of required funding levels are likely to be around several billion pounds per year for at least a decade, and there is no specific breakdown of the costs and funding for the dental elements of the plan. There will need to be, for example, investment in dental schools’ estates to accommodate additional student numbers, but the Plan sets out no details on this.

Calculating workforce size

The figures set out above on the size of the workforce are based on an imprecise estimate, which derives the number of full-time NHS dentists by dividing the total number of UDAs by 6,000, on the basis that an average dentist would perform that many UDAs per year. While this is a rough rule of thumb, it is a crude basis on which to undertake workforce planning.

Increasing NHS commitment

The Plan sets out an intention to increase the number of full-time NHS dentists by 7,100 by increasing the ‘participation rate', by which they mean increasing the NHS commitment of each dentist. This is extremely ambitious in a context where dentists are decreasing their NHS commitment. Very little detail is provided about how this might be delivered. It is unclear how this is achievable in the current circumstances without significant changes to the dental contract and wider system to reverse current workforce trends.

Expanding dental school numbers

The Plan intends to increase the number of dental school places by 40% over the next decade, with the first larger intake from 2028. As well as the estates issues raised above, there will also need to be a larger academic workforce and then more Educational Supervisors and Dental Foundation Training places. This requires funding, time, and planning, but the Plan sets out little detail on how the ambitious expansion in dental student numbers will be delivered.

The rest of NHS dentistry?

The Plan appears to be almost exclusively focused on the NHS General Dental Service. There is little to nothing about postgraduate training pathways for the expanded number of dental graduates, nor is there anything on addressing workforce issues in the Community Dental Service or Dental Public Health.

A leaky bucket

The Plan also largely fails to address the issue of retention, and why it is that so many dentists don’t want to work on the NHS. Adding more dentists into this broken system is akin to adding more water to a leaky bucket. There need to be solutions to the fundamental issue of the contract to begin to address the workforce challenges.

All of this leaves NHS England and the Government with questions to resolve.

What role does skill mix play?

The plan states that the amount of NHS activity delivered by DCPs is set to rise from current levels of 5% to 15% by 2038. This would appear to overstate the current levels of NHS activity quite significantly by DCPs. We understand that currently as few as 1% of FP17s indicate that a DCP has been involved in the provision of the course of treatment.

To achieve this, there is a planned expansion from the assumed 500 FTE dental therapists and hygienists to between 2,700 and 3,500 dentists' worth in 2036/37. To support this, dental therapist and hygienist training places are set to expand by nearly 150 by 2031. While numbers remain small, the plan implies a 500% increase in the NHS dental therapist and hygienist workforce.

NHS tie-ins for new graduates

There is a proposal that new graduates could be tied into doing NHS work. This is because the model of how to increase the number of NHS dentists is also based on significantly expanding the amount of NHS work each dentist does. We understand that around 40% of the 7,100 FTE expansion in the participation rate is coming from an NHS-tie in of new graduates. The Government is looking to achieve this, in part, by requiring graduates to work on the NHS. The terms of this are subject to a consultation expected in the coming months.

This would be a bold move and signal a major change in the relationship between the NHS and the profession. Demand for dental undergraduate education remains high, but appetite to work in the antiquated UDA system, a lack of true funding for expenses, and exceedingly high workloads, amongst a set of other concerns, is deteriorating dentists’ faith in the service. We believe the focus should be on reforming the contract so that dentists want to work in the NHS, rather than tying them to a broken system.