Over the last few months Health Education England (HEE) has been sharing proposals on the review of dental training. The proposals appear to be fairly significant and if accepted could result in a monumental change to the way the dental workforce is trained in the future. Its proposal would result in the introduction of a common entry to shared degree courses for dentists and other dental care professionals. This could be a departure from the current approach where the entry to dentistry and medicine remains similar but is distinct from other courses.
These changes could invert the current programme structure resulting in applicants potentially not knowing if they will exit as a dental surgeon or a dental hygienist. On the one hand this may suit the government as it provides for even more control over the profession but this may also distort the market of education so much that dental surgery becomes unattractive as a career pathway. There is a knock-on risk in that the current parity with medicine is also lost in the process.
Workforce modelling in dentistry is complex at the best of times, there is an intricate dynamic between the incoming and outgoing workforce, the time it takes to train someone, the needs of the population, demand for services, policy, regulation and technology. Previous workforce modelling exercises have made a range of conclusions about how much work could be transferred to a hygienist or a therapist, the cost effectiveness of this remains unknown however, especially when there are certain types of treatment that only a dentist can provide. However, there will be some patients in the population that could in the future be treated in their entirety by hygienists and or therapists.
The issue with most of these assumptions is that they view NHS and private dentistry as being mutually exclusive. They also seem to ignore the flows between mainland Europe and the UK, or the flow of dentists across the UK. Most of these modelling exercises are based on current clinical activity in the NHS. They often do not account for future needs; or the potential for any increase in scope for dental surgeons. For example, dental surgeons may start using their broader surgical skills in the future which may be possible with advances in technology resulting in more complex care being provided. Equally patients may elect to have a greater range of procedures provided privately outside of those typically available from the NHS.
Undoubtedly, flooding the market with more hygienists and therapists will reduce the cost of either of those simply by changing the supply curve. However, there also needs to be sufficient work that can be transferred to them in the most efficient way.
Health Education England has been deploying its top team to sell these proposals to the profession, yet little has been done to explain how this relates to NHS contract reform, GDC regulatory changes or the relationship with the devolved nations. The meetings and presentations so far, help set out some ideas but little has really been done to properly consult with all those that are likely to be affected. At this stage the proposals seem confused and it is unclear which government strategy these proposals relate to. There does not appear to be any ministerial commitment or manifesto commitment which would seem to drive this approach, and other than a cost saving it is hard to establish what improvements in quality are expected.
In my view, policy makers should first establish the outcome they are seeking and present the evidence that this outcome is both necessary and critical. After doing that they should consider working with the profession to establish the approaches to achieving the outcome, for example agreeing what they want and then working out how to do it. The current proposals seem more focussed on how, rather than what. If policy makers want to achieve the best outcome then a change in tact seems essential as the profession is unlikely to respond well to central command.