In my 3rd May 2024 blog, I speculated on the timing of the election and the options for the next government when it comes to plans for NHS Dentistry. Just like almost everyone else, including a large number of Conservative MPs who have since decided not to contest it, I got it wrong.
It will now be on the 4th of July 2024 and not in November 2024 as I had expected. Why Rishi Sunak chose that date is anybody’s guess, but we now have the opportunity to study the plans of various political parties. While they’re scrambling to finalise their manifestoes and spiels, let us digress for a moment and consider the future of the dental profession, the newly qualified dentists who must work in the NHS if it is to survive into the future.
There has been a trend for some years now of newly qualified dentists exiting NHS Dentistry either immediately after foundation training or within their first five years as fully qualified clinicians. Why would they do this? Is there something inherently wrong with NHS Dentistry? Are there character flaws in these generations of new dentists? Do they no longer feel a sense of duty to the population and the taxpayers who part-funded their training? Has working in the UK become so unattractive? Does NHS Dentistry only have to be propped up by immigrant dentists like me?
NHS Dentistry has not been an attractive career option for UK qualified dentists for a very long time. That’s how the opportunity for people like me arose in the first place. Until Brexit materialised, it was also supported by many dentists from the EU. The saga of UK dentists leaving the NHS or never having worked in it is not altogether new, but the reasons now are more compelling than they have been for previous generations. By hiking student fees and student debt, the coalition and subsequent conservative governments have made students and new graduates more transactional. After all, if they’re paying for more of the cost of their education, would they feel that they owe a moral debt to anyone? They have a large financial debt to think of and working for the lowest price that the government can offer would not be an enticing prospect. Real terms funding of NHS Dentistry in England has shrunk by a third since 2010. The contract hasn’t been attractive even to old-timers who have worked in it for many years and many of whom either retired or went private during and in the aftermath of the COVID-19 pandemic disruption. The narrative and campaign around the Brexit vote alienated many EU dentists, with some choosing to leave and other potential recruits going elsewhere.
In comparison to the advanced techniques and technologies employed by dental practices in other developed nations and even in the private sector in the UK, NHS dentistry is very basic and cannot provide anything other than the minimum required for the achievement and maintenance of dental health. Imagine a newly qualified dentist having been educated in all those wonderful possibilities that we read about and entering a world of work which doesn’t look much different to one that their parents may have seen decades ago. Would they want to condemn themselves to decades of a career doing the basics and nothing else? Wouldn’t such work result in de-skilling? As many current NHS dentists have discovered, once deskilled it becomes very difficult to develop further and we get stuck in a world with a limited skillset. If we did pursue further training and skilling-up, we wouldn’t be able to use the new skills in the delivery of NHS primary dental care anyway, so why bother? Should new dentists be shackled to such a system? Hospital dentistry may provide one route to the development and deployment of further skills but that opportunity would only be practicable for a fraction of the dentist population.
Why shouldn’t they aspire to the incomes and lifestyles of peers in other comparable economies or even to those of the private sector in the UK?
The one strong reason for many dentists persevering with the many problems that they face in NHS Dentistry is the hope of an NHS Pension at the end of a long and punishing if sometimes rewarding career. Successive governments have worked to dilute the benefits of public service pensions and today’s young have no faith in government or society to help them. They are working for themselves and no one else and will plan according to their own needs and circumstances.
If the NHS is to survive, one option is to rely as it has done for decades on professionals from poorer countries, but as those countries develop and provide better lives for those professionals, that tap is bound to run dry sooner rather than later. Those professionals may also choose to migrate to countries offering the best deals and the UK definitely isn’t the preferred destination for such migrants any longer.
The only option for long term survival of the NHS is to train and retain homegrown talent. That cannot happen unless there is fundamental reform of both the funding and the remit of NHS Dentistry. The idea of a tie-in to NHS work is fundamentally illiberal and not one that we should support. Is the government willing to tie-in other graduates similarly? Would law graduates have to work for the Crown Prosecution Service? Would accountancy graduates have to work for His Majesty’s Revenue and Customs? Even indentured labour will only go so far.
The government could propose funding courses key to national welfare and security by offering tuition waivers and military cadet style stipends/salaries to fund students in those sectors and then propose a tie-in to working in the key sectors for a set number of years with exceptions or modifications for those pursuing further study and research. Would the next government be willing to do that?
The NHS offering should be attractive to highly trained professionals to enable them to be the best dentists that they can be and not have to jump through hoops to survive.
If it cannot be a service fit for 21st Century professionals, then it will die out when 20th Century professionals retire.