Nils Bohr was a Danish hero who received the Nobel Prize for Physics in 1922. The national brewer, Carlsberg, built Bohr a house. The home was next door to the brewery and allegedly had a direct feed from it, he fathered six children thus providing an early inspiration for the Carlsberg “refreshing the parts” adverts.

He once said, “Prediction is very difficult especially when it’s about the future.” Difficult or not I’m going to look at the future for young dentists in (general) Dental Practice.

It would be wrong to stare into the crystal ball without a quick glance over my shoulder. A sage told me in 1988 that in the future in the UK, “There will be NHS clinics and Private Practices”. With hindsight I’m surprised it took so long to get to where we are now.

Post Brexit, one big hitter remaining in-post is the Health Secretary Jeremy Hunt. There is still no money. The UK doesn’t care what Europe thinks of it, I know, but sometimes you hear the truth. A medic on Irish radio this week said, “The Tories don't like the NHS and Jeremy Hunt is doing his best to dismantle the basic principles of it”. In dentistry many of those basic principles are long gone and the remaining ones are being eroded as we watch.

No more money for education either. University fees and associated living costs are on the rise. Without free movement across borders in the future, university incomes from overseas may fall and UK student fees must rise accordingly. Dentistry is one of the most expensive courses to run, why not make the fees reflect those costs? Dentistry may well become the domain of the privileged, whose parents can afford to subsidise their offspring or arrange the loans for them.

With the recent relaxation of University status perhaps “a large corporate” could create or take over one or more of the Dental Schools to provide cadetships. The armed services have done this for many years. Five undergraduate years in receipt of a bursary and the tuition fees paid. The opportunity for vacation work/internships getting experience of all sorts at flagship practices and the indoctrination / assimilation becomes complete. Post-qualification you commit to, say, 10 years of service or have to repay their investment.

It is possible with this model that corporate dentistry can provide the closest thing to a career structure in general practice, something that the NHS has failed to do and significantly prevented private practice from doing.

The status of NHS associates does not bear close examination. In England and Wales there are fixed targets. Countrywide, associates do not provide their own equipment, are not directly responsible for marketing, wages, materials and so on and by any stretch of the imagination cannot retain the privilege of being self employed for much longer.

A quick flick of the pen by someone senior at HMRC would convert the status of associates to salaried employees. This might be welcomed by many dentists, young and old, especially those who have responsibility for childcare or who have spouses or partners who are in reasonably rewarded jobs.

Time and attitudes have changed and full ownership or traditional partnerships aren’t for everyone. The baby boomers who qualified before compulsory VT/FD and are now the (predominantly) male/pale/stale retiring on the proceeds of the corporate cash which many once derided. They may well be the last of their species.

Many young dentists look at the price of practices, the bureaucracy and the day to day pressure of practice ownership and decide that is not for them. The NHS has evolved into “turn up, get your UDAs, keep your nose clean from the GDC & CQC and go home”. Sounds like a job to me - not a vocation. The millennials are, allegedly, not keen on being tied to one particular practice.

In 2015-16 the admission target, for English dental schools only, was 809, presuming a 10% drop out rate and excluding overseas students there will be another 700 new dentists joining the ranks of the profession year on year. Of these about two-thirds will be female. At present the profession’s mix is 50-50 but it’s a fact that women work less than men over the course of a career, men don’t have babies and predominantly childcare duties fall to mothers not fathers.

This trend started with medicine and has had a profound effect both in   general and hospital practice. Interestingly the sex-mix pendulum has swung back in some medical schools.

One reaction with medical GPs is the change in status in response to the difficulty in recruiting partners by expanding the number of salaried doctors.  The government sees this as easier to control and privatise. Those GPs in favour of becoming salaried has now reached nearly 30%, nowhere near a majority but significant numbers are beginning to think the unthinkable.

In my last piece for GDPUK I wrote, “Meanwhile many quiet, thoughtful young dentists are taking a long view and working at their skills.” They are realising that to escape the mire of the NHS demands a commitment to growing themselves and that the sacrifices don’t stop with a BDS. In fact the years of serious dedication are just starting.

So the future, NHS clinics run by a handful of large corporates with salaried dentists and therapists, and private practices where an M.Sc is the starting point for consideration.

Your choice.

The Dental Update Study Day was this year held at The Dentistry Show, providing added value to all delegates.

A speaker line-up consisting of some of the finest members of the Dental Update Editorial Board delivered the full-day programme, informing and enthusing delegates throughout.

Professor Trevor Burke, Professor Crispian Scully, Professor Avijit Banerjee and Professor Jonathan Sandler each shared their extensive experience and expertise in their chosen fields.

It was clear that all those in attendance shared the same thirst for knowledge and passion for clinical excellence, each making the most of the speakers before them. Delegates also had the opportunity to visit The Dentistry Show during breaks, where they had access to the latest products and innovations in the profession, as well as further education and CPD.

We would also like to congratulate Professor Burke on winning the Outstanding Achievement Award 2015 during The Dental Awards on Friday evening – a highly deserved accolade to add to your existing achievements!

To enjoy some of the most remarkable speaker line-ups, make sure you don’t miss future Dental Update Study Days!

I told you January was interesting …

First we have a BDA EGM on the cards. Anyone who reads tea leaves must be thinking Friday 21^st of February is the new Ides of March. While the BDA turns in on itself in what some might see as a death roll, the world moves on and, boy, how fast!

The DFT numbers have been formally announced – see the link – and the big picture?  1 in 5 students have not got a job to look forward to – nice motivation if you can get it – NOT!  Approximately 240 out the UK Graduate bag of about 1100 have been ‘placed on a “Reserve List” I say approximately – the numbers are not entirely clear even if the big picture is.   What’s that – about 10% in the end? well, give or take.

Have we all been witness to a Coup d’Etat in dentistry – CoPDenD have quietly become the most influential body in dentistry. If you are a student on the receiving end, it must feel like a very unfair and cruel arbitrary selection process.

You know what sucks?  It is clear that CoPDenD would have you believe that the NHS and it’s public funding is the only kid on the block. They saw off Private Vocational Training and now have a monopoly grip on the peri-graduation phase of ones career. Is it me or does CoPDenD have a funny smell around it?

The size of the private dental market is now likely bigger than all of the NHS dental funding for dental care, both primary and secondary.

So why is there not a flourishing private-public partnership in dentistry in which the shortfalls of NHS funded DFT are more than taken up by a commercial organisation?  If ever an opportunity for the FGDP to do something practical ever has been missed this must be it.  I’ll bet if SERCO or Compass were bidding, Private VT would be up and  running by now.

And now ... midway though a Manpower Review at the Higher Education Funding body…  the word on the block  is that a blanket 10% student cut across the board has been enacted with immediate effect.  The Twittersphere is lighting up this week as the well  hinted cuts are finally publicised.

Perversely, that actually sounds like some form of a solution.  Fewer graduating dentists are an inevitable consequence of reduced Government funding. Since we all know the Government IS broke, maybe this 10% cut will be in ADDITION to the chopping of two dental schools, which is being widely trawled.

That will in 2 years mean a broad reduction of about 270 students per annum - job done, CoPDenD’s DFT books balanced.

But where is the drive to use the vibrant private market to create educational opportunities which support and supplement the NHS funded basic training? Lots of willing weekenders but no structure.

In its small way, dentistry is now witnessing the effects of lack of public funding. If the profession of dentistry is a thermometer for public finances, the mercury is falling.  So be it. Can’t spend what we don’t have.  It is not entirely unexpected after all

But there is a £7Bn, and growing,  private market for dentistry.   In fact, year on year growth of 10% and more is anticipated.

There has to be a better way.  The big picture of publicly funded dentistry is gaining a degree of focus.  We need to ensure that private dentistry builds its own big picture, and fast.

How? By whom?

Questions a’plenty. Answers on a postcard please!  If 10% of you reply…

See you soon people. How much more news can there be?

https://www.bda.org/docs/EGM-Notice-2014-02-21.pdf

http://www.copdend.org/content.aspx?Group=press%20releases&Page=press%20release%20january%202014

http://www.dentalschoolscouncil.ac.uk/

http://www.hefce.ac.uk/

This period of low interest rates in the UK combined with changes in society and demographics have had some long term effects which are far from coming to roost. Since the financial collapses of 2008, UK Government policies have been to minimize the economic shock; people have been protected by saving the banks from failure and also by continuing low interest rates. 

History tells us that economic policies designed to insulate from short term shock tend to come with a long term consequences. But no-one has thought about a cohort affected more badly by this economic effect, hard working young adults. They have to deal with high property prices and high rents, less secure employment together with rock bottom interest rates if they manage to save, but high interest rates if they have credit card or pay day debts.

Will there be friction between the younger generation whose lives are markedly different from their parents in so many ways? There hasn't been a revolution or even a rebellion, just a combination of changes of circumstance in society at large – greater access to further education, starting careers later on average, starting families later, so many important aspects of life have been shifted by a few years.

One piece of good economic news in the UK, along with growth of the economy, has been the gradual fall in the employment rate in late 2013 and early 2014. However, in UK dentistry, this seems to be in reverse, through unintended consequences, and the combination of many seemingly unaccountable people acting in what they think is the right way, but having a terrible effect on the lives of young dental graduates.

In our dental profession we are now seeing, possibly for the first time in history, unemployment of newly qualified dental professionals. What is now known as the Dental Foundation Training [DF1] scheme, which was commenced as an educational process to help young graduates move to the pressures of working as a trusted professional from those of a dental student. This scheme has now, over many years, become a requirement that dental graduates must complete before they can do any work within the NHS. They have to have a "performer number", obtained by joining then completing this scheme. 

Interestingly, graduates of dentistry from the EU do not have to gain this requirement in order to work in the NHS. However, in the present national foundation dentistry scheme, EU dental graduates have equal standing with UK graduates, and each year some of those from the UK miss out, and cannot work. They may reapply but can only enter the recruitment process twice. After that, if they fail to get through an interview and psychometric assessments, they can have no future career in NHS dentistry EVER.

In the interview process which started in November 2013, with results issued in mid January with no fanfare nor press release, it is estimated [and this is a SHOCKING figure] that more than 10% of UK dental graduates have been left with no employment next summer when they graduate.

What a waste of studying, hours of hard work and sacrifice. Students these days live from loans, those qualifying presently have student debts around £30,000 with potentially no prospect of working in dentistry. Last year, tuition fees rose to £9,000 per annum, so those qualifying soon will have debts of £60,000 or more, yet carry this risk of not having a job when they pass their university examinations and graduate. A further insult is the 18 month rule, where applicants have two chances to apply and go through the process. If then unsuccessful, the artificial rule that bars them from following their career in the UK adds to the injustice.

In addition, this pre-judgment of their chance of a career is insulting and morale sapping, to say the least, before even sitting for their final exams, which seems to relegate those exams, which are the true arbiter of whom is fit to practice, not this FD1 assessment.

Dental colleagues rightly ask where is the British Dental Association in all this? Cannot the dental schools do something – teams of staff there must be angrier than GDPs. And what about COPDEND, who administer this – you must know what is going on? Why can someone take the problem by the horns and change something to benefit UK dental graduates and exclude EU nationals qualifying elsewhere in the EU? Even if you believe there is a risk of breaking an EU law, surely that is better than wrecking the careers and morale of hundreds of young dentists, prejudging the results of their university finals?

The inter-generational friction I referred to earlier might surface in the dental school. Morale must have been affected by this unjust system, university staff must feel that action must be taken for the sake of those they educate. 

This is now the third year of this disastrous situation – something must be done, someone must take responsibility, and make the system fair for UK dental students.

1. COPDEND DF1 Policy statement: http://www.copdend.org/content.aspx?Group=foundation&Page=foundation_policystatement
2. GDPUK forum discussion: https://www.gdpuk.com/forum/gdpuk-forum/vt-national-recruitment-process-opens-9971 [this page requires a GDPUK login]