NHS dentistry faces "recruitment crisis"

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BDA evidence shows NHS dentistry faces recruitment crisis as morale plummets

A recruitment crisis for NHS dentists is imminent, and set to deepen access problems across England, according to new data from the British Dental Association (BDA)[1].

Survey evidence suggests over two thirds (68%) of NHS practices in England who attempted to recruit in the last year struggled to fill vacancies. Half of the NHS practices who attempted recruitment reported issues in the previous year.

Figures reflect widespread disillusionment with England’s unreformed NHS dental system, with levels of NHS commitment now a leading driver of low morale and motivation. Those with the highest levels of NHS work (over 75% NHS work as opposed to private) appeared more than twice as likely (39%) to report job dissatisfaction than those with lighter commitments (16%).

In the latest sign of emerging crisis Plymouth’s Director of Public Health, was instructed by councillors the week to write to NHS England requesting “urgent local action to improve access to NHS Dentists” amid 9,000 long waiting lists fuelled by staff shortages and patients facing a 70 mile journey for treatment. Recent reports for both the Times and BBC have highlighted access problems across England, with half of practices across England unable to take new NHS patients [2].

The BDA has previously reported that 58% of NHS dentists say they are now planning to leave the service in the next 5 years. Dentist leaders say that failure to reform the target-driven system in England and Wales, and the 35% real-terms fall in practitioner incomes continue to threaten retention, recruitment and the long term sustainability of the service [3]. The BDA has called for the re-introduction of NHS commitment payments in all four countries to help NHS associates, who generally have a higher NHS commitment and form the vast majority of the workforce, and NHS support towards indemnity payments.

Latest workforce statistics have shown the first year on year decline in workforce numbers in a generation.

BDA Vice Chair Eddie Crouch said: “When patients are struggling to get access government should not be punishing dentists for commitment to the NHS.

“It is a damning indictment of current policy that the dentists who go over and above with NHS care are now paying the price in low morale. The constant treadmill of targets and pay cuts mean something has to give, and services cannot be maintained when practices are unable to fill vacancies.

“Failure to act is already leaving millions of patients across the country in limbo. We look to ministers to take responsibility and show dedicated health professionals that NHS care is not an unattractive option.”

Key points: BDA evidence to DDRB

• The key challenge for NHS dentistry is recruiting and retaining dentists. The impact of morale and motivation is vital to recruitment and retention and in stemming the rates of attrition.
• Ongoing work is needed to ensure that we attract new members to the profession but we also need to make sure that those currently working in the NHS are valued and want to stay.
• The NHS is losing valuable dentists as they reduce their NHS commitment and seek to retire or leave the profession and this situation is causing a recruitment issue in general dental practice and the community dental services in many geographic areas.
• We are warning of a looming and fast approaching crisis in recruitment and retention of NHS primary care dentists in the UK.
• We have similarly significant issues in secondary care and consultant vacancies in Scotland and clinical academic posts across the UK.
• Of real significance is that our members are reporting that the higher the NHS/HS commitment the lower the levels or morale/motivation and enthusiasm about work in the dental profession. This is of grave concern.
• We would like to see the re-introduction of NHS commitment payments in all four countries which would particularly help NHS associates, who generally have a higher NHS commitment than practice owners and form the vast majority of the workforce.

• As a result in this 2018/19 submission, our position is that a pay uplift recommendation must at the very least curb any further erosion of pay in real terms and, similar to other NHS professionals we are calling for inflation (RPI) linked award plus 2%.

• General dental practices are suffering with less than one applicant per post (outside London) for advertised positions and 63% of practices that attempted to recruit associates experienced difficulties in doing so in England, huge sums of money are clawed back from practices unable to meet their NHS commitment for various reasons including failure to recruit associate.

• In the community dental services morale and motivation have got worse since last year and there are recruitment problems, particularly to specialist posts.

• For the first time BDA evidence suggests that the majority of CDS dentists are dissatisfied about pay
• The role of the service is changing in all four countries to concentrate on complex specialist work with patients who can, in theory, be cared for in general dental practice being discharged back. This increases recruitment problems and does not aid retention.

• In dental academia there is a permanent 10% vacancy level amongst Senior Clinical Lecturers, the backbone of clinical undergraduate, teaching.

• GDPs seriously question the effectiveness of the whole DDRB process. Despite engaging, constructively with the DDRB over the last four years, it is our view that all that has been delivered is a massive drop in income and no prospect of any meaningful improvements in the pay, morale and motivation of the workforce in the near future.

• Despite the financial challenges facing dental practices and the ongoing cuts in pay, patients’ expectations for high quality care are just about being met. However, the DDRB cannot allow for patient access and care to be severely adversely affected before acting on dentists’ declining incomes.

• Successive below-inflation pay awards, combined with lengthy delays in their implementation, have led to very considerable erosion of dental incomes. In Northern Ireland, the 2017/18 process has still not concluded.

References
[1] Figures from BDA survey of General Dental Practitioners. 1,212 questionnaires were completed and returned by post or submitted online. Figures are based on the BDA’s newly published evidence to the Review Body on Doctors' and Dentists' Remuneration (DDRB).

[2] Plymouth City Council has cited recruitment problems as a major driver of recent access issues. See: https://www.plymouthherald.co.uk/news/plymouth-news/plymouth-people-being-sent-70-1141068. In November The Times found that in 24 local authorities in England dentists can only take on private patients. Of those surgeries with information on NHS Choices 49% currently cannot take on new adult NHS patients, while some 42% are unable to see new children entirely. BBC News analysis from September of 2,500 dental practices on the NHS Choices website found half were not accepting new adult NHS patients, while two-fifths were not accepting new child NHS patients.

[3] Figures from NHS Digital show that taxable income for high street NHS dentists continues to decline, with a fall of nearly 35% in real terms since 2006 (figures reflated by BDA using the RPI). This unprecedented drop has seen the real incomes for practice owning dentists fall by over £45,000, and their associates by over £20,000 over the last decade. Costs facing individual practitioners for regulatory compliance and registration have gone up by 1086% in the same period. Latest workforce statistics have shown the first year on year decline in workforce numbers in a generation.