Oral Evidence To Commons Committee Pulls No Punches – Part Two
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- Published: Monday, 27 March 2023 10:07
- Written by Guy Tuggle
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In this second article reporting on the oral evidence presented to the Health & Social Care Committee’s Inquiry into NHS Dental Access, GDPUK’s Guy Tuggle reviews the wide ranging topics evaluated by Ian Brack, the Chief Executive and Registrar of the General Dental Council; Dr Abhi Pal, President of the College of General Dentistry; and Malcolm Smith, Chair of HEE’s Advancing Dental Care Review and Dental Education Reform Programme.
The second half of the Inquiry opened with a discussion of the initiatives the government could take to incentivise dental graduates to work in the NHS.
Dr Pal said “I have, first of all, to concur with my colleagues about the state of the contract and dental contract reform, which is sorely required. It is not just a question of contract reform, while that is very important. It is also a question of making dental professionals’ careers more fulfilling and providing some degree of recognition for what they do.
Everyone goes into dentistry to provide the best care they can. It is worth pointing out that beyond dental core training, which is some two years post-qualification, there is no effective career pathway or structure for dentists to follow. A large void is left there. There is also little recognition from the NHS for dentists who have sometimes invested significant quantities of money in order to enhance their skills. There is little recognition for that in the NHS.
If the working conditions in that sense, and the recognition, could be made better, the NHS would be seen as a more attractive place for particularly younger dentists and international dentists …. to come and work.”
Training v Reality of the job …
Lucy Allan MP (CON, Telford) asked the witnesses “Can you advise us as a Committee to recommend to Government how we can have a better model, where graduates are incentivised to work in the NHS?” Mr Brack stated that his job was to supply and regulate dentists (via GDC register) but reiterated “ You have heard this morning what is wrong with the situation. The contract is the problem. We are producing graduates who are trained to carry out dentistry in a certain way. Then they come into the profession and they are not permitted to do that. Allow them to do it.”
The training issue was taken up by Dr Caroline Johnson MP (CON Sleaford and North Hykeham) who said that the government has trained plenty of dentists and compared their career progression to doctors.
“Most doctors work in the NHS, even if they do private practice. It is relatively unusual to do solely private practice in the way that we see in dentistry. With a doctor, you usually spend about 10 years learning to be a consultant before you do private practice. To what extent does the lack of postgraduate qualification and a lack of postgraduate pathway mean that people go into dentistry in the private sector very early and then just stay there, or do you think it has no impact at all?
Malcolm Smith replied saying “We do, of course, have postgraduate pathways for specialty training. They are fairly well defined, but specialty delivery in dental care is relatively small compared with medicine, where it is almost all a specialism. Even being a GP is a specialism, or a specialist part of the training. We do not have that for primary care.
We need to develop those models for a young dentist. I qualified a million years ago. You could be working in general dental practice, delivering the same thing, for 40 years or longer. We need to change that. For the younger generation that is not acceptable. That is what they have told us through our events and our dental care report. They are young, highly qualified and highly intelligent people. We need to stimulate them. We need to offer them opportunities.
We have doctors with special interests in medicine, and that is less common in dentistry. Maybe that is something else. How do we develop a primary care dentist to feel as though they are an integral part? But it is not just that. I go back, I am afraid, to the word “team”. There is a huge opportunity for the rest of the dental team to free up our dentists to deliver the things that they are uniquely able to deliver.”
The Committee heard that there was a crying need for more dental training facilities to be built and spread into areas that need a dental workforce.
Obstacles to Overseas Dentists
“ If you are a dentist who has trained in France, for example, and you have been there for 10 years treating people’s teeth, and then you come to work in the UK, you can register to become a dentist and work in private practice. My understanding is that you would need to undergo extra training and get another certificate to be able to work in the NHS. Is that right, or am I mistaken?” asked Dr Johnson.
Ian Brack of the GDC explained “Our job is to ensure that those practitioners are safe to practise. There is a curiosity, which is that we are required to automatically register dentists from the EEA. We check that they are who they say they are, that they have the qualification that they say theyhave, and that they can speak English to a level which is satisfactory. Those are the checks that we carry out.”
Brack explained that the procedure stems from “the treaty obligation that the UK Government entered into” and that “there are currently transitional arrangements which continue that, but it is still mandatory. With the rest of the world, you go through a process of validation that is done through the overseas registration examination, so we say, “Safe to practise.”
“What that does not say is that you understand the National Health Service and that you are trained in the way the National Health Service works. It is important to understand that dental training is very varied, even across Europe. One cannot automatically assume that one set of qualifications will cover the full panoply of skills that the NHS requires. We can say they are safe, but the NHS will want more. That is what registration is for, as I have always understood it. It is the training for, if you like, doing it the NHS way.”
Different sets of legislation were responsible for this situation Messrs Brack and Smith confirmed. “What we will be doing is revising our rules and revisiting how we deliver the overseas registration examination in the short term, because that is the quickest thing we can do” said Mr Brack who added that there were currently 1700 candidates waiting to sit the exams.
“The question is, who wants to come and work in the UK? That is the bigger driver. That is the thing I cannot control…”
Impact of Crisis on wider NHS…
Dr Johnson said “ We know that if you have toothache, you will have poor sleep. You may have time off work. You may have poor mental health. Having poor dental health can mean you have poor cardiac health, for example, and poor general wellbeing. To what extent does the unmet need that we have in the population impacton the overall wider NHS budget? Do you have any assessment of that?”
Dr Pal went first: “Yes. The link between systemic health and dental health is well established, and increasingly more so. If more prevention is focused on dental health, fewer of the other illnesses may become apparent. There may be elements of flexible commissioning that can be used to address it.
The overall statistics of exactly how much of the NHS budget could be reduced if oral health was vastly improved are unknown to me, but there is no doubt that there is a very strong link, and a strong case to be made, if the service is appropriately funded, to put in preventive measures that might reduce the impact on secondary healthcare.
Dr Johnson wondered if fluoridation would help ease the access crisis but Dr Pal was unsure. “ I am not sure if it will absolutely reduce the need, but what it will reduce is the overall amount of dental disease, particularly at the higher end where we are see very sad stories of the number of general anaesthetics that are required for children.
In his next and third instalment to be published in GDPUK this week, Guy Tuggle will report on the Committee’s discussion of more ‘radical’ solutions including the possibility of salaried dentists.
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