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Posted by: The Probe 8th June 2021
In the last few years, dental recruitment challenges have escalated from a localised problem to a national crisis. Some within the profession argue that the situation will only intensify in light of Brexit and the lack of clarity when it comes to recognising dental qualifications obtained overseas.
Dr Sanjay Shah, Chief Executive Officer of Together Dental, believes there are simply not enough UK graduates servicing NHS dentistry, which he suggests is having a major impact on the dental service provision in the UK, particularly in coastal locations.
“The result is inequality in areas where many patients are unable to access the dental services they need,” says Dr Shah. “We’ve had no UK graduates apply at our Sheringham practice on the Norfolk coast, for example, despite the fact that we offer enhanced employment packages. Although we’ve had the practice for seven years, the previous owners had it for 36 years and never took on a UK graduate in that time, which demonstrates the scale of the problem.”
Historically, practices have made up for a lack of home-grown dentists by employing EU graduates with relative ease, as Dr Ian Gordon, Dental Director of Riverdale Healthcare, explains:
“Up until about a year ago, it was indicated that 17% of General Dental Council (GDC) registrants were EU graduates, delivering approximately 30% of NHS dentistry, rising to 50% in hard-to-reach areas. Then came Brexit, the run up to which saw a cliff-edge dive in the number of EU graduates coming to work in the UK. The irony is that many areas of the country that voted for Brexit typically rely on the EU dental workforce for the provision of treatment. In addition, practices across the south west of England have probably relied on recruiting dentists from abroad more so than those in the northeast.
“Dental recruitment is certainly more challenging. We are becoming increasingly reliant on foundation dentists (FDs) owing to the COVID-19 response. However, FDs working within NHS dentistry at the moment are simply not the equivalent in terms of experience and output as someone who qualified three years ago. These clinicians are playing catch up, which means there is a lag in the system.”
Dr Shah agrees that there could be major issues in the near future, as he says: “The number of dentists in the UK is already thin but will eventually become anorexic if immediate action isn’t taken. First, overseas-qualified dentists have to travel to the UK to sit the Overseas Registration Exam (ORE), which – for obvious reasons – hasn’t been possible for the last year or so. There are only a few ORE sittings annually and at certain times of the year. Exam slots are booked within seconds and even if clinicians secure a place, the ORE has a very high failure rate.
“Upon passing the ORE, dentists then have to register with the GDC and apply for the Performers List Validation by Experience (PLVE) to be able to work in NHS dentistry. Not only is the PLVE a long-winded process with additional barriers, but it has also recently been inaccessible due to the pandemic. Furthermore, lack of remuneration for PLVE mentors is prohibitive as well.”
Working in private dentistry is also becoming more appealing to young dentists.
“I think the support from NHS England over the course of the pandemic has been exceptional, with most practice principals passing on remuneration to their associates and promoting retention,” says Dr Gordon. “However, I suspect that this associate loyalty won’t remain long-term if the NHS offer doesn’t improve. Working privately – away from the pressures and restrictions of NHS dentistry – will become increasingly attractive.”
Indeed, a 2019 survey found that 77% of NHS dentists didn’t see themselves working in the NHS after five years, with 46% expecting to have moved to predominantly private care. Both Dr Shah and Dr Gordon believe a complete overhaul is necessary to make recruiting dentists from abroad easier.
“There needs to be less bureaucracy and red tape around the process of applying to work in the UK and join NHS dentistry,” says Dr Shah. “By making it easier for overseas dentists to work in the UK, we can really change the provision of dental services across the country. This involves ditching the old-school mind-set that the standard of dental education in the UK is far superior to that of other countries, which simply isn’t true anymore.”
Beyond this, Dr Gordon suggests restructuring the NHS contract to provide flexible commissioning, which would help make working in NHS dentistry less stressful, more enjoyable and, therefore, more appealing, with added benefits for improving retention. He says:
“This wouldn’t just apply to EU and non-EU dental professionals but also UK graduates. By managing retention, recruitment becomes less of a crisis. Ultimately, unless there is urgent action, patients will eventually lose out with access to essential treatment becoming almost impossible in many areas.”
Dr Shah adds: “Those at the very top within governing bodies seriously need to address this issue and ask, ‘What quality of care are local populations receiving in areas where there is limited access to NHS dentistry?’ There’s no reason why anyone in rural areas should receive worse dental services than someone living in a large UK city.”
The reality is that many practices are already struggling to keep pace with an increased demand for treatment, particularly given the access problems associated with the pandemic. The majority of a practice’s value lies in its goodwill, which is maintained and enhanced by delivering the exceptional quality treatment that patients seek. As such, workforce shortages may be the tipping point for some practices, restricting their ability to treat patients and resulting in a potentially heavy impact on goodwill values.
A pro-active and decisive approach is vital if UK dentistry is to thrive in the wake of Brexit and the COVID-19 crisis. Developing a sound recruitment strategy that focuses on retention is key to protecting your dental business from future challenges. Get in touch with Dental Elite to leverage expert advice and guidance on maximising your recruitment activities.
Dr Sanjay Shah is the founder and Chief Executive Officer of Together Dental. He graduated as a dentist in 2007 from Guy’s, King’s and St Thomas’, before going on to buy his first practice in 2010 in Clacton-on-Sea. Relentlessly raising standards and keeping patient care and training at the core, Dr Shah grew a three surgery NHS practice to a flagship eight surgery practice providing multiple services under one roof. This set the tone – the group went on to win NHS tenders and acquired additional practices, growing Together Dental to 34 practices today. Dr Shah also sits on the Association of Dental Groups Board.
Dr Ian Gordon was born in Stokesley, moving only when he gained a place at Newcastle Dental School from where he qualified in 1984. He returned to North Yorkshire before starting his own practice, The Dental Centre, in Eaglescliffe in 1989. Dr Gordon expanded that NHS practice group to include practices in Middlesbrough, Martonside and Guisborough before leaving to establish Vitality Dental Practice with his wife, Jayne, in 2008, whilst at the same time establishing Alpha Dental Group with four other partners. The group joined with Riverdale Healthcare – of which Dr Gordon is Dental Director – in January 2019, expanding the portfolio of practices in the North East and North Yorkshire to the current 25-practice group. Dr Gordon has been involved in dental politics and vocational training throughout his 37-year career – he is currently Chair of the North Yorkshire Local Dental Committees (LDC) and Vice Chair of the Yorkshire regional LDC. He also works part-time as a dento-legal advisor for Densura and is part of the management team within the Association of Dental Groups.
 Practice Plan. (2019) Dentistry Confidence Monitor Survey: Results Report. Available at: https://v.fastcdn.co/u/897636ad/46142165-0-The-Electronic-Denti.pdf. [Last accessed: 25.03.21].