The British Dental Association has welcomed reports the Home Office has reconsidered plans to introduce the use of dental x-rays to determine age in asylum cases. The Association has been campaigning against the rollout of dental age checks for migrants, working closely with the Refugee Council, alongside other healthcare bodies and opposition health and home teams.

It is expected government amendments to the Nationality and Borders Bill will still give significant latitude to the Home Office to define in due course what constitutes ‘robust’ and ‘scientific methods’ of age assessment. On that basis the BDA will continue to seek amendments to the Bill to rule out radiographic tests. 

The Association has vigorously opposed the use of dental X-rays to determine whether asylum seekers have reached the age of 18, stressing they are an inaccurate method for assessing age.  

The BDA also believes that it is inappropriate and unethical to subject people to radiation when there is no health benefit for them. X-rays taken for a clinically justified reason must not be used for another purpose without the patient’s informed consent and must be carried out without coercion and in full knowledge of how the radiograph will be used and by whom.

British Dental Association Chair, Eddie Crouch, said: “It’s welcome news that Ministers appear to have ruled out dental checks on migrants that fail basic tests on accuracy and ethics.

“However, new laws will still give the government power to define what constitutes a ‘robust’ measure of age. Dentists do not want to see pseudoscience make a return via the back door.” 

Twenty individuals are being celebrated in the latest round of the prestigious BDA Honours and Awards, for their outstanding achievements, their commitment to the BDA, and their work for the dental profession.

From all sections of the profession, general practice, through to community and hospital dentistry, and across the four nations, the BDA is proud to honour these people.

The Association also recognises the commitment and dedication of the BDA staff to our members and the profession during the COVID-19 crisis, and has awarded a Certificate of Merit for Services to the Association. 

Roz McMullan Chair of the BDA’s Honours and Awards Committee, said:

“I am delighted to see these people honoured for their hard work and commitment to dentistry.

“Through these times of immense challenge and change, we are proud to be able to highlight the work of those who have gone above and beyond, making our profession better. We are proud to showcase those who have supported our causes, gone over and above for the profession, and/or given exemplary patient care.

“During 2021/2, we want to find dentists who have shown a commitment to advancing dentistry. We strongly encourage nominations from all areas of the profession – please consider putting forward a colleague/s who you think deserve recognition for what they do.”

You can find out more and nominate via Honours and Awards. The deadline for the next round of nominations is 27 May 2022. Nominations for the Joy Harrild Award for Young Dentists should be submitted by 29 April 2022.

Fellowship Medal

Dr Colette Bridgman, former Wales Chief Dental Officer and specialist in dental public health

In the last five years Dr Bridgman has succeeded in improving many aspects of dentistry and the oral health of the population in Wales, and in doing so she has on occasion taken bold steps to overcome institutional inertia, and latterly taken head-on the challenges caused by the pandemic. She made improvements by introducing electronic dental referrals across all specialities in Wales, as well as moving along the process of NHS General Dental Services contract reform, towards an alternative contract based on clinical need. She has taken calculated risks to navigate through the most challenging period in living memory to support the profession and serve the oral health needs of the population of Wales.

Laurie Jacobs, Deputy Chair East Midlands Branch and retired GDP

Laurie Jacobs has supported the dental profession for many years, at both a local and national level. As a representative on the BDA’s former Representative Body, he was diligent in taking concerns forward and provided clear and concise reports back to members. His friendly and approachable manner enables him to empathise and communicate effectively with all members of the dental team. Laurie had a keen commitment to post graduate education in the region and was involved in setting up the John Reeves Memorial Fund for support of post graduate education.

Dr Nigel Monaghan, Chair Wales Committee for Community Dentistry and consultant in public health and dental public health, Public Health Wales

Dr Nigel Monaghan has gained huge respect by all the members of the BDA Welsh Committees for his vast understanding of all things to do with dental public health. Nigel has provided great insight over the years regarding epidemiological studies of dental caries in children and adults and how the data relate to public health measures such as Designed to Smile. Nigel is not only highly esteemed for his vast academic understanding but also his keen sense of politics when discussing any aspect of dental policy. Nigel gave frequent commentary on the covid situation last year providing dentists with considerable insights to the complex unfolding of pandemic conditions.

Dr Graham Smith, Chair Scottish Public Dental Services Committee and consultant oral and maxillofacial surgeon

Dr Graham Smith has been a member of the BDA since 2003 and has worked tirelessly to promote the interests of the dental profession both locally and nationally for the last 11 years. He has been a member of several Scottish Government committees and was involved with the Children and Young people (information sharing) (Scotland) Bill and the UK Government’s consultation on future healthcare regulation. He has engaged with the Chief Dental Officer (CDO) for Scotland, Scottish Government and health ministers to fight for oral health issues and the interests of Salaried Dental practitioners throughout Scotland. More recently he has led the Scottish Joint Negotiating Forum with the CDO and senior civil servants. He has also been responsible for setting up the Urgent Dental Care Centre in Portree, and was the sole dentist working in face-to-face dental care in the North West Highlands at the start of the pandemic.

Dr Sandra White, past national lead for dental public health at Public Health England

Across her career, Dr Sandra White has undertaken a huge range of work to advance the standing and status of the profession, gaining high regard and respect of fellow BDA members. In her role at PHE, her leadership in advocating the importance of epidemiological surveys and dental intelligence has been crucial in the continued existence of the key oral health studies. She has also been a powerful voice in support of water fluoridation and oral health improvement. Sandra continued to push the fluoridation agenda and undoubtedly played a key part in it featuring in the current UK Government’s public health agenda. Her previous clinical work in special care was also noteworthy, setting up services for those who were homeless, and providing domiciliary and sedation services from scratch and a general anaesthetic service. She has been an advocate of strong collaborative working on many important dental public health issues and has also played an active role in some key BDA projects, most recently working actively in 2020 on mental health and wellbeing, as well as our AMR summit in 2014.

Life Membership

Michael Cranfield, past Chair England Community Dental Service Committee and retired clinical director

Michael Cranfield has been a member of the BDA for over 30 years. He has made a substantial contribution to the BDA England Community Dental Services Committee (ECDSC) and to community dentistry. He was Chair of the BDA ECDSC for three years, working tirelessly to promote the needs of community dentists, the community dental service and its patients. He was also BDA CDS Group President in 2010. Throughout Michael’s outstanding dental career, he has shown dedication to his colleagues and actively promoted the needs of the Community Dental Services, with passion, drive and innovation. As Clinical Director of CDS CIC, this organisation was a key player in setting up multiple Urgent Dental Care Hubs (including clinically vulnerable and shielded patients and covid positive patients) to provide care during the COVID 19 pandemic, as well as continuing to provide care for CDS patients too

Allan Franklin, Chair, BDA East Lancashire/East Cheshire Branch and retired GDP

Allan Franklin has given outstanding service to the BDA’s Benevolent Fund and to dentistry. His long-term commitment to helping members of the profession is matched only by his dedicated service to the Association. Allan joined his local BDA Section after qualifying as a dentist and became Secretary. Through his hard work, commitment and resourcefulness, he became Chair and then served as President. In recent years Allan has revived the Branch and Section and is a highly regarded senior member of the Branch.

Professor David Hussey, Chair BDA Hospitals Group, Northern Ireland and Emeritus Professor, Queen’s University Belfast

Professor David Hussey has played a leading role in dentistry within Northern Ireland for over 30 years as a clinician, teacher and researcher. He has encouraged and mentored generations of undergraduate students at Queen’s University Belfast as well as leading postgraduate training as the Postgraduate Dental Dean for Northern Ireland for a decade. He was an active member of the BDA for 44 years and supported the Northern Ireland Branch throughout that time, culminating in his term as Branch President in 2017. During his career, David has promoted dentistry in Northern Ireland around the world and this is exemplified by the network of Queen’s University Belfast’s international alumni who trained at the School of Dentistry. The internationalisation of the School of Dentistry has been led by David and the excellent international reputation of the dental undergraduate programme is testament to his work.

Roll of Distinction

Maria Morgan, Senior Lecturer in Dental Public Health and Public Health Specialist, Public Health Wales

In 1997, when Maria Morgan started in dental public health, there was nothing in place in terms of a national approach to oral health information. She put in the foundations and now Wales has an effective oral health information service that is embedded in dental academia, thanks to her efforts. She is a prolific author of reports and papers and her work is highly respected and valued. Maria’s legacy to the dental profession is one of applied research and a pragmatic approach to dental public health, she was responsible for the coordination of, and reporting, on the successful Designed to Smile programme in Wales.

Penny Whitehead, BDA Head of Policy & Research

Penny Whitehead has provided exceptional service to the BDA, and to the profession, over a long and distinguished career. Penny’s integrity has shone through in all the roles she has performed for the Association. She was the first full-time adviser and was the backbone of the development of advisory services. In that role, she was committed to providing a high-quality service. Her involvement in the preparation of the first national advice to dentists on infection control in the 1980s was significant. When the ‘new contract’ came, Penny played a major role in helping dentists learn about new requirements and applying new regulations – she is an expert in the regulations and was instrumental in sorting out numerous disputes between dentists and Primary Care Trusts at the time. As Head of Policy and Research, she has led on many important research projects, most recently championing our work around mental health and wellbeing and racism. She has supported our policy and negotiating work, making a significant contribution particularly in the area of dental contract reform, always with the same level of dedication and commitment. Penny has also made a significant contribution to the BDA’s role in advising and representing members during the pandemic.

Certificate of Merit for Services to the Association

Tom Bysouth, past Chair Wales General Dental Practice Committee and GDP

Committee members in Wales have immense respect and admiration for all Tom Bysouth has done and contributed to dentistry, especially someone who is still early in his career. Tom was a most able Chair of WGDPC and has given commendable leadership to the profession. His constant communication and negotiation between all parties, LDCs, Health Boards, BDA members and Welsh Government has been hugely appreciated by all our colleagues. He was WGDPC’s member for RBEC and gave oral evidence to the Review Body for Doctors’ and Dentists’ Pay (DDRB) for the last four years. His work behind the scenes has been vast, and he has striven to keep us all informed, ensuring the best outcomes for the profession.

Fiona Gray, BDA Museum Volunteer and retired GDP

Fiona Gray started volunteering at the BDA Museum in 2011 and since then she has devoted one day a week to the museum. Her interest in art led her to research many of the oil paintings in the Museum’s collection, which revealed previously unknown valuable information about the artist and sitter. She produced a leaflet for visitors exploring their significance to art history and to dental history. More recently, Fiona researched the collections relating to the First World War and the BDA’s role in the formation of the RADC. The Dental Historian published her paper on BDA Honorary member R G Ash and his experience of military tribunals during the war. Her knowledge was an integral contribution to an exhibition commemorating the end of the First World War at the BDA, and her valuable contribution to enabling a loan to Hall Place, Bexley for a First World War exhibition including dental equipment.

Philip McLorinan, BDA Northern Ireland Branch and GDP/specialist lecturer in restorative dentistry

Philip McLorinan has been an active member in the BDA’s Northern Ireland Branch for many years. He can be relied on to provide a pragmatic approach to discussions and is never afraid to ensure the patient voice is not forgotten. Philip was one of the first dental practitioners in the Belfast area to volunteer to work in the Belfast Urgent Dental Care Centre (UDCC) during the pandemic. He is a part-time Special Lecturer in Restorative Dentistry at Queen’s University Belfast, fitting this around owning a busy general practice.

Sue Page, BDA North Western Branch Council Member and community dentist

Sue Page has made a huge contribution to the BDA North Western Branch, holding many roles over the years. She is a passionate advocate of the CDS and patient-centred care. As secretary of the Lancaster and Morecombe section, she organised an extensive programme of meetings each year. She has always been an enthusiastic participant in branch council meetings, offering her dedicated help and support.

Kiran Shankla, Chair BDA Reading Section, and GDP with a specialist interest in restorative dentistry

Kiran Shankla is not only a very skilled clinician but also a caring and popular one with her patients and staff alike. She has also been very active politically within the BDA, serving as Chair of the Reading Section. During her time as Chair, she put on a successful continuing professional development programme that was well attended throughout the 12-month programme. She is passionate about promoting dentistry to the next generation and has volunteered as a mentor for a social mobility charity to encourage disadvantaged A Level students apply for dentistry. She is also a STEM Ambassador for the Nuffield Foundation, which promotes careers in STEM, and will be promoting dentistry for the first time ever in this programme.

Tim Vernon, North Herts Section Treasurer and GDP and orthodontic specialist

Tim Vernon has made a profound contribution to the Section over many years. He has been the ‘go to’ person in North Herts on all things orthodontic. He has provided excellent advice and support to younger members of the profession in times of difficulty, with his calm and approachable manner. He has been a member of the Section for 26 years and has always kept a cheerful and supportive attitude.

Arabella Yelland, BDA West of Scotland Branch member and visiting GDP/clinical teaching fellow

Arabella Yelland is fully committed to her chosen profession and care of her patients. She continues to improve her knowledge to the benefit of patients, her training dentists and the undergraduate students in her charge. She has been the glue that holds together the BDA West of Scotland Branch for many years. She devotes so much of her time, both to the Branch and the BDA, being involved with the Ayrshire and Arran LDC, the Scottish Dental Vocational Training Scheme and as a Clinical Teaching Fellow at Glasgow Dental School. She is a role model to all her colleagues, but especially to younger dentists who she inspires with her leadership, commitment and dedication to improving patient care.

Certificate of Merit for Services to the Profession

Lauren Harrhy, BDA Principal Executive Committee member and GDP

Lauren Harrhy has served on numerous BDA committees in Wales and UK-wide, to promote the interests of dentists and their patients. She has significantly supported the work of WGDPC as Vice Chair and only stood down when she was elected to PEC. In recent years, Lauren has focused on the mental health support for the dental profession, by both providing insight to inform policy and setting up practical support. She has set up and governed charitable organisations for the sole purpose of providing mental health support to fellow professionals.

Sagar Shah, specialty dentist and clinical tutor in oral surgery

Sagar Shah worked as a DCT1 and Junior Clinical Fellow in Oral and Maxillofacial Surgery across hospitals in Nottingham and London providing inpatient and outpatient care, after qualifying. He also works as an associate in a mixed NHS practice. He is the London Regional Representative for the British Association of Oral Surgery and BDA committee member for Central Committee for Hospital Dental Services. At the start of the COVID-19 pandemic Sagar was seconded to NHS England to help in the national response. During this time, he was part of the authorship team for a national guidance document: ‘Redeploying the clinical dental workforce to support the NHS clinical delivery plan for COVID-19,’ which is published on the NHS England website. He has also worked with the BDA on matters relating to sustainable practice in dentistry.

Joy Harrild Award

Carly Fraser, North of Scotland Representative on Scottish Council and GDP

Carly Fraser has made an outstanding commitment to the BDA, her LDC and the BDA’s Scottish Council. She has shown exemplary initiative and leadership skills in organising various events and functions, going above and beyond to ensure they are a success. From March 2018 she has been the North of Scotland representative within the Scottish Council and been an active participant. At a practice level she ensures delivery of high-quality care to her patients, ensuring appropriate support and advice is given and colleagues are supported, going above and beyond when needed. She achieves ambitions, delivers excellence, supports people in working together to ensure a good service and everything she does is underpinned by compassionate care for those she works with.

The British Dental Association has welcomed two more experts into its dento-legal team. Clare Lawrence and Shreeti Patel join BDA Indemnity to hold members’ hands through complaints and investigations.

Clare has 20 years of experience as a dentist, working in both primary and secondary care. Having worked in the dento‐legal field for the last 6 years, she has continued her interest in the law and recently became a member of the Faculty of Forensic and Legal Medicine, going on to complete a diploma in forensic medical science. Clare is committed to pursuing proper and fair outcomes for her dental colleagues in all manner of dental complaints, claims, regulatory and disciplinary processes and advice cases.

Shreeti completed her Master’s in Medical law and Ethics in 2018 where she focused her dissertation on consent and regulation of endodontic treatment.  Since completing her first Master’s in Endodontics at Guys in 1999, Shreeti practised in Oxfordshire where she was a principal dentist and provided endodontic services at two other practices in Berkshire.

With her legal and clinical expertise, Shreeti will assist members with complex endodontic medico-legal issues amongst other complaints, claims and regulatory cases.  

Len D’Cruz, who heads BDA Indemnity, said: “We are really pleased to welcome Clare and Shreeti to our team. They come with a wealth of experience, helping us provide a high-quality dentist-to-dentist service on the phone, helping respond to complaints, providing advice as well as supporting members with any claims or GDC investigations.”

The British Dental Association has welcomed the new joint statement from all four UK Chief Medical Officers highlighting the benefits of water fluoridation in reducing tooth decay.

The BDA fully supports community water fluoridation as a safe and effective public health intervention, as part of a package of measures to improve dental health, where technically feasible and appropriate for local needs. The Health and Care Bill, currently before Parliament, is set to simplify the rollout of the policy in England. Dentist leaders are now urging all 4 UK administrations to restate their positions on water fluoridation in light of the statement.   

Public Health England modelling shows water fluoridation more than pays for itself in medium term, owing to reduction in treatment need. £1 spent equates to £12.71 savings in five years, rising to £21.98 in ten. The BDA has stressed that upfront investment by Government is vital to unlock these benefits. 

In their statement, the four UK CMOs recognise water fluoridation should be seen as a complementary strategy, and not a substitute for regular dental check-ups and other effective methods of increasing fluoride use. The BDA backs a joined-up approach in which tried and tested policies like water fluoridation and supervised tooth brushing in early years settings are expanded, with parallel effort applied to rebuilding high street dental services.

Oral health inequality is anticipated to widen, given combination of unprecedented access problems, the suspension and ongoing disruption to public health programmes and changes to dietary habits since the start of the pandemic. Over 30 million appointments have been lost in NHS dentistry since lockdown, in England alone.  

Around 5.8 million people in England receive fluoridated water, the lion’s share artificially added, but in some locations the appropriate level exists naturally within local water supplies.

British Dental Association Chair Eddie Crouch said: “Every dentist will thank the CMOs for recognising the lasting benefits water fluoridation could bring to the nation’s oral health. However, these gains are purely theoretical without upfront investment. Spending here will pay for itself, and Ministers need to show they are willing to seize the moment.

“We need a joined-up approach. COVID has left millions unable to access care, and deep inequalities are now set to widen. The four Governments must double down on tried and tested policies while rebuilding the services millions depend on.”

The British Dental Association has said new funding is essential to realise the ambitions set out in Health Education England’s Advancing Dental Care review.  

The report, published this week, concludes a three-year programme examining training pathways in dentistry and makes a number of recommendations for future change. The BDA has been involved and provided feedback on ADC proposals since its inception.

The BDA has supported proposals for more flexibility in training, and shares concerns raised in the report about underserved areas. It is also supportive of working with the GDC to continue developing a more workable route for mediated entry to the specialist lists.

However, the BDA maintains concerns that plans may risk destabilising some of the existing training structures that serve current populations. While dentist leaders were offered assurances that posts will not be taken away and reallocated, and will only be created with extra funding, the report itself does not offer guarantees. While it mentions ‘new posts’ the review focuses more generally on ‘equitable distribution’. The BDA has also warned that creating new Centres for Dental Development will require significant investment, and that jobs must be available for those undertaking training for new qualifications.

The union remains unconvinced about some of the suggestions of how future dental teams will work, especially the suggestion that teams working with high-needs patients do not require a dentist, and reminds HEE that contract reform in England will need to lead to a more workable arrangement if the government is serious about countering the exodus of professionals from the NHS.  It has also expressed disappointment that financial modelling from consultancy London Economics – on which many of the assumptions in the report are based – have not been published alongside the main report.

The report identifies 20 workstreams, covering 5 core proposals. The BDA has stressed partnership working will be fundamental going forward, given many fall outside of HEE’s statutory role, a point the report itself acknowledges. The BDA has stated it expects to feed into all workstreams going forward.  All relevant BDA committees will now consider the review in detail and will provide further commentary in due course.

Shareena Ilyas Chair of the British Dental Association’s Education, Ethics & Dental Team Working Group, said: “While many of the ideas and ambitions set out are laudable, there is a tangible risk plans could destabilise services across England. These trainees provide care to thousands of patients. ‘Redistributing’ existing places will only mean moving young dentists from areas already struggling to meet demand.

“All practices face huge and competing demands, and any idea we can secure new training places without new funding is pie in the sky. The numbers this report is based on have not yet been shared. As we move forward we need HEE to make openness the rule, and to ensure dentists have a seat at the table.”  

Professor Liz Kay, a leading dental academic and dental public health specialist, has taken up office as the 135th president of the British Dental Association.

Taking over the role from past-President Russ Ladwa, Professor Kay has vowed to keep up the work done over the past few years to pursue fairness in the profession, and to continue to tackle the problem of oral health inequality.

Professor Kay qualified in 1982 from the University of Edinburgh. She went on to acquire a Masters Degree in Public Health from the University of Glasgow and remained there as a lecturer while studying for a PhD and working in the dental hospital and gaining her Fellowship in Dental Surgery.

She then became senior lecturer at the University of Dundee, before joining the University of Manchester where she became Professor of dental health services research and head of the orthodontic and children’s department. She also undertook specialist training in dental public health and for the last 25 years has been a consultant in the speciality.

Her dental academic career culminated in her being appointed as the inaugural dean of Peninsula Dental School in the South West where she introduced a new model of primary care based education for dental students.

Professor Kay serves as vice chair of the Medical and Dental Students Trust, served as oral health topic expert for NICE, and currently chairs a NICE guideline committee on epilepsies in children. She is also a non-executive director of an NHS Hospital Trust. She  held the post as an equality advisor to the Medical and Dental School Councils and is also trustee, and immediate past President of the Oral Health Foundation.

Her scholarly work includes over 250 scientific papers and journal articles, being principal author or editor of six textbooks, along with contributing several chapters to academic books. Her research interests lie in decision analysis, health service research and behavioural science.

Professor Kay was previously chair of the BDA’s Health and Science Committee and the BDA’s scientific advisor. More recently she has been appointed as editor of the BDJ’s Evidence Based Dentistry where her mission is to bring the research community and general dental practice closer together and which now takes original publications as well as commentaries on scientific articles.

Professor Kay said: “I am honoured to take up this role, notwithstanding that this is one of the most challenging times in our history. Covid has had a devastating impact not just on dentists’ livelihoods and wellbeing but also on our patients and has exacerbated pre-existing inequalities and access difficulties. However, I hope that the long anticipated roadmap out of Covid will focus minds on tackling these difficult issues and will result in a fairer system for patients and a more welcoming environment for dentists and their teams.

“The BDA has been working hard to raise awareness of all these issues, which are dear to my heart; I look forward to being part of this and meeting dentists around the country in the year ahead.”

Professor Kay was officially installed at the BDA’s AGM on 7 September 2021 – you can view the proceedings online.

She will hold the post for two years, instead of the usual one, due to the disruption caused by the pandemic.

The British Dental Association NI and 500 high street dentists have written to Health Minister Robin Swann to call time on the dire situation facing Health Service dentistry, urging the Department of Health to set out tangible solutions to overhaul the decades-old General Dental Services (GDS) contract.

18 months on from the start of this pandemic, signatories state that many are now burned out and utterly demoralised, and that the present situation in Health Service dentistry has become intolerable, and unstainable. Dentists report they have been working harder than ever to meet more stringent Infection Prevention Control measures but remain “hamstrung” in the number of patients they can see in a day. 

Many indicate they are now being pushed out of being able to continue to offer care under the NHS. Latest published figures show dental earnings in Northern Ireland have fallen once again, by an average of 4.2% compared with the previous year, or 36% in real terms for Associates and 43% for Practice Owners since 2008/09. Those with the highest commitment to Health Service dentistry (75% or more) have recorded the lowest earnings of all, averaging taxable income of £49,700 in 2019/20.

Practices are now facing huge challenges trying to recruit Associates and dental nurses to provide Health Service care, and the growing public access problems that have resulted post-COVID. Health Service dentistry has been on a downward trajectory for over a decade, with the service becoming increasingly financially unviable in its own right.

Dentists have urged the Department of Health to face up to the crisis in dentistry and come forward with concrete solutions aimed at modernising Health Service dentistry, and that addresses the terms and conditions associated with providing Health Service dentistry to safeguard its future.

Richard Graham, Chair of the British Dental Association’s NI Dental Practice Committee, said: “We have reached a point where the majority of NHS committed dental professionals are feeling utterly demoralised, burned-out, and concerned for the future.

“Already, we see the difficulties patients have in being able to access NHS dental services. That situation will only be compounded many times over if dentists continue to see little hope that their decades-old contract model will be replaced with something that works, both for practitioners, and the public alike. A 1990s activity-based contract model that was driven into the ground pre-Covid, has collapsed irreparably. We need an overhaul of GDS, and we need it urgently.   

“Over the course of a weekend, almost half of GDPs in Northern Ireland put their name to our letter to the Minister saying ‘enough is enough. 

“Without a fundamental shift of trajectory away from a race to the bottom, and meaningful work on a new GDS contract that works better for the public and practitioners alike, Health Service dentistry will not survive.”