Select Committee on Health Written Evidence

Memorandum by Dr JE Gallagher and Professor NHF Wilson (DS 30)


  We have pleasure in submitting evidence to the Health Select Committee on Dentistry, based on our perspective as academics with a specific interest in the dental workforce as health services researchers, and educators, at the largest clinical academic centres in the United Kingdom.

  1.  As a result of policy changes in 2004, we are training an increased number of dentists and other dental healthcare professionals.

  2.  In order to promote oral health, dental services must provide graduates with the opportunity to practice quality dental care, including a strong emphasis on disease prevention and promotion of oral health. Research with graduates has confirmed this view.

  3.  Recent research, with final year dental students at Kings' College London Dental Institute [KCLDI] and Vocational Dental Practitioners in England and Wales, suggests that new entrants to the profession have been significantly attracted to dentistry by "features of the job" and hold a vision of a "contained professional life" [1-3].

  4.  New entrants to the profession also consider themselves to be "undervalued" by patients, government and the profession [2]. This impacts on their view of NHS dentistry[2].

  5.  Many dental graduates are entering the workplace with the pressure of significant student debt [1, 2]. Management of student debt impacts on the attitudes of new graduates in respect of developing a career in NHS dentistry.

  6.  Whilst a system should not be designed around the workforce, the dental system needs to be sufficiently attractive to the members of the workforce to retain their services. Whilst research suggests that the professional career expectations of the present generation of new graduates do not necessarily sit well with a highly managed system, they do however relate to government priorities of providing quality and preventive care. In support of workforce retention in the NHS and meeting the oral health needs of the population, an approach which supports quality and prevention, neither of which has been incentivised under the new dental contract, must, it is suggested, be implemented as a matter of urgency.

  7.  There are issues regarding the location of practice; however, in light of the changing demography of dental students [4], it is important to recognise that workforce movement is not always possible for social, family and cultural reasons.

  8.  Workforce planning should be an ongoing process in light of the pace and nature of change, with the anticipated developments in skill mix being managed in such a way as to capitalise on the strengths of the dental education system in the UK.

  9.  It is important that the system proactively harnesses the abilities and enthusiasm of new graduates. Students at KCL Dental Institute have, by way of example, identified that a range of factors may attract them to work within the NHS [unpublished]:

    —  Opportunity to gain experience.

    —  Reward of providing a public service.

    —  Option of salaried posts.

  However, the students went on to make suggestions regarding changes that they considered would help to make NHS dentistry more attractive:

    —  Incentives to practice in deprived areas.

    —  Philosophy of care—re-orientating to prevention.

    —  The value of NHS dentistry—addressing the stigma.

    —  Permitting mixed economy—combining NHS and private practice.

  Similar views were shared by Vocational Dental Practitioners [5].

  Commissioners of dental care are one stage removed from employing new graduates, but should take account of the need to make the NHS an attractive option to new dental healthcare professionals.

  10.  Students need a degree of certainty about the future, in particular for the initial years following graduation when they are making the transition from dental school and endeavouring to address student debt. Systems should be put in place to address this need.

  11.  It is important that current reforms address career prospects for new graduates. There needs to be clear training paths for new graduates within the NHS, giving opportunity to experience and contribute to NHS care, with the prospect of being an integral element of healthcare provision in general.

  12.  Finally, there is a need to ensure the best use of the skill-mix of the dental team in future service developments. New graduates seek to have opportunity to lead dental teams in the provision of modern, patient-centred oral healthcare provision—a key factor in attracting new graduates to work within the NHS system.

Dr JE Gallagher

Senior Lecturer/Honorary Consultant in Dental Public Health

Professor NHF Wilson CBE FKC

Dean and Head of School

King's College London Dental Institute, in association with Guy's, King's College and St Thomas' Hospitals

December 2007


1.  Gallagher J, Patel R, Donaldson N, Wilson N: Why dentistry: a quantitative study of final year dental students' views on their professional career? In BMC Oral Health. Volume 7. 2007.

2.  Gallagher J, Clarke W, Wilson N: Why dentistry: a qualitative study of final year dental students' views on their professional career? European Journal of Dental Education in press.

3.  Gallagher J, Clarke W, Eaton K, Wilson N: Dentistry—a professional contained career in healthcare: a qualitative study of Vocational Dental Practitioners' professional expectations. BMC Oral Health in press.

4.  UCAS: Universities and Colleges Admissions System: statistics. Volume 2006. 2006.

5.  Gallagher J, Clarke W, Eaton K, Wilson N: Vocational Dental Practitioners' views on healthcare systems: a qualitative study. In IADR. New Orleans; 2007.

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