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
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
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 . This impacts on their view of NHS dentistry.
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 , 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
Philosophy of carere-orientating
The value of NHS dentistryaddressing
Permitting mixed economycombining
NHS and private practice.
Similar views were shared by Vocational Dental
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
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
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
provisiona key factor in attracting new graduates to work
within the NHS system.
Dr JE Gallagher
Senior Lecturer/Honorary Consultant in Dental Public
Professor NHF Wilson CBE
Dean and Head of School
King's College London Dental Institute, in association
with Guy's, King's College and St Thomas' Hospitals
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
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:
Dentistrya 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.