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Where are we currently?

Our expensively educated and trained oral health workforce is the backbone of our dental systems in the UK. We currently have 44,601 dentists and 77,490 dental care professionals registered to practise, the majority being female.1 This represents one dentist for every 1,500 population - a healthy ratio given the volume and scope of dental care professionals. Approximately 10% of dentists hold a specialist title, with men in the majority for 8 of the 13 specialties.1 Interest in developing special interests within the NHS has stalled; thus, for most of the workforce in primary care, there is little hope of career progression.

The COVID-19 pandemic has exacerbated the pressures on an already fragile workforce in a complex environment.2,3 Furthermore, different ‘generations' within our workforce are taking stock of their relationship with work; retiring, moving to the private sector or leaving the profession altogether.2,3 Currently, 42% of dentists work 30 hours per week or less.4 Workforce retention is an increasing challenge.5 Many healthcare professionals feel undervalued and unsupported, particularly those in the front line of the NHS.2,3,6 Thus, we must wrestle with how best to achieve a sustainable oral health workforce.

We are not alone. Similar issues are being experienced across the health workforce generally in Europe.5,7 We must consider how to make NHS dentistry attractive again and unleash the creativity of our professions to serve the population,8 enabling them to thrive, rather than driving them into other fields of endeavour. Furthermore, Generation Z entering the workforce is recognised to have very different values from ‘baby boomers' in leadership. Research suggest that they are ‘self-driven', ‘caring', ‘highly collaborative', valuing ‘flexibility, relevance, authenticity and non-hierarchical leadership';9 they have much to offer in shaping our future systems and professions.

Health workforce stewardship is critically important for the NHS overall.10 However, it appears that government, particularly in England,11 is focused largely on finding more dental ‘workers' and short-term actions, such as golden hellos, handcuffs for graduates and pre-registration for international dentists. We need more fundamental reform to tackle the deep issues affecting NHS systems and professional careers.

The World Health Organisation has long suggested that ‘there is no health without a workforce'.12 In relation to oral health, there are now two clearly accepted overarching global targets: first, universal health coverage for oral health; and, second, reducing the oral disease burden, as outlined in the important 2022 Global Oral Health Strategy and 2023 Action Plan.13 Whilst historically the UK has played a leading role on the world stage in workforce development and delivering an accessible public dental system, we are now at a ‘tipping point'; our workforce and NHS systems are in crisis and there is much unmet demand for care in a population which largely cannot afford private care.14 As health professionals seek to work differently, achieving greater balance between work and the rest of life, they face the pressures of an ageing dentate population, in a fast-changing digital age, where we will need to deliver care differently for the sake of our planet. It is time to act.15

We need more fundamental reform to tackle the deep issues affecting NHS systems and professional careers.

Where would we like to get to?

Simple? First, ‘health is a human right', for the population in general and for the health workforce which cares for them.13 Second, achieving universal health coverage must be inclusive of oral health across state and private sectors.13 This will involve clearer articulation of what care will be covered by the NHS, and for whom. Third, to reduce the burden of disease, we need to provide high-quality, evidence-informed patient-centred care, which embeds prevention of disease and promotion of health,16 whilst also tackling the wider determinants of health.8 Furthermore, we need to bring science to bear for the maximum number of people and use it to decrease, rather than increase, inequity. All of this requires an engaged thriving workforce with the opportunity for fulfilled professional careers.

How do we get there?

Whilst ‘simple' to articulate, given that healthcare is a complex system, we need an innovative, flexible, long-term strategy, effective leadership, and collaborative action, to support health for all. We first need to draw on the broader thinking in existence to tackle the health workforce crisis,7,8,15,17,18 across five key identified areas.7

Retain and recruit

We must urgently improve the working conditions of dental professionals in the public sector to facilitate retention and recruitment, which will achieve a return in investment.7 Remuneration should be fair and equitable supported by flexible conditions in a positive culture of ‘valuing' dental professionals. Particular attention is required for underserved areas. And international recruitment should be ethical.15

Build or enhance supply

As dental professionals choose work more flexibly, more people will need to be educated and trained to meet population needs. Innovation will be essential to ensure that dental professionals are equipped to keep pace with change and can develop their skills and expertise across their careers. Perhaps it is time to explore career enhancement trajectories for all dental professionals and a specialty of primary dental care?

Optimise performance

We must consider how the creativity of our workforce can be harnessed in optimising the performance through innovative health systems redesign, developing context-relevant models of care, using digital health technologies, redefining teams and maximising skills and skill mix in an effective manner.18

Plan

Needs-led oral health workforce planning is essential to address both current and future needs of the population.19,20 We must model the resources required to achieve the global goals and national targets for access to care and oral health improvement. This will include frontline dental team members, specialised and specialist services, together with academic and dental public health expertise.

Invest

Last, but not least, there is an urgent need and case for investment.21 Inaction is proving costly on all fronts. A healthy workforce provides better care for patients and healthy patients contribute to society and the economy. We must fund NHS dental care and workforce development for the benefit of all.