'There is only so long that people can work in a crisis-stricken service before it will all collapse'

For years, the British Dental Association warned about impending crises across NHS dentistry in England. The signs were there, but with patient revenue charges filling the gap of real investment, those concerns fell on deaf ears.

As we approach 30 months after COVID-19 decimated the service as we knew it, those concerns have all come to fruition, resulting in an unprecedented crisis in multiple areas of the profession. Shawn Charlwood, Chair of the British Dental Association's General Dental Practice Committee, spoke to BDJ In Practice about the current plight of the profession, contract reform and his hopes for the future of dentistry.

What's your assessment on the current dental political landscape in England?

SC We have seen more engagement and discussion of dentistry by MPs in Parliament - more than at any point in the last decade, and both of the candidates for Prime Minister have talked about the challenges with NHS dentistry. This reflects what they are hearing from their constituents about the very real problems that they are facing accessing dental care. As the recent BBC research found, 9 in 10 practices are not able to take on new NHS adult patients. This is an unprecedent crisis, but there seems to be a real roadblock in Government, particularly with the Treasury, in actually taking the urgent and significant action needed to resolve these problems.

That impacts contract reform. The recent marginal changes weren't welcomed by the BDA. Will these changes have any impact on the day-to-day workings of the profession?

SC Ultimately, the GDPC opted to take a neutral position on the marginal changes. We could see that they will help some practices and make life a bit easier when it comes to treating high needs patients and achieving UDA targets, but they fell so far below what the profession was expecting that we just couldn't positively endorse them. We worked hard in negotiations, to secure the 7 UDAs for molar endodontics and it is positive that there will now be a minimum UDA value. However, NHS England only ever intended these reforms to be 'modest and marginal' and that's all they are. We now need to get on with real contract reform and have much greater urgency and ambition about delivering that. The BDA is ready and willing to get to work negotiating that reformed contract, but we need to see the same will from the other side of the table.

Besides contract reform, what needs to happen to improve the working environment for dental professionals?

SC What I've heard repeatedly over the last couple of years has been that colleagues just don't feel that the NHS treats them with respect. It's often relatively 'small' things like the quarter-by-quarter targets being issued last minute or late, and free flu jabs being withdrawn but all of this builds up a picture that we are not seen as a valued part of the NHS. Many dentists have taken the message and acted.

The fundamental issue that sits alongside contract reform is that of funding. NHS dentistry has seen significant real-terms cuts to its budget over the last decade. We've estimated it would take nearly £900 million per year to restore funding to the levels in 2010, but that just gets us back to where we were twelve years ago. For reform to really have a chance of success it is going to require further investment and if NHS England want more access, then they will need to start paying for more than 50% of the population to see a dentist.

Access problems. Funding. Pay. Three issues, to name but a few. How is dentistry still able to function with these 'deadweights' holding them down?

SC Dentists are a hard-working, resilient, entrepreneurial, efficient and innovative profession! Practices have been able to keep NHS dentistry viable by running extremely slick operations, but that means there's no slack when things don't go to plan. Private income also helps to keep practices afloat and subsidises loss-making NHS work. Ultimately, this isn't a sustainable situation. Dentists and their teams are stressed and burnt out. It is becoming nearly impossible to recruit an associate to work in an NHS practice, and it's extremely difficult to find dental nurses and other key team members. There is only so long that people can work in a crisis-stricken service before it will all collapse.

Another issue is the drain of professionals moving to the private sector. How concerned about this are you, and can you blame them?

SC I can absolutely understand why people are shifting to doing more private work given the situation in the NHS. There is a public misconception that this is about earning more money, but for most it is about taking back control of their working life. Working in a way, at a pace and for a fee that you're happy with. The issue the NHS needs to realise, is that once people move to the private sector, it is very unlikely that they'll ever be coming back to the NHS.

There was plenty of discussion about learning and improving post-pandemic. Have you seen any evidence of this?

SC Despite all of the talk about 'build back better', this has proved to be a slogan with no substance. We did propose to NHS England that we use the opportunities presented by how the pandemic had changed ways of working to not rush back to 'business as usual', and instead work out how we move to a reformed contract from where we were 18 months ago. Instead, they chose to go full steam ahead with reimposing the UDA, ramping up targets quarter-after-quarter and letters now arriving demanding adjustment and clawback payments.

Are there any positives we can focus on?

SC We still have a skilled and dedicated profession, providing high quality care for patients across the private and NHS sectors. The future for private dentistry looks strong. I would like to be similarly positive about the future of NHS dentistry, but I am repeatedly frustrated by an apparent lack of ambition. Again, we can say that the recent marginal changes will help some practices and patients, but so much more needs to be done. Despite the colossal challenges thrown at the profession, I am proud that dentists and their teams have managed to keep things going, do the right thing for their patients, keep their businesses running, and adapt to overcome difficulties.

Finally, what do you think will happen if things don't change?

SC I genuinely think that we are reaching a tipping point. If NHS England, the Department for Health and Social Care and the Treasury don't work urgently with us to deliver change on the scale needed, then NHS dentistry as we currently know it, won't exist for millions of patients. ◆

Bio

Shawn Charlwood graduated from Birmingham Dental School in 1986 and has postgraduate dental qualifications form the University of Bristol and the Faculty of General Dental Practitioners. He owned a large mixed practice for twenty-five years and was a foundation trainer for over twenty years. He had previously held postgraduate positions at Manchester Dental School and Manchester Royal Infirmary Maxillo-facial, as well as being an officer in the Royal Army Dental Corps TA for five years. He has been on the GDPC for 13 years and is now Chair, having previously served as Vice Chair, Chair of the GDPC Remuneration Sub-Committee and Chair of the GDPC Private Practice Committee. He also currently sits on the GDPC-LDC Regional Liaison Group, GDPC Associates Group, the BDA's Review Body Evidence Committee and the British Dental Guild. He was previously the Chair of Lincolnshire LDC, which he has been a member of for 25 years.