Why I became a Life Fellow

Alasdair Miller FCGDent talks to Nairn Wilson CBE about becoming one of the first Life Fellows of the College.

Alasdair Miller FCGDent (left) and Nairn Wilson CBE FCGDent (right)

Nairn: Alasdair, first and foremost congratulations on becoming a Life Fellow of the College. A few questions, if I may; firstly, what do you hope to contribute to the College as a Life Fellow and member of the 1992 Circle?

Alasdair: I was attracted to the College as its career pathway seemed ideally suited to a practitioner’s working life and rather mirrored my less structured career development with life-long learning at its heart. I have been very fortunate in my career and becoming a Life Fellow and member of the 1992 Circle allows me to stay in touch and continue to contribute.  I have assisted with the development of the College’s Certified Membership scheme, based on my experiences as Programme Director of Bristol University’s Open Learning for Dentists and updating the arrangements for Certified Membership Facilitators. Life Fellowship was a logical progression for me: FFGDP to FCGDent to Life Fellow, to support the College as it develops and give something back.

NW: Growth in the number of retired and, in particular, Life Fellows would be a great boon for the College. Why should retired colleagues eligible for FCGDent ‘By Equivalence’ or ‘By Experience’, who are not yet members of the CGDent, consider joining the College?

AM: I have always enjoyed the collegiate nature of the profession and company of colleagues. The College, specifically the 1992 Circle provides a ‘home’ for like-minded retired colleagues who wish to stay connected and involved in the profession, albeit they are no longer practising. Fellowship of the College ‘By Equivalence’ or  ‘By Experience’ allows retired colleagues to have their professional experience and achievements recognised and valued, with opportunity, amongst other things, to support young colleagues and put something back into the profession.

NW: What message would you like to send to existing retired Fellows of the College to encourage them to become Life Fellows?

AM: If one is retired and a Fellow, I would ask: What’s stopping you becoming a Life Fellow? In so doing, you provide invaluable support to the fledgling College, helping it to grow and prosper to become the Royal College all Fellows wish it to become.

NW: Is it a strength of the College that all members may aspire to becoming a Life Fellow in retirement?

AM: Yes, it is a strength, specifically as it applies to all members of the dental team. While becoming a Life Fellow in retirement is a personal choice, I hope that all retired Fellows, present and future will consider it a way of enabling the College to continue to grow and prosper.

NW: Finally, as one of the College’s first Life Fellows, what would you most like the College to achieve as it continues to grow and prosper?

AM: I hope the College’s Career Pathway will be valued by the profession and as many practitioners as possible travel up it and become Fellows. Having a structured plan for professional development that is customised to one’s own aspirations and circumstances is unique. The Pathway is a way to have your career development recognised and validated, whilst at the same time acquiring skills and knowledge in areas of interest that support a member’s professional aspirations. It encourages continuous improvement for the benefit of patients, the profession and the professional. I anticipate the College developing programmes that enable College members and others to meet the challenges of modern practice life. In the process, it is to be hoped that the College will be granted a Royal Charter.

NW: Alisdair, many thanks for your insightful views and comments. It is most encouraging and reassuring to know that the College will be able to avail itself of your wisdom and wise counsel during your lifetime.  Thank you on behalf of the College for your commitment and most generous support. Enjoy being a Life Fellow.

Subject to being 65 or over and no longer registered with the GDC or an equivalent body, eligibility for Life Fellowship of the College is automatic for retired former Fellows of the FGDP, and for retired current or former Fellows of CGDent, the Royal Australasian College of Dental Surgeons, the American Academy of Implant Dentistry or any of the faculties of dental surgery or dentistry of the Royal Colleges of the UK or Ireland. Retired colleagues from across the spectrum of oral healthcare who satisfy the criteria for Fellowship are also encouraged to apply. Further information is available here.

Nairn Wilson is President Emeritus of the College. Those interested in becoming a Life Fellow are invited to contact him at [email protected]

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2022-2023: the year in review

.Janet Clarke MBE FCGDent, Chair of Trustees, reviews the College’s achievements over the last twelve months.

The transfer of FGDP to the College of General Dentistry in July and August of 2021 was not the end of a process, but just the beginning for the new organisation…

The first few months were dominated by the immense task for the small staff team, of building the necessary infrastructure to support our members and embark on the broader mission that we have set for ourselves. That work continued into 2022 – not just in building a College for the future, but re-thinking our role as an independent professional body, in the modern, post-pandemic world.

The most significant keystone for the College’s future will undoubtedly prove to be the Career Pathways that we have been developing in this time, culminating in the publication of the underpinning Professional Framework in June. So why is this quite so significant?

Dentistry, alongside so many other healthcare professions, faces immense challenges in attracting and retaining the talented people that will define the character of the profession for a generation, and inspiring the best from them. Yet dentistry in the UK faces a greater challenge than other healthcare professions, in lacking the structure and support of a national structure for progression, outside the Specialist Dentist pathway. Our Career Pathways provide a concrete, but adaptable framework, across the entire dental team, upon which we and others can now build the opportunities and recognition that dental professionals crave. It starts with College membership: we now have a clear point of reference for defining the ways in which your membership can reflect your capabilities and experience in dentistry.

Early this year (2023) we opened our Certified Membership scheme to a first group of candidates: a modern approach in supporting dental professionals to find their way and build a career in a fast-moving and confusing world. A chance to fully recognise their commitment and capability. It has been gratifying to see the immense level of interest in Certified Membership across so many organisations that are grappling with the workforce challenges we have been working to address, including regulators, policy makers, and dental corporates.

In April 2022, we launched our new Fellowship by experience, bringing new opportunity for highly accomplished dental practitioners, across our community, to be recognised. We have been delighted with the response, with a significant number submitting applications. The eligibility criteria are being further developed to embrace the great diversity of senior professionals. Feedback has been so positive: at last, we are told, their work can be properly acknowledged.

The College aims to build an authoritative community of leadership in dentistry, enabling the professional team to engage constructively with the challenges for all. In January, we hosted our first Fellows’ Winter Reception in Manchester, to complement the Summer Reception which has attracted an impressive group in the past two years. This is an inspiring occasion in itself; but important, too, in our ambitions to attract active support from those with the influence to make a positive difference in dentistry – harnessing their energy in a common cause. In the same vein, we also hosted our first meeting of the 1992 Circle in Manchester: nurturing the community of outstanding dental professionals in retirement, many of whom have so much more to give to support the profession that has been central to their lives. 2022 marked the 30th anniversary of the foundation of FGDP, and the 1992 Circle celebrates that anniversary in its title, providing the opportunity to reflect on all that the Faculty achieved, and inspiring us in our continuing mission today.

CGDent is now the authoritative body for standards in dentistry, building on the highly respected work of FGDP and reflecting our commitment to setting standards, supporting careers. We continue to revise and update our standards to serve the profession, but also to extend into other areas where we see a need to support the profession. In 2022, we published our Implant Dentistry Mentoring Guidelines, and plan to do more in the arena of implant dentistry in 2023.

One of the major areas of interest for FGDP under Ian Mills’ leadership was diversity in the profession, and we have continued that work in CGDent. Most notably, we are pleased to host the Diversity in Dentistry Action Group, previously hosted by the CDO for England. We have hosted a number of important webinars on the subject, all of which are available to members online.

We have continued the FGDP partnership with Dental Protection to offer a significant discount for Full Members, Associate Fellows and Fellows – but now, with our wider remit, we are delighted that Dental Protection have been able to extend their offer to all dental professionals. All our work aims to address the needs of the whole team, and this is a welcome step in line with our overall philosophy and mission.

Twelve months after the opening of the College for business, we were pleased to publish a special issue of the Primary Dental Journal to mark our own special anniversary: a year since the activation of CGDent. The journal continues to thrive, with a number of notable issues in this past year. The number of high-quality articles submitted to the journal has also increased, as illustrated by the special back-to-back “general issues” that were published in 2022.

Your College depends on the support of its members. These are historic times, as we seek to fulfil the long-held ambition in dentistry for our own Royal College, but that goal cannot be achieved without a strong membership. Help us build that support – which translates into a richer offer for all members, greater authority in the profession generally, and ultimately better advocacy for our patients.

Your membership helps to secure our future: we must not let this opportunity pass us by.
Do tell friends and colleagues!

Sadly this will be my last blog as I stand down as Chair of Trustees at the end of March. I have very much enjoyed my time as Chair and am incredibly proud of what we have achieved. I am delighted to be handing over the role to Mick Horton, so I know the College’s Trustee Board is in safe hands!

You may be interested in Janet’s blog reviewing the College’s inaugural Annual Members’ Meeting in March 2022…

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Updating postnominals

Professor Emeritus Nairn Wilson CBE FCGDent, Honorary Founding President of the College, encourages former members and fellows of the FGDP, together with colleagues who have recently joined CGDent, to update their postnominals.

While honours and university degree postnominals may normally be used throughout life, the use of postnominals linked to membership and fellowship of colleges, academies and other bodies, including memberships and fellowships earned by examination and assessment, is more complex.

The College has previously issued guidance on the continuing use of postnominals awarded by the Faculty of General Dental Practice (FGDP). This guidance states that, while postnominals relating to diplomas awarded by FGDP(UK) and the Royal College of Surgeons of England – i.e. Dip. MFGDP(UK), Dip. FFGDP(UK), Dip. MJDF, DGDP (RCS Eng.), Dip. MGDS (RCS Eng.), Dip. Imp. Dent. (RCS Eng.) and Dip. Rest. Dent. (RCS Eng.) – were not affected by the transfer of FGDP(UK) into CGDent, postnominals which conveyed ongoing membership or fellowship of FGDP(UK) – i.e. MFGDP(UK) and FFGDP(UK) – should no longer be used, as the FGDP(UK) no longer exists.

The only exceptions to these arrangements are honorary memberships and fellowships of FGDP(UK), i.e. Hon. MFGDP(UK) and Hon FFGDP(UK), which are honours rather than denoting ongoing, substantive membership.

Continuing use of the redundant, membership-specific Faculty postnominals MFGDP(UK) and FFGDP(UK) could be considered misleading, specifically to patients, and therefore to contravene the GDC’s guidance on advertising.

Equally, failure to use recently acquired CGDent postnominals – MCGDent, AssocFCGDent or FCGDent – contributes to the unhelpful misunderstanding that dentistry continues to lack its own independent standards setting body.

In addition, it fails to convey our professional standing, and our commitment to the CGDent Code of Conduct and, in turn, the standards established and promoted by the College, to other healthcare professions, and more importantly to patients.

In updating their postnominals, former members and fellows of FGDP(UK) who have not yet joined CGDent may replace their redundant FGDP(UK) postnominals with CGDent ones by doing so – former members and fellows of FGDP(UK) being eligible, respectively, for MCGDent and FCGDent.

In this process, there is opportunity for former members of FGDP(UK) who have obtained experience and postgraduate qualifications since obtaining their FGDP(UK)/RCS Eng. diploma to apply for Associate Fellowship (AssocFCGDent) or even Fellowship (FCGDent) of the College ‘by experience’ or ‘by equivalence’.

Also, all retired oral healthcare professionals (i.e. colleagues who are no longer GDC registrants) who wish to maintain a link with their chosen profession, are most welcome to join the College through its ‘by experience’ or ‘by equivalence’ processes, with opportunity for those who become Fellows (FCGDent) in retirement to join the College’s recently established 1992 Circle.

The College’s online register of current members can be used to confirm the membership status of any individuals using CGDent postnominals.

The College will be most pleased to assist former members and fellows
of FGDP(UK) in updating and possibly upgrading their postnominals, together with all other oral healthcare professionals, both in the UK and elsewhere, wishing to join CGDent, which is increasingly gaining recognition and standing as a ground-breaking, world-first for the dental team – just get in touch with us here

This blog is adapted from a Letter to the Editor published in the British Dental Journal on 10 February 2023.

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How to be a dentist

Dr Shaun Sellars AssocFCGDent, general dental practitioner and co-host of the Incisive Decisive podcast on the philosophy and ethics of dentistry, has conducted detailed research into non-clinical skills in dentistry. Here he considers the ‘soft skills’ that improve patient care.

What makes a dentist? You might say that having a BDS and physically drilling, filling and extracting is all it takes. But I’d argue that there there’s more to it than that. To be a dentist, and importantly to be a ‘good dentist’, we need to develop a whole host of distinct and less well-understood non-clinical skills to complement our clinical abilities.

Undergraduate teaching has historically focused on developing the practical skills trainee dentists need to become competent clinicians. These ‘hard skills’ consist of the necessary knowledge and techniques students attain during training. While these clinical skills are critical to dentistry, it has become increasingly recognised that non-clinical attributes are also valuable assets to the dental practitioner. While considered ‘soft’, non-clinical skills are hard to learn and often overlooked because they don’t directly add to our clinical repertoire.

When we consider these softer skills, most people instantly think of communication. While communication skills are essential, soft skills are wider-ranging, incorporating empathy, leadership, professionalism and more. And if we can’t develop our non-clinical skills alongside our more practical ones, our lives as dentists can be fraught with difficulties. Having talked to dentists extensively about this, most agree that, at least further along in our careers, we will rely on our non-clinical skills much more than our clinical ones. The act of clinical dentistry often becomes second nature over time, but the challenge of interacting with people is fresh every day. The concept of emotional intelligence (EI) is vital to mastering these interactions. EI is, by definition, the capacity to be aware of, control, and express one’s emotions and to handle interpersonal relationships judiciously and empathetically. In practice, people with a high level of EI tend to have better social interactions, and for us, that means a better relationship with patients, work colleagues and peers.

Fortunately, EI and other non-clinical skills can be taught and developed. Russian psychologist Lev Vygotsky (1896-1934) developed the concept of the zone of proximal development (ZPD), from where people learned new skills. Vygotsky proposed that the ZPD could be expanded and knowledge gained, with the help of “more knowledgeable others”, such as peers or mentors, who could impart their wisdom. We cherry-pick the information we most closely relate to and incorporate that into our knowledge base. This doesn’t just increase our comprehension but helps us interpret what we already know in a different light adding a depth of insight to our understanding. All our skills develop in this manner, from a new clinical technique to a method of dealing with a difficult patient situation.

Our non-clinical skills also help us develop into ‘good dentists’. Or, more accurately, as there is no specific ‘good dentist’ template, they allow us to practice ‘good dentistry.’ This is more than just ensuring that our composites are aesthetically pleasing and that our crowns fit well. Good dentistry takes a less uniform approach to what makes a good professional because, in reality, good practice comes from a complex jumble of factors.

Much like our clinical skills, soft skills are best learned and developed through doing. Non-clinical skills are often difficult to pin down, so working on your own management or communication style, for example, is essential. Using the knowledge you’ve assimilated from those around you to hone your professional persona is vital and happens even if you’re unaware of it. Better to consciously take ideas and concepts from those who have already achieved success and whose professional attitude you admire.

Dental school teaches us how to do dentistry, but we must learn how to be a dentist. That involves surrounding ourselves with what we consider good practice and emulating it. All the time, building on what we know with other examples of good practice. This way, the profession builds on what’s been before it and emerges stronger. As Vygotsky suggests, the people we choose as mentors strongly influence how we develop as practitioners and, in turn, how the profession evolves. So choose your mentors wisely, not just from the realms of key opinion leaders or social media personalities we’re constantly exposed to but from the more discreet masters of their craft who quietly influence us to be better.

The College has recently launched its new Certified Membership scheme, which provides dental professionals with a structured learning programme to help us recognise and develop the skills we need in order to provide the best care to our patients – including the soft skills I’ve been discussing.

Certified Membership is underpinned by the College’s Career Pathways and Professional Framework, which describe the knowledge, skills, experience and behaviours a dental professional could be expected to demonstrate at each stage of their career. These attributes fall into five areas: clinical and technical, professionalism, reflection, development, and agency and aim to encompass the full range of abilities we need as dental professionals today.

Certified Members are guided through the learning programme by a trained Facilitator, who helps them realise their existing skills, plan further development and identify new skills to work towards acquiring as they develop their career.

Find out more about Certified Membership and how to enrol as an existing member or join the College and sign up for the scheme.

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Why I have left the College a legacy in my will

Dr Shelagh Farrell FCGDent, a College Founder and Ambassador, talks to Professor Nairn Wilson FCGDent, President Emeritus of the College, about leaving a legacy to CGDent.

Nairn: Shelagh, may I begin by thanking you on behalf of the College for your tremendous support for the College as a Founder, one of its first Fellows, Ambassador and now one of its first legators. Such exceptional support is hugely appreciated and of immense importance to the College as it grows and develops. Also, thank you for agreeing to answer the following questions:

Why have you considered it important to support the College with both a Founder’s donation and a legacy?

Shelagh: The Faculty of General Dental Practice (FGDP(UK)), from the time of its foundation in 1992, always had the ambition of forming a College – Royal College of Dentistry. At the time, we promised the Royal College of Surgeons of England (RCS Eng) that the Faculty would remain part of the College for 10 years, filling a void left by the Faculty of Anaesthetists which had separated away to form what became the Royal College of Anaesthetists within a matter of a few years. Despite attempts to leave after 10 years, FGDP(UK) remained part of RCS Eng for 28 years.

The income of most, if not all, Royal Colleges comes from its members who pay subscriptions and fees to sit their examinations and benefit from postgraduate qualifications. Over the years, FGDP(UK) changed its qualifications to reflect the ways in which dentistry had moved on; for example, with the increasing use of implants. It is time to change again to create career pathways for all members of the dental team, which are challenging but achievable, thus enhancing standards in the provision of dental care.

When FGDP(UK) was established, it had one office on the ground floor of the RCS Eng. In a short space of time, it was obvious that more staff were needed to support and promote the Faculty’s activities and examination system. The Faculty was then allocated a redundant animal house on the top floor of the RCS Eng building. This became the Faculty offices for the remainder of its time at the RCS Eng.

The new College needs to acquire suitable premises in the process of becoming the Royal College of General Dentistry. This requires money and that is why, besides giving a Founder’s donation, I have left the College a legacy in my will.

N:  What would you like to say to colleagues who have not yet joined and donated to the College?

S: Some colleagues say that they will join the College when it receives Royal status. This, however, creates a “catch 22” situation. Unless the College expands its now growing number of Full Members, Associate Fellows and Fellows, it is unlikely to receive Royal status. Hence, I would urge colleagues of all ages, specifically younger colleagues to join, support the College and, in the process, benefit from a worthwhile career pathway, with mentoring, which will add to their enjoyment of dentistry and enhance their professional fulfilment.

N: In what ways has dentistry in the UK been compromised by not having its own, independent Royal College?

S: The UK has three Royal Surgical Colleges based in London, Edinburgh and Glasgow, all with Faculties of Dental Surgery. Over the years there has been great competition between these Faculties to promote themselves and increase their influence and income both home and abroad. But more important is the opportunity they have to advise and influence (or not) governments, albeit that general dentistry, let alone members of the dental team are not well, if at all, represented in their memberships. Governments listen to Royal Colleges. When the College of General Dentistry becomes the Royal College of General Dentistry, dentistry will at long last have its own independent, UK-wide, collegiate influence, speaking for the whole of the profession. Dentistry, specifically general dental practice, which provides more than 90% of oral healthcare, certainly needs this, as it seems to me at the moment that this core provision of dental services is at the lowest ebb that I have seen over the last 50 years.

N: Shelagh, two more questions. Firstly, what do you see to be the immediate priorities of the College?

S: Recruitment is clearly the way to increase the membership and the influence of the College. Dentistry is the only major healthcare profession which has not got its own Royal College. The majority of dentists are in practice, even if they are specialists. All these dentists, together with the members of their dental teams, need to come together to strengthen their unified voice, to improve standards, and to enhance the care provided to the general public.

N: And finally, what would you like the College to achieve by 2030?

S: I would like to see the College granted Royal status, with the majority of the profession being part of the membership, reaping and continuously improving the benefits the College can provide, enhancing their enjoyment and fulfilment in the wonderful and great career that dentistry can bring. I also hope that the College, then Royal College, will have suitable premises where members, politicians, the media, members of the general public and others can contact and meet staff to enable the College to realise its potential as the much-needed collegiate home for general dentistry.

N: Shelagh, very many thanks for your insightful and thought-provoking answers to my questions. Hopefully, this interview will encourage others to follow your lead as an inspirational Fellow and legator.

With renewed thanks for your exceptional generosity to the College.

Any member wishing to make a legacy to the College is encouraged to contact Abhi Pal, President of the College, or Simon Thornton-Wood, Chief Executive of the College, at [email protected] or Nairn Wilson, President Emeritus, at [email protected].

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Orthodontics in general dentistry – an unknown, unknown

Specialist orthodontist Professor Ross Hobson, discusses the complexity and importance of correct assessment and diagnosis of a patient before orthodontic treatment.

Why is Orthodontics important? And why is it important to correctly assess and diagnose the malocclusion before starting out on restorative or orthodontic treatment?

Firstly, it is important to understand that tooth movement occurs throughout life as a natural phenomenon. This mainly affects the lower arch resulting in a reducing arch length, collapse of the inter-canine width and crowding of the anteriors. This is a combination of mesial drift (the process that is thought to allow for interproximal wear occurring due to an abrasive stone age diet), facial growth occurring throughout life and soft tissue age changes (reduction in muscle tone and flexibility). The combined effect on the dentition is similar to blocking the end of a travellator, in that the forward moving teeth crowd up against the ‘barrier’ of the lips.

This crowding results in reducing the ‘Envelope of Function’, a concept first described by Pete Dawson, and ‘Pathway Wear’, described by Greggory Kinzer. The combination of continued tooth movement, the dynamics of the Envelope of Function and Pathway Wear, means that a patient’s anterior tooth position changes with time but the patient’s pattern of function or parafunctional movements do not. 

The lower teeth moving forward at a greater rate than the uppers is a natural phenomenon and the result of this constricts the Envelope of Function resulting in the wear of upper and lower incisal edges. This can lead to chipping of the incisal edges and continued wear occurring.

Too commonly there is failure to correctly diagnose the underlying orthodontic problem. The uppers are restored but the undiagnosed occlusal forces result in failure of the composite. Then porcelain is used and the lower anteriors begin a destructive cycle of incisal wear, with significant loss of lower incisor crown height and overeruption of the lower incisors. Eventually, becoming an extremely difficult problem to correct.

Then there are skeletal and dental malocclusions that can further complicate restorative care eg increased overbites due to skeletal growth, anterior open bites and significant anterior-posterior and transverse malocclusions. Some may be accepted and ‘ignored’ but many will influence the outcome and success of care, dooming some to predictable failure.

In orthodontics there are many ways of achieving a good treatment outcome, fixed, lingual and aligners all can do ‘The job’. However, in some circumstances one appliance type may be better suited to achieving the desired outcome. So, it is important to know the advantages and limitations of the different types of appliances. BUT you must be aware that there is no such thing as a ‘magic’ brace that moves teeth faster or can avoid some implications of orthodontic treatment eg need for extractions.  What is essential is understanding the treatment options available to the individual patient and the advantages and disadvantages of the treatment options – including no treatment.

Understanding orthodontics, the identification and cause of malocclusion and knowledge of how it can be corrected or managed as part of general dental care is essential for all dental practitioners.   Some may be encouraged to go on to learn basic orthodontic techniques to achieve small changes that can be life changing for practitioners and their patients, and others will wish to further develop their orthodontic skills to much higher levels.  This is the basis of the College’s postgraduate training and qualification in primary care orthodontics – to build on current knowledge and skills, with progressive development with skilled mentoring.

Whatever level of skill you wish to attain, it is all based around a sound knowledge of assessment and diagnosis, without identifying a problem, it is an unknown, unknown….

Professor Ross Hobson Leads the College’s Postgraduate Diploma in Primary Care Orthodontics and is hosting a three-part CGDent webinar series exploring the possibilities and limitations of orthodontic treatment with fixed braces. The live webinars are free to view for all dental professionals and College members have free access to the recordings and CPD.

The next intake on the CGDent Postgraduate Diploma in Primary Care Orthodontics will start in April 2023.

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What’s in a name? The importance of professional depiction

In support of National Dental Nurses Day on 22 November 2022, Dr Debbie Reed FCGDent explains why Dental Nurses should claim and gain recognition through the professional depiction of their important role in the dental team.

For the past 10 years or more I have been writing about the importance of professional depiction and professional identity1-5.

Over the past few months there has been much reporting of dental ‘deserts’6-9. Earlier in the Autumn, the then Secretary of State for Health and Social Care, declared that the solution to ‘dental deserts’ was to ensure all members of the dental team, not just dentists, “are using their qualifications to their full extent by undertaking particular procedures“10.  However, recent studies, have highlighted that dental nurses, part of the group being relied on to ‘use their qualifications’, are reported to be leaving the dental sector, due in part to dissatisfaction with their role, a consequence, according to a number of those leaving, to the lack of recognition and a general lack of value afforded to dental nurses for the contribution they make to patient oral health11.

So now, more than ever, it seems opportune to bring the matter of professional depiction and identity to the fore once again, as a means through which dental nurses can claim and gain recognition. Critical to achieving recognition is giving consideration to how dental nurses refer to themselves and the importance of slipping into the habit of reducing their professional title to that of ‘nurse’. 

There are four key reasons for ensuring the professional name of ‘Dental Nurse’ is routinely used, and as dental nurses, why we should take the lead in using our correct professional title, as well as encouraging others to follow our example.

Firstly, and most obviously, it is illegal for any Dental Nurse to style themselves as a ‘nurse’ because nursing is a separate and distinct occupation. It should be borne in mind that the term ‘nurse’ is a protected title for a specific role regulated by the Nursing and Midwifery Council.

Secondly, by failing to use the full and proper title Dental Nurse, which was granted through legislation12 and protected through regulation by the General Dental Council13, dental nurses are missing an opportunity to ensure that patients and the public at large are reminded of dental nursing as an occupation. Also, missing an opportunity to encourage the public to:

  1. recognise the occupation of Dental Nurse, and
  2. start to acquire an understanding of the distinct role that dental nurses play in oral health and dental treatment.

Thirdly, it is important that we as dental nurses ensure that our colleagues working within the dental sector also use the correct title, Dental Nurse, rather than conflating the professional role, in doing so in turn they will routinely acknowledge the Dental Nurse role, and the valuable work being carried out by the dental nurses working with them in the dental team.  It also provides other dental colleagues an opportunity to demonstrate an understanding that the Dental Nurse, who, like them, is a regulated professional, and like them, deserves to be recognised by their professional title. In order to retain the best people in dental nursing, and to provide the quality of support that the other dental clinicians deserve, there needs to be recognition and respect, demonstrated by the use of the correct professional title, for the valuable contribution that dental nurses make to patient oral health.

Finally, recruitment of other dental nurses. By using the protected and regulated occupational title ‘Dental Nurse’, the occupation will be recognised by patients and others, and potentially by those leaving school and seeking to understand the range of dental and healthcare related occupations that might be potentially available to them as career choices. To enable Dental Nurse recruitment, it is necessary that potential recruits recognise that the fulfilling and rewarding career role of Dental Nurse exists and is potentially available to them.  The first step to raising awareness is for those potential recruits (and the public in general) to hear the name of the Dental Nurse occupation, as distinct from other healthcare roles.  This will be particularly important in the future if all those interested in healthcare careers are taught together to achieve T-Levels. Dental nursing, and other Dental Care Professions (DCPs), need to ensure that their occupations are known to these T-level students, that is if the dental occupations are to successfully compete and attract the most capable of those leaving school into the dental sector when they finish compulsory education.

So what is underpinning this?

As a Dental Nurse it is interesting to reflect on the General Dental Council (GDC) Standards For The Dental Team (2013) 2.3.1 which states that:

 “You should introduce yourself to patients and explain your role so that they know how you will be involved in their care.”13

The way in which this GDC standard is observed and the necessary information presented provides an opportunity for dental nurses to ensure that they and their role is known, and that they are depicted professionally, and a message is conveyed in that depiction about the status, professional agency and esteem of their dental care professional occupation.

In the past, other health care professionals have found it useful to present themselves, as well as their role in the treatment of patients, by depicting their knowledge using language which elevates their position to that of professional colleague.

This simple action has been crucial in the negotiation of professional status within society. As dental nurses we understand that by developing an audible professional voice, like other health care professional groups, dental nurses are able to help society to construct an understanding of the importance of what we do; our professional identity, and why what dental nurses do is so valuable.

Who am I?  What do I do?

So… if someone asks about what you do as a Dental Nurse, what do you tell them?

Being able to describe or depict the knowledge that is necessary in respect to a routine action is critical.   Often tasks are so routine to us as dental nurses that we do not take time to consider their importance or significance, or the skills involved in carrying them out, never mind trying to articulate that information in a clear and positive way.

If we could consider for one minute a “routine act” carried out by most dental nurses – the act of receiving the patient in the waiting room and escorting them to the surgery for treatment. 

This act involves a number of specific and significant elements, such as asking the patient to consider their medical history.  This task requires the Dental Nurse to have considerable professional knowledge and understanding related to the questions posed, the underpinning conditions being explored, the implications to the treatment if particular answers are given by the patient and the ability to respond to a particular query or uncertainty the patient might have related to the question being asked. 

In addition, in carrying out the “simple” task of meeting and receiving the patient, the Dental Nurse requires considerable knowledge and understanding related to patient anxiety, how that might be exhibited by the patient, along with the professional skill and ability to support the patient to deal with that anxiety sufficient to proceed to the surgery.  During the process of receiving the patient the Dental Nurse is monitoring the patient for other signs related to more general aspects of health and well-being which may be being communicated and providing insight into the potential impact on any treatment to be undertaken. 

The previous described are vital tasks which require professional skill and considerable knowledge and understanding. Remember, just because you make it look easy – it does not mean that the tasks are not complexed, and moreover achieving excellence in Dental Nurse practice requires a significant depth and ability to think critically. 

Accurate professional depiction

Professional depiction requires professional confidence and there might be a number of reasons why this is inhibited, why as dental nurses we might be cautious or reticent about choosing to professionally depict ourselves.  However, accurate professional depiction is not about self-aggrandisement but about appropriate recognition and acknowledgement of the contribution that we make. Few dental nurses or dental professionals work for purely altruistic reasons, most choose their professions with the intention of building a professional career through participating in a fulfilling and meaningful occupation, which is recognised, respected, valued and rewarded. If dental nurses are neither recognised nor valued then the dental work force is likely to be depleted of the brightest and most capable individuals, who will seek professional fulfilment and meaningful work elsewhere.

Conveying and depicting Dental Nurse practice cannot be achieved effectively without reference to the research and theoretical concepts, which underpin it.  Thus, routine Dental Nurse work is now starting to evolve towards evidence-based Dental Nurse practice.  No longer is it sufficient for dental nurses to defer to a colleague’s direction and decision without understanding the theoretical and evidence base for that decision14.

The future…

Despite the current challenges, dental nurses have much to look forward to, from the outcome of Advancing Dental Care, and the related Dental Education Reform Programme (DERP)15, to the newly launched CGDent route through which dental nurses can gain recognition for their advanced levels of practice.

Most notably, the complex nuance of dental nursing has been skilfully captured within the recently published Dental Nurse Career Pathway16.

CGDent has been forward-thinking and responsive, producing a framework through which dental nurses can gain recognition and parity of esteem for their significant achievements commensurate to the level of expertise and standing within the dental community, across the various stages of their career. 

To those dental nurses seeking to be valued for what they do and what they contribute, visit CGDent17 to find out more about the Faculty of Dental Nursing and Orthodontic Therapy and how you can start your journey to gain professional acknowledgment, and be part of a Dental Nurse community.  After all dental nursing is a profession that is looking to the future, and the CGDent Dental Nurse Career Pathway is a perfect vehicle to get us there. 

Bibliography used in the compilation of this blog:

1.            Reed, D. (2018) ‘What Is Professional Voice?’, British Dental Nurse Journal, Spring: Edition 2.

2.            Reed, D. (2014) ‘The Stories we tell about ourselves can change the Professional Image of Dental Nursing’, Dental Nursing, Dec.

3.            Reed, D. (2011) ‘Novice to Expert’, Vital, Spring.

4.            Reed, D. (2010) ‘Professional Depiction’, Vital, June.

5.            Reed, D. (2009) ‘Speak up DCPs: Professional Voice’, Vital, 7, pp.24-27

6.            Sutton, N. (2022) NHS “dental deserts” persist in rural and deprived communities – LGA analysis. Online: available at https://www.local.gov.uk/about/news/nhs-dental-deserts-persist-rural-and-deprived-communities-lga-analysis

7.            The Dentist (2022) England’s ‘dental deserts’ and the urgent need to level up access to dentistry. Online available at https://www.the-dentist.co.uk/content/news/england-s-dental-deserts-and-the-urgent-need-to-level-up-access-to-dentistry

8.            The Week (2022) The crisis in dentistry: why has finding an NHS dentist become so difficult? Online available at https://www.theweek.co.uk/news/uk-news/958125/the-crisis-in-dentistry-explained 

9.            Public Policy Exchange (2022) Eliminating Dental Deserts: Ensuring Access to an NHS Dentist Across the UK. Online 27th October 2022.   Available via https://www.publicpolicyexchange.co.uk

10.          Hansard (2022) Health and Social Care Update – 22nd September 2022. https://hansard.parliament.uk/Commons/2022-09-22/debates/1D1D386B-0440-4DE7-A810-D13A968EC920/HealthAndSocialCareUpdate?highlight=dental%20deserts#contribution-1756705C-4F88-49D0-9EC6-EB69D5C9528F

11.          Morley, C. (2022). Dental Nurse Recruitment and Retention:  Health Education England Northwest. Unpublished

12.          Dentists Act (1984) Section 36c.  Available online: https://www.legislation.gov.uk/ukpga/1984/24/2006-07-28?wrap=true&view=extent

13.          General Dental Council (2013) Standards For The Dental Team. GDC: London. Available online https://standards.gdc-uk.org/Assets/pdf/Standards%20for%20the%20Dental%20Team.pdf

14.          Government of Health and Social Care, the Welsh Government, the Department of Health Northern Ireland, Public Health England, NHS England and NHS Improvement and with the support of the British Association for the Study of Community Dentistry (2021) Delivering Better Oral Health; An Evidence-Based Toolkit For Prevention. 4th Edition. Available online: https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention#full-publication-update-history

15.          Health Education England National Health Service United Kingdom (2021) Advancing Dental Care Review: Final Report  https://www.hee.nhs.uk/our-work/advancing-dental-care

16.          College of General Dentistry (2021) Career Pathway For Dental Nurses. Available online at https://cgdent.uk/career-pathways/

17.          College of General Dentistry (2022) Our Memberships. Available online at https://cgdent.uk/membership-eligibility-2/

Dr Debbie Reed FCGDent, is a Dental Nurse and Associate Professor and Director of Advanced and Specialist Healthcare at University of Kent. She is Chair of the College’s Career Pathways Dental Nursing and Orthodontic Therapy Group and Vice Chair of CGDent’s Faculty of Dental Nursing and Orthodontic Therapy.

How do we create a positive patient safety culture?

In his recent CPD seminar, delivered for the College at Dentistry Show London, Jason Wong MBE FCGDent, Deputy Chief Dental Officer for England, discussed contemporary concepts relating to patient safety, and in this blog, examines recent developments.

For some years I have spoken about the culture of fear and anxiety that has gripped the dental profession in the United Kingdom and how it has wide ranging impacts including its effect on the culture in clinical practice, limiting access to care and wellbeing of the dental workforce.

In a nutshell, what I was asked to speak about by the College of general Dentistry at the recent Dentistry show London, is how we, the dental profession, are attempting to initiate steps to move away from the current blame and fear culture to a fair and learning culture, and how this will improve patient safety.

I have always had an interest in this area, and from my time as a Local Dental Network Chair in the Midlands, and with my Leadership fellow Dr Priya Chohan and Oral Surgeons Professor Tara Renton and Dr Edmund Bailey, published an article in the British Dental Journal which concluded that there is a lack of knowledge concerning Patient Safety Incident reporting and a culture of fear affecting the profession.

Coincidentally, one of the first things I was asked to work on when I was appointed as Deputy Chief Dental Officer for England was whether wrong tooth extraction should still be classed as a Never Event by the NHS.

On 17 June 2021, I brought together key stakeholders from across dentistry to discuss the significant potential for patient safety improvement. The group’s discussions concluded with a commitment to work together in collaboration with the profession, to better embed a culture of fairness, openness and learning with regards to patient safety in dental settings.  

At the core, we knew that we needed to address the issue of what to record and what to report. We have looked at the available literature and have concluded that barriers to recording and reporting patient safety issues in dentistry is not just an England problem or even a UK problem, but a worldwide one.

At the same time, we welcomed the introduction of the Learn from patient safety events (LFPSE) service, which will support patient safety improvement across all dental care settings. We are encouraging recording of Patient Safety Events but there is still some work to align the system so that it is more user-friendly for dental practices.

Using LFPSE to record and share details of Patient Safety Events means that we could be participating in a profession-wide effort to support national safety improvement work. We recognise that most dental care is delivered in safe settings by caring practitioners, and that the profession has a safety record of which it can be proud.

However, there is always more to be done to ensure that we are delivering the best possible care for patients. Whilst event reporting is a vital tool for information gathering, patient safety engagement, and shared learning, further work is needed to facilitate a just culture for patient safety in dental settings.

Maintaining consistent, constructive, and fair evaluation of Patient Safety Events will facilitate a supportive and safe learning environment for all colleagues. Consistent evaluation will also aid local safety improvements, while assisting continuing professional development and encouraging personal reflection.  

It has been a major advantage to align our work with the rest of primary care and the NHS Patient Safety Strategy, so that dentistry does not work in a silo.  We therefore have NHS officials attend our meetings and we attend their strategy meetings, and the work that our group has carried out has been well received by the NHS.

However, defensive dentistry is rife, a lack of clarity about what is best and acceptable practice means that there is significant cognitive dissonance alongside the anxiety and fear.

What is patient safety?

Patient safety is the avoidance of unintended or unexpected harm to people during the provision of health care. We support providers to minimise patient safety incidents and drive improvements in safety and quality. Patients should be treated in a safe environment and protected from avoidable harm.

In the CGDent/Dentistry Show London presentation, I examined the principles contained in official publications, several well-known books as well as the patient safety syllabus from HEE’s e-Learning for Healthcare (e-LfH) programme.

Project Sphere

Regional HEE Clinical Leadership Fellow and Dental Therapist, Jyoti Sumel, also presented at the Dentistry Show London this year. Jyoti leads Project Sphere, a project aimed at improving patient safety recording. The Project Sphere working group wants to initiate a culture change, a change that will see dental care move from a perceived blame culture to a learning culture.

They are encouraging the entire dental team to get involved: the safety of patients requires a team approach and is the responsibility of every individual. Project Sphere currently has wide ranging aims to improve systems for learning, recording and workforce support.

The Project Sphere group is fortunate to have both support for their work from both regulators and indemnity. With their support there is a real opportunity to affect the change they want to make.

Clinical leadership

Recent studies of organisational culture and patient safety emphasise the role of senior leadership. Senior leaders can support learning and communicate the importance of safety over other organisational goals. Effective leaders show active engagement with patients and staff and this has a bearing on safer patient care.

Dentists, dental nurses, and dental care professionals can all play an important part as clinical leaders. Clinical leaders make sense of patient safety problems, mobilise resources and put solutions in place. They also create a just culture which encourages colleagues to speak up when things go wrong, rather than fearing blame.

So how do you start to cultivate these principles in your practice?

Here are my top ten tips:


  • Be genuine and build a vision for the whole practice
  • Be a genuine learning practice
  • Create a safe working environment
  • Build relationships – show genuine concern for interests of co-workers and patients
  • Lead by example

Communication culture

  • Optimal communications – try using freely available digital platforms to improve communication
  • Help to make traditions
  • Celebrate wins
  • Clear job description & expectations – identify strengths

System culture

  • Continue to develop comprehensive systems tailored to your setting

Have fun if possible but do build a system that everyone can work to.

Project Sphere – the future

Project Sphere will continue its work this coming year and will continue to socialise the concepts that I have been discussing in this blog. The College of General Dentistry has kindly agreed to publish some guidance for the workstream, the first of which involves lone working and the circumstances that surround it in dental settings. The Project Sphere group are working with the indemnity providers on a consensus statement to reassure clinicians, as well as guiding them to the best place to obtain advice. Hopefully the early positive signs from the impact of their work will continue to develop. As for culture change, that will take some time but the journey has to start somewhere and we hope that this will be the start of many positive changes in dentistry.

Free webinar for all dental professionals

Dental professionals are invited to join a free webinar to learn more about creating a positive patient safety culture, with Jason Wong. The webinar, Creating a positive patient safety culture in dentistry, takes place at 7pm on Tuesday 10 January 2023.

The webinar, hosted by the College and available through ProDental CPD, is free to view live for all dental professionals, but prior registration is required. College members will have free access to the recording afterwards. 

Shaping Faculties for the whole dental team

It has long been a vision for the College to form distinct Faculties for the different professions within the dental team. Faculty Chairs, Louise Belfield, Bill Sharpling and John Stanfield, update us on the progress they have made so far.

Louise Belfield, Chair of the Faculty of Dental Nursing & Orthodontic Therapy

I am delighted to announce the formation of the inaugural board for the Faculty of Dental Nursing and Orthodontic Therapy.  Combined, Dental Nurses plus Orthodontic Therapists make up around 50% of the dental workforce, and it is our privilege to represent our registrant communities at the College of General Dentistry.

Our Board brings together a wealth of knowledge and expertise, along with a broad range of experience in general dental practice and beyond, including practice management, NHS and private practice, civilian and military, workforce, postgraduate education, academia, and research, as well as representation from the United Kingdom nations.

Our Board members are:

  • Louise Belfield (Chair and member of the College Council)
  • Debbie Reed (Vice-Chair)
  • Jane Dalgarno
  • Angie Heilmann
  • Amanda Knight
  • Kathryn Marshall
  • Sharon Morrow

All of our Board members are passionate volunteers, dedicated to the advancement of career opportunities, recognition of achievement, and parity of esteem for our Dental Nurses and Orthodontic Therapists.

Developing our new Faculty board presents some unique challenges, and with those come unique opportunities. Perhaps more than other registrant categories, Dental Nurse training is varied and diverse; there are multiple qualifications that can lead to GDC registration, and they are typically delivered outside of Higher Education Institutions, which can funnel graduates into well-established career pipelines. Combined with the lack of an obvious direction for career development once qualified, these factors can make the waters of career advancement rather muddy. Therefore, a key objective for our inaugural Faculty board is to implement the newly developed Career Pathways framework, led by our Vice-Chair Debbie Reed.

We have also prioritised development of the Faculty membership pathways for Dental Nurses and Orthodontic Therapists. Our newly developing Faculty membership criteria uphold the highest clinical standards and are relevant and accessible to our community of professionals. It is also important to note that for the first time, all levels of membership and fellowship of the College are open to all dental professionals, and we encourage our eligible members to consider application. Our Career Pathways framework can support our members to meet the different levels of Faculty and College criteria.

However, our Faculty is only as strong as its membership. It is imperative that we work together with our members at all stages of their careers, including trainees and newly qualified members, to develop the Faculty in a direction that serves our community. We are determined that both registrant categories within the Faculty have equivalent voice, and as such we are especially keen to engage with our community of Orthodontic Therapists.  We know that amongst our Dental Nurses and Orthodontic Therapists there are many experienced, talented, highly achieving professionals who have made significant impact on patient and public health, and the dental profession. Our ultimate aim as a board is to provide means to fully recognise those contributions, in parity with other registrant categories, and to provide support and guidance for our members to realise their career ambitions to their fullest potential.

Louise Belfield AssocFCGDent is a dental nurse, research scientist, lecturer, Health Education England Dental Clinical Fellow, and National Examination Board for Dental Nurses Trustee. Louise is a member of the College Council, the Professional Affairs Committee and the Membership Admissions Panel.

Bill Sharpling, Chair of the Faculty of Clinical Dental Technology & Dental Technology

It has been a pleasure to be involved in the College of General Dentistry since its very early days, after registering as a supporter in 2018. In 2020, I was invited to join the College Advisory Strategy Group and I built a team of Clinical Dental Technicians (CDTs) and Dental Technicians (DTs) who were keen to work together for the greater good of the College and the profession. I Chair the CDT and DT Working Group that has contributed to the development of the Career Pathway and Professional Framework and am a member of the College Council.

As soon as the opportunity arose to progress the creation of the four College Faculties, work began on assembling what would become the Board of our own Faculty, the Faculty of Clinical Dental Technology and Dental Technology (FCDTDT). It is worth noting that the actual final title of the Faculty is still under discussion by the Board and has not yet been finalised.

The Faculty Board members are:

  • Bill Sharpling (Chair and member of the College Council)
  • Steve Taylor (Vice Chair)
  • Mike Brindle
  • Lee Butler
  • Tony Laurie
  • Jiri Matl
  • Caroline Persaud
  • Emily Pittard
  • David Reay

The Board are a great bunch with a real mix of experience and huge amounts of enthusiasm to see real progression for our CDT and DT professions. Each member has shown such dedication to their role and have all taken on specific positions to enable progress. With such a small group it is not possible to replicate the structure and member roles of the full College Council but we have hopefully been able to cover most elements with this select group.

Each of the devolved nations has representation should it be needed. Mike, Jiri and Caroline have made themselves available to consider issues relating to Scotland, Wales and Northern Ireland respectively. Tony and Steve are overseeing the faculty’s CPD activities and Emily is the Early Careers representative. Membership admissions will be managed by Lee and David with Caroline and Mike having the extra responsibility for Career Pathways activity.

The Board has met a couple of times and is scheduled to meet at least three times each year just ahead of Council meetings. Each meeting will have a principal theme. So far, the schedule has included CPD, membership levels and Career Pathway work. During the CPD meeting, Board members were joined by Robert Dyas from ProDental CPD and good progress was made regarding arranging a CPD programme for both DTs and CDTs.

DTs and CDTs are encouraged to join CGDent and once they have done so, will automatically also become a member of the Faculty. Members will be able to apply to join the Faculty at a certain level which is dependent on qualifications and/or experience. The level that one can join then determines the post nominals that a Faculty member is entitled to use. Members will also be able to join a Certified Membership Scheme which will enable them to be supported and mentored at the same time as progressing through the Career Pathway, mapped against certain criteria.

These are very early days for the Faculty, but with the continued support from the Board and the guidance and direction from the College, progress will continue to be made and the profession will see significant benefits for the long term.

Bill Sharpling FCGDent is Associate Dean (CPD) and Director of the London Dental Education Centre (LonDEC) at the Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London and Honorary Professor at RAK College of Dental Sciences, UAE. Bill is a member of the College Council and the Careers and Training Committee.

John Stanfield, Chair of the Faculty of Dental Hygiene & Dental Therapy

Throughout the formation of the College of General Dentistry, the creation of Faculties supporting each of the dental team groups, with membership levels that are attained by progression through the Career Pathway, has been a key vision.

The work that has been ongoing in a multi-threaded stream, has now allowed us to start to form the faculties.  To this end, we have appointed an inaugural board to the Faculty of Dental Hygiene & Dental Therapy which will guide the Faculty until we have enough members to have elections.

The Board members are:

  • John Stanfield (Chair and member of the College Council)
  • Frances Robinson (Vice Chair)
  • Sarah Hill
  • Laura McClune
  • Sarah Murray
  • Fiona Sandom
  • Miranda Steeples
  • Deborah Stratford
  • Kirstie Thwaites

The Board, as you can see, brings together a huge amount of experience and qualifications to lead us forward in this historic and bold move for the profession.  Our tasks, as we go forward, enthuse each of us, knowing this can only improve our standing both within the dental profession and that of the general public.

Our Faculty has to grow, we require members to become part of our community, to set and raise standards, and to have input into how the Faculty and the College are run.  We have our voice on the College Council, with full voting rights, this task has been appointed to me until we vote for a chair of the Faculty who will then join the Council. 

Previously I had been involved with FGDP, both as a member and vice-chair of the DCP committee and as the editor of ‘Team in Practice’.  However, we couldn’t be full Members, nor did we have any voting rights.  I took on this role to support the vision of a College that would represent the whole dental team with an opportunity for all to be full Members.  We all have the same chance to be admitted to the community as Members, Associate Fellows and Fellows of the Faculty and the College.  Many have already been admitted as Associate Fellows of the College and we have just had our first Faculty member admitted as a Fellow of the College – my congratulations go to Fiona Sandom.

Currently, the Board is working on adapting the Career Pathways in Dentistry Professional  Framework to meet the needs of our constituents, mapping this against the expected career stages.

The Faculty will be expected to contribute to College publications, standards and guidance, to any of the press releases which involve our members and to this end we will be bringing on board those of you with particular experience and expertise.  We are very aware of the increasing academic achievements of our constituents and the research they are carrying out and want to make the most of this.

Joining the faculty and the college brings with it certain benefits:                                              

  • Recognition of postgraduate training and experience, your pathway from Safe Practitioner to Accomplished Practitioner
  • CPD via ProDental CPD (over 1000 hours)
  • Primary Dental Journal
  • Certified Membership Scheme
  • Belonging to a community of like-minded professionals

John Stanfield AssocFCGDent has over 40 years’ experience as a dental hygienist, and works in private dental practice in Cheshire. He was Editor of the FGDP’s Team in Practice journal and Vice-Chair of its DCP Committee, and now serves on the College’s Membership Affairs Committee. John is also a member of the College Council.

Career pathways in general dental practice – filling the big void

In this article, originally published in the British Dental Journal, members of the College’s Career Pathways programme explore the need for defined career structures in the oral healthcare team and explain how CGDent’s Career Pathways aims to fill the big void. 

Those who carve out a career in primary dental care have been almost unique amongst healthcare professionals in not having defined career structures to support their professional development, notwithstanding the multitude of training opportunities open to them.

There are many causes for this: the high level of autonomy in general dental practice; the limited overall regulation of post-qualification training in primary dental care; and the limited support for both career enhancement and resulting reward from the NHS. Yet the vast majority of NHS dentistry takes place in general dental practice. Existing structured career pathways in dentistry have been successfully and comprehensively created under the auspices of the Faculty of Dental Surgery of each UK Royal College of Surgeons. However, these have been designed almost entirely for supporting dentists undergoing Specialist Training.

There has been a pressing need to create some form of structure that is fit for modern careers in general dental practice for the following reasons:

  • Providing recognition of professional development and training for all dental professionals working both in NHS and private practice, and salaried services;
  • Promoting job satisfaction and workforce retention;
  • Inspiring public confidence in the post-qualification professional development of dental professionals;
  • Complementing NHS workforce development plans;
  • Engaging the oral healthcare team holistically – not just individuals in isolation.

However, a delicate balance also needs to be struck between a structure for career development, minimising regulatory burden, and allowing for the flexibility and independence that have been an attraction for many in general dental practice.

The College of General Dentistry, the successor organisation of FGDP(UK) since July 2021, has been working for the last two years to create pathways for dental professionals which will allow for such a balance. Furthermore, since oral healthcare provision requires the involvement of the whole team, the pathways have been designed with all members of the team in mind.

Our starting point has been the definition of career “inflection points” for an individual’s professional journey. We have purposely not adopted terminology which might have currency today, but might well change as trends and policies evolve. In other words, we have gone back to first principles: what might we expect or wish a person to be able to do, as their skills evolve over a career?

Our next step has been to design a Professional Framework of capabilities that would be expected for each of those career stages. We convened Working Groups for each dental professional group: dental hygienists; dental therapists; dental nurses; dentists; dental technicians. Each group has drawn together these capabilities under five domains, which has resulted in a total of 22 skills. The five domains have been identified as:

  • Clinical and Technical
  • Professionalism
  • Reflection
  • Development
  • Agency

The result: our recently published College of General Dentistry Professional Framework. This publication lays out a blueprint, addressing a gaping void that has been present in primary care dentistry. Individuals are encouraged to use it in reflecting on their own progress, and organisations to adopt it in support of their teams, and their workforce planning and development.

Our own next step will be the introduction of our Certified Membership Scheme, soon to be rolled out. This will be the means by which an individual demonstrates they are practising with the capabilities defined for each career stage, and achieve recognition through College post-nominals. Unlike assessments of the past, this will not be based on examination. It will be a journey over two years along an individualised reflective personal development plan, where support from a Facilitator is provided. Gateway qualifications from a range of accredited providers will form part of this journey and our Scheme will enhance the value of these qualifications. The components of Certified Full Membership for dentists, demonstrating capabilities of an Experienced Practitioner, is illustrated below – allowing awarding of the post-nominal Cert MCGDent. This will typically, but not exclusively, appeal to those who have recently completed Foundation Training. Parallel pathways are being developed for each stage of the pathway and, most importantly, for all oral healthcare team members.

We think this is a fresh and unique approach to career progression, and we believe it is consistent with the needs and aspirations of the next generation of dental professionals. The time has now come for the profession to seriously consider the future of careers in primary care, and this College is mapping a bright future for the whole team.


  • Abhijit Pal, President – College of General Dentistry
  • Janet Clarke MBE, Chair of Trustees – College of General Dentistry
  • Roshni Karia, Chair of Certified Membership Scheme Working Group – College of General Dentistry
  • Avijit Banerjee, Chair of Careers Pathway Programme Board – College of General Dentistry
  • Shamir Mehta, Chair of Careers Pathway Reference Group – College of General Dentistry
  • Simon Thornton-wood, Chief Executive of the College of General Dentistry

The Version of Record of this article is published in the British Dental Journal, and is available online at https://doi.org/10.1038/s41415-022-4907-1

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