On 13 December 2023, the President of the College, Dr Abhi Pal, participated in a roundtable meeting with the newly appointed Minister for Primary Care, Andrea Leadsom MP.
Held at the Department of Health and Social Care, the meeting had been called by the newly-appointed Minister to outline her priorities for NHS dentistry in England – ensuring access for urgent dental care and increasing preventative activities such as perinatal advice and supervised toothbrushing schemes – and to hear the profession’s suggested solutions to the problems facing patients and NHS providers.
A wide range of stakeholders were present and discussed the critical need for contract reform as well as the delayed Dental Recovery Plan amongst other issues. On behalf of the College, Dr Pal made the case that the NHS needs to focus on arresting the exodus of the existing dental workforce and on increasing its appeal to newly-qualified professionals and those from overseas, and that to do this it needs to offer more attractive prospects by supporting a formal career progression framework for all those delivering NHS primary dental care.
World leading consumer health company Haleon, in conjunction with the College, has launched the ‘Dental Health Barometer’ to provide insights into the role of preventative oral healthcare in the UK.
Preventative care is defined as proactive dental care and advice that helps a patient to take action to maintain a healthy mouth, protecting against tooth decay, gum disease and more serious issues such as tooth loss and negative impacts on general health.
However, the survey of UK consumers and dental health professionals reveals that preventative oral care advice is not being offered consistently to patients. That’s despite a high incidence of tooth decay – with 70,000 people treated in UK emergency departments for the disease last year alone[1]. Just one third (34%) of oral health professionals said they always offer preventative care advice to patients, while one in four (25%) patients said they weren’t given preventative advice during their last dental appointment.
Over half (59%) of oral health professionals said that they are more likely to offer preventative advice for private patients than NHS patients, and over a third (37%) of NHS oral health professionals cited time constraints as the top reason for not being able to routinely offer preventative care advice, as opposed to just 15% of private oral health professionals. Though we know oral health professionals are working hard during a time of unprecedented pressure on the UK dental landscape, these figures come as little surprise given the widely reported ‘dental deserts’ where some areas of the UK have over 3,000 patients for every NHS dentist[2].
Additionally, oral health professionals differed on the preventative advice they would recommend to patients. While half (50%) said advice on additional oral hygiene products and brushing techniques were key, only 2 in 5 (41%) pointed to advice on diet as preventative care and just over a third (34%) would consider advice on caring for gums to be preventative advice.
Bas Vorsteveld, General Manager GBI, Haleon, said: “We know that oral health professionals are facing huge pressures, and we want to help support them to be able to provide better preventative advice – not just during routine dental appointments, but outside of appointments too. Our findings revealed preventative care advice is not always offered consistently, despite patients and dentists understanding its importance. We remain committed to addressing these issues and will look to develop new initiatives to support dental professionals.
“These will form alongside our existing initiatives which include providing educational materials to healthcare professionals, continuing to innovate and provide therapeutic oral care for patient issues at home and through campaigns like Shine Bright which raises awareness in children of the prevention of oral health conditions.”
The importance of preventative care
Nearly half (49%) of the UK public think preventative care for oral health is very important with over half (54%) of consumers saying they would prefer to receive preventative care advice for their oral health from their dentist. Meanwhile, the majority (87%) of oral health professionals think that preventative action is beneficial and aim to provide it proactively.
Confusion over the availability of preventative care on the NHS
However, there is a lack of understanding across consumers and oral health professionals over whether preventative care is routinely available on the NHS. Almost half (48%) of consumers said preventative oral healthcare advice is offered on the NHS, and over a third (34%) were unsure. Oral health professionals were more aware, with 74% saying preventative oral healthcare advice is offered on the NHS. Once again, younger dentists are more aware that preventative care advice should be routinely available on the NHS.
The importance of preventative care has already been acknowledged by the Department of Health, through the roll out of the Delivering Better Oral Health toolkit, which was updated in 2021. This aims to provide best practice guidance on routine preventative care. It is encouraging that over a quarter (76%) of oral health professionals surveyed were aware of this toolkit. Younger dentists are more likely to be aware of it, with 82% aged 23-34 were aware compared to 58% of dental health professionals aged 45 – 54.
Dr. Kate Fabrikant, Medical Affairs Director, Northern Europe, Haleon, further supports this: “Working in the industry, we must find ways to support the availability and accessibility of preventative oral care for all. We will continue to support dental professionals in facilitating behavioural change towards better oral health in their patients, whilst improving health literacy of the patients to seek out and engage in preventative care, to help them practice better everyday self-care and avoid longer term dental issues. There is a long road to travel to normalise healthy smiles in society, and it will take professionals, industry and policy makers coming together to get to this end goal.”
Consumers are open to preventative advice, but guidance is needed
The study found patients have a strong level of trust in advice given by their dentist. Where it is offered, 9 in 10 (88%) found the advice helpful. The study found that NHS patients, younger people and men were less likely to proactively ask for preventative care advice.
Dr Abhi Pal, President at the College of General Dentistry said: “We are committed to quality and standards of excellence in general practice dentistry – helping professionals to do the best for their patients. The research revealed some fascinating insights into the role that preventative care plays in the UK. It’s quite properly a mainstay of both private and NHS appointments, and we support any initiative that promotes prevention.”
Regional split
The Barometer also found that there were regional discrepancies between both patients and oral health professionals. It was found that:
Only 40% of consumer respondents from Greater London think that preventative care is very important for oral health compared to over half (55%) in Northern Ireland and South West England.
Respondents from Greater London also were less likely to have received advice, with only 37% having encountered preventative care advice compared to over half of respondents (55%) in the South East and nearly half (47%) in the North East.
Over half (55%) of respondents in Wales said thinking back to their most recent trip to an oral health professional, they received preventative care advice verbally from them,
compared to 50% of those in Scotland,
48% of those in England,
And under 2 in 5 (37%) in Northern Ireland
Northern Ireland have recalled a particularly low level of preventative care during dentist visits – with only slightly over a third of respondents (37%) having received advise at their last appointment. Despite this, the respondents from the region were some of the most interested in learning about preventative advice (53%) compared to (36%) of East England, West Midlands and Yorkshire and Humber who were less interested.
The East of England saw the lowest level of detail from their oral health professional on preventative care advice, with only 30% feeling their dentist provided a lot of detail.
A poster depicting the key findings of the research is available to download here.
Understanding antimicrobial resistance (AMR) and the drivers for its development will help healthcare professionals work together to reduce its emergence and spread. It is well documented that the more we use antimicrobial agents, the more drug resistance will develop. Fourteen national dental organisations have come together to support the World AMR Awareness Week theme, “Preventing Antimicrobial Resistance Together”.
If no action is taken, AMR infections are predicted to lead to 10 million deaths annually by 2050; a number higher than the total caused by COVID-19 during the pandemic period. Therefore, dental professionals have worked together to update the online dental antimicrobial stewardship (AMS) toolkit with resources for dental teams, students and patients as well as wider healthcare professionals.1 The range of educational resources included a new website for students and educators providing links to various online training courses.2
Our profession already focuses on the prevention of oral diseases to reduce the incidence of severe infections that necessitate the use of antimicrobial agents. Adhering to the best practice recommendations aimed at preventing infections, in addition to stewarding the use of antimicrobial agents, is very important. Accordingly, “Delivering better oral health: an evidence-based toolkit for prevention3” is included in the updated AMS toolkit1. It is also acknowledged that system-level changes are required to facilitate the provision of best practice. Furthermore, we need to look to the future and ensure appropriate disposal of antimicrobials to reduce environmental contamination. Guidance on the appropriate disposal of waste in healthcare settings including dentistry is available in HTM07-01 and SHTN3.4
We encourage you to make the most out of these resources to ensure you and your team are working together to help keep your patients safe by tackling the problem of AMR:
This statement is developed and supported by the Association of Clinical Oral Microbiologists, College of General Dentistry, Association of Dental Hospitals, British Association of Oral Surgeons, British Association for the Study of Community Dentistry, British Dental Association, British and Irish Society of Oral Medicine, British Society of Antimicrobial Chemotherapy, Faculty of Dental Surgery of the Royal College of Surgeons of England, Faculty of Dental Surgery of the Royal College of Physicians and Surgeons of Glasgow, Faculty of Dental Surgery of the Royal College of Surgeons of Edinburgh, Faculty of Dentistry of the Royal College of Surgeons in Ireland, Scottish Antimicrobial Prescribing Group and Health Education and Improvement Wales.
*Recent updates to the Dental Antimicrobial Stewardship Toolkit are in the process of being made online. If signposted to the former FGDP, users should instead visithttps://cgdent.uk/standards-guidance/
CGDent is working with Haleon (formerly GSK), to explore the opportunities for enhancing oral healthcare advice through dental practices, and supporting those members of the team on the front line for advising patients and your communities.
We are inviting interest from practices and teams around the UK that might be interested in hosting a focus group for an evening, early in 2024. It’s a great chance to spotlight the valuable work of team members and for them to contribute to a national project.
We aim for our focus groups to comprise 6-9 people, drawn from the host practice and others in your local area, that you might like to invite.
Sessions are expected to run in the evening for 1.5-2 hours, facilitated by our team. We only require a comfortable space for ten people, in a relaxed setting such as a reception room. We will bring the biscuits!
If you would like to contribute, please get in touch at [email protected] by Friday 17 November 2023. We cannot promise to take up every opportunity, but look forward to joining practices up and down the UK in developing this project.
The College and Haleon are hosting a live webinar on Tuesday 30 November at 2pm (GMT) where we will share insights from our recent study on preventative oral care and provide information about the full research programme – register your place.
The College has published Sustainability in dentistry: Leading for change, a scoping review to inform and engage the dental profession, industry, and wider oral health and dental care infrastructure on the environmental sustainability of practicing dentistry.
With the sub-title Environmentally sustainable dentistry to address the climate crisis, the review is organised thematically to provide an in-depth exploration of a wide range of factors such as legislation, health service emissions targets, prescribing, procurement, education and regulation, and makes recommendations for change that can be undertaken by each part of the system. It also presents case studies of exemplar efforts made to address the environmental impact of dental care and oral health services, and includes suggestions for further reading.
The review was written by a team of eight Clinical Fellows working at national dental organisations as part of the Chief Dental Officer for England’s Clinical Leadership Scheme, with input from expert contributors from academia, dental practice and government organisations.
Produced with the support of the Office of the Chief Dental Officer for England and the College of General Dentistry, it aims to inspire positive change by all those involved in the provision of oral healthcare related products, services and policy.
On behalf of the authors, Amarantha Fennell-Wells, Senior Clinical Policy Manager at the Office of the Chief Dental Officer England, said:
“Dental care creates a significant carbon footprint, and we owe it to current and future generations to contribute to emissions reduction by making our dental practice as environmentally sustainable as possible. Each practice and all staffcan play their part in delivering sustainability in dentistry, and our review synthesises information which we hope will be educational and inspiring of collaboration to achieve a more sustainable future for the profession and dental patients.”
The document is freely available to download via a new College webpage which signposts a selection of free e-learning resources, guidelines and other tools which dental practitioners and practices can use to understand and reduce their environmental impact.
The President of the College, Dr Abhi Pal, has given evidence to the House of Lords Committee on the Integration of Primary and Community Care.
Addressing Peers remotely during an evidence session held yesterday afternoon, he said that while there are huge potential benefits for patients if dentistry were to become more integrated within wider NHS care delivery, in practice dental care provision remains isolated.
Dr Pal, a general dental practitioner and Principal of an NHS-contracted dental practice in Edgbaston, said there has been a lack of national policy to promote such integration, and that the current dental contract, along with other systemic constraints, actively gets in the way of achieving it.
In wide-ranging evidence, he also:
said dental representation and input into Integrated Care Boards was inadequate and needs to be formalised and properly resourced
noted the role of dental hygienists, therapists and nurses, in addition to dentists, in providing preventive messages in areas like diabetes, coronary heart disease, obesity and smoking
highlighted the bidirectional links between some oral health conditions and some wider health conditions, and the effects of the management of each on the other
referred to the ‘pockets of innovation’ in integrative care and flexible commissioning, such as the limited number of local and regional pilots around urgent care, diabetes and older patients, but made clear that they are exceptions to the norm
suggested that access within dental practices to patients’ medical records could enhance patient care
Dr Pal – the first elected President of the College, which became fully operational in 2021 – was speaking alongside representatives of the College of Optometrists and the Royal Pharmaceutical Society, and is the only representative of the dental profession out of over 60 individuals who have either given evidence to the enquiry to date or are currently scheduled to do so.
In March, he addressed the House of Commons Health and Social Care Select Committee as part of an oral evidence session on NHS dentistry in England, telling it that if the government wishes to retain and reinforce the NHS dentistry workforce, it needs to offer greater professional fulfilment and recognition in addition to reforming the NHS contract.
Last year, he also visited No.10 Downing Street for a discussion on access to careers and progression in dentistry, and he has previously discussed these issues with the Shadow Health Secretary.
The President of the College, Dr Abhi Pal, has told a committee of MPs that it will take more than contract reform to persuade more dental professionals to deliver NHS dental treatment.
Dr Pal, a general dental practitioner and Principal of an NHS-contracted dental practice in Edgbaston, was addressing the House of Commons Health and Social Care Select Committee during an oral evidence session on NHS dentistry in England. During a discussion focussed on the attractiveness of NHS dentistry to dentists, he said:
“I’ve heard the evidence earlier on, and first of all I have to concur with colleagues about the state of the contract and dental contract reform, which is sorely required. But it’s not just a question of contract reform – whilst that’s very important – it’s also a question of making dental professionals’ careers more fulfilling and providing some degree of recognition for what they’re doing.
“Everyone goes into dentistry to provide the best care they can, and it’s worthwhile pointing out that beyond Dental Core Training, which is some two years post qualification, there is no effective career pathway or structure for dentists to follow, and there is a large void left there.
“There’s also little recognition from the NHS for dentists who have sometimes invested significant quantities of money in order to enhance their skills. If working conditions in that sense, and recognition, could be made better, the NHS would be seen as a more attractive place – particularly for younger dentists, and international dentists – to come and work.”
He later added:
“We speak to a lot of early career dentists – dentists within the first three or four years of qualifying – and invariably they say a number of things. One is that they are a little bit lost as to which direction they should go. And they see less future within the health service – we’ve talked about all the reasons that there are before, and they can’t work to the best way that their training has allowed them to work. I think there are small changes, including contract reform, in terms of supporting professional development, that the NHS could be considering.”
He said that in order to retain dental professionals within the NHS workforce, consideration should be given to supporting their training and development, and to supporting the development of more professional networks, peer review opportunities and mentoring schemes. He summarised that:
“All of these things, put together, in addition to contract reform, would go some way in making the NHS more attractive than it is now.”
The College recently opened a Certified Membership programme built around its freely available Professional Framework for Career Pathways in Dentistry, and speaking during the same evidence session, the Chair of Health Education England’s Dental Education Reform Programme informed committee members that HEE was already working with the College to look at how the NHS might recognise the career progression of dental professionals working in primary care.
Written evidence previously submitted by the Faculty of General Dental Practice – which transferred into the College in 2021 – told the committee that the current NHS dental contract in England is “ill-conceived and not fit for purpose”, “crude and ineffective”, and that many patients struggle to access NHS dental care as “the funding simply does not provide the universal offer they expect”.
Last year, Dr Pal visited No.10 Downing Street for a discussion on access to careers and progression in dentistry, and he has also discussed these issues with the Shadow Health Secretary.
The Health Committee’s evidence session on NHS dentistry can be viewed in full here
The Diversity in Dentistry Action Group (DDAG) is now hosted by the College of General Dentistry.
The group, formed in 2020 to deliver action to identify and address discrimination of all types within the dental professions, comprises over 70 members drawn from more than 35 national dental organisations.
These include the College as well as the Annual Conference of Local Dental Committees, the African & Caribbean Dental Association UK, the Association of Dental Groups, the Association of Dental Hospitals, the British Association of Dental Nurses, the British Association of Oral and Maxillofacial Surgeons, the British Association of Dental Therapists, the British Association of Oral Surgeons, the British Association for the Study of Community Dentistry, the British Association of Clinical Dental Technology, the British Dental Association, the British Dental Industry Association, the British Dental Students’ Association, the British Endodontic Society, the British Institute of Dental & Surgical Technologists, the British Orthodontic Society, the British Society of Dental Hygiene & Therapy, the British Society of Paediatric Dentistry, the Care Quality Commission, Dental Protection, the Committee of Postgraduate Dental Deans and Directors, Community Dental Services, the Dental Laboratories Association, the Dental Professionals Alliance, the Dental Schools Council, the European Dental Students Association, the Faculty of Dental Surgery of the Royal College of Surgeons of England, the General Dental Council, the LDC Confederation, the National Association of Specialist Dental Accountants and Lawyers, the National Institute for Health Research, the NHS Business Services Authority, NHS Health Education England, Restorative Dentistry UK and the Society of British Dental Nurses.
In 2021, DDAG published a landmark report, Equality, diversity and inclusion within dentistry: a profession-wide commitment, which made a number of recommendations after identifying significant disparities in the ethnic profile of dental students, dental professionals and clinical dental academics, and significant under-representation of individuals from black ethnic minority backgrounds, and of women in leadership positions within dentistry.
While originally initiated within the Office of the Chief Dental Officer for England, DDAG has always been led by the member organisations themselves and operated independently of the NHS, and it will continue to operate independently within CGDent.
Dr Nishma Sharma, Chair and founder of the DDAG, said:
“Like the College of General Dentistry, the Diversity in Dentistry Action Group is an organisation formed by and for the profession it serves, and our move to the College reflects our shared commitment to ensuring that all dental team members are represented and supported, across both NHS and private dentistry, throughout the UK and beyond. On behalf of DDAG’s members, I would like to thank the OCDO for having enabled and supported our work over the last two years, and we look forward to continuing to work together at CGDent.”
Dr Abhi Pal, President of the College of General Dentistry, said:
“The realisation of the College’s founding mission – to promote career progression and job satisfaction for every dental professional – requires a wholehearted commitment to ensuring equality, diversity and inclusivity within our great profession. The Diversity in Dentistry Action Group brings the whole profession together with this purpose, we have been a member since its inception, and we are extremely proud to be its new home.”
The College is working to raise awareness of the safeguarding role of dental professionals in response to signs of domestic abuse, and to support information-gathering on the profession’s own experiences.
In the UK, around 1 in 4 women and 1 in 7 men experience domestic abuse during their life, including psychological, emotional, physical, sexual or financial abuse, and/or coercion, control or stalking. Healthcare professionals are at even higher risk.
Working in partnership with researchers at Bristol Medical School’s Domestic Violence and Abuse Health Research Group (DVAHG), the College is inviting all dental professionals to join a free webinar to learn how to recognise signs of abuse among colleagues or patients and act accordingly, and is encouraging all those in the profession who have experienced abuse, or supported colleagues who may have done so, to complete the DVAHG’s survey.
Preetee Hylton, a dental nurse, safeguarding lead and domestic abuse survivor, together with Dr Alison Gregory and Dr Sandi Dheensa of Bristol Medical School, will help participants:
Understand the various types of domestic abuse, and recognise the possible signs
Be confident in assisting patients and colleagues who require support
Work together as a team to create a safe space in the workplace
Grasp the importance of the Employer’s Initiative on Domestic Abuse
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. CPD certificates for the webinar, and on-demand access to the recording, will be available to non-members on a chargeable basis, but provided free of charge to College members.
The survey of primary care staff in England is part of the PRESSURE study, which is examining:
the impact of healthcare professionals’ own experiences of domestic abuse and coercive control
whether dental practices and other healthcare employers have useful policies for staff who are experiencing domestic abuse
what help and support healthcare professionals who have experienced domestic abuse seek or might need; and
what implications there may be for managers and senior staff
The study is independent of the NHS and healthcare regulators, and is for healthcare workers who have experienced abuse, control, or violent behaviour from a partner, ex-partner, or family member, and for staff who may support healthcare workers.
The survey closes on Sunday 4 December 2022, and its findings will inform recommendations to help improve healthcare employers’ policies.
If you have experienced domestic abuse, YOU ARE NOT ALONE, and there are people ready to listen and help. Details of support options are included in the survey, including the National Domestic Abuse Helpline (0808 2000 247 – 24/7), and Respect Men’s Advice Line (0808 8010327 – Mon–Fri 10am-8pm).
The College has responded to changes to the NHS England dental contract announced by the Chief Dental Officer for England, Sara Hurley FCGDent.
Dental therapists will soon be able to accept patients for NHS treatments, providing fillings, sealants and preventative care for adults and children. Providers will also be able to claim for five Units of Dental Activity (UDAs), rather than three at present, where a patient requires filling or extraction of three or more teeth in a course of treatment and/or non-molar endodontic care to permanent teeth, and seven UDAs for a course of treatment requiring the provision of molar endodontic care to permanent teeth. In addition, practices may be able to increase their NHS activity by up to 10% beyond their contracted amount if local dental funding is underspent.
Responding to the announcement, Abhi Pal FCGDent, President of the College of General Dentistry, said:
“While the NHS dental contract in England still needs wider and more fundamental reform, we welcome these changes – the first in 16 years – as positive and significant improvements.
“In particular, we have previously called for the removal of unnecessary restrictions on the roles played by members of the wider dental team, and are pleased to see that steps will be soon taken in this direction. The College believes that greater recognition and use within NHS dentistry of the full range of skills of all team members will benefit patients, enable the delivery of more preventative care, and support professional satisfaction and staff retention.
“We have also said that while truly universal access to NHS dentistry can only be achieved with greater funding, access can still be improved through better allocation of existing resources. We therefore welcome the direction of more resource to the treatment of patients with greater needs, as well as the potential for practices to deliver additional care so that all funding allocated to dentistry is used for its intended purpose.”
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