A greater emphasis on therapy-led dentistry was among the measures announced in the NHS 10-Year Health Plan, but how will this work? Dental therapists share their thoughts.
Released on 3 July, the 10-Year Health Plan introduced several key changes for dentistry as part of the government’s future plans for the NHS. One of these was the introduction of a Neighbourhood Health Service bringing many sectors of healthcare including dentistry under one local system.
As part of this service, dental therapists will perform check-ups and treatments, referring to dentists only when the treatment is outside of their scope. The government said it hopes to make greater use of the wider dental team, particularly dental therapists.
We heard from five dental therapists on whether the 10-Year Plan will be effective in improving NHS dentistry and fair for the dental professionals working within it.
Cat Edney, dental therapist
I think we knew this was coming, and it is a welcome change from being ignored within healthcare policy for so many preceding years. The shift shows that shared care really is viable, makes sense and is the future: not only to us but to policymakers and business minds alike.
However: is this where the plan ends? Is this the entirety of their thinking? There are two main concerns that spring to mind when implementing a radical shift in thinking like this:
Parity for clinicians
Currently dental therapists are not graced with the same pay and conditions as dentists. With no pension benefits or maternity pay – what is there to attract therapists to work where many dentists have decided they will not? Will the government address this inequality and finally treat clinicians as clinicians – paying for the work undertaken rather than the letters after the name?
Scope of practice and training
The scope of practice really is out of date now, 10 years may feel like a while away but there is so much to change in terms of improving the scope to reflect modern dentistry. If we are truly to look after the nation’s health, dental therapists need more powers to prevent. For example, a greater focus on occlusion and the ability to provide splint therapy and minimally invasive indirect cuspal coverage would greatly improve the long-term outcomes for patients under their care.
Now is the time to improve and refine undergraduate training, to include deeper understanding on occlusion, orthodontic assessments and indirect restorative procedures. Also to truly integrate undergraduate training on shared care into the BDS programme – both creating a better understanding of shared care and creating pathways allowing for career progression within the profession.
Are we forgetting our colleagues?
Without working effectively with dentists, dental therapists are being placed on a glass cliff. We have already seen issues with tier two services rejecting referrals from dental therapists because the treatments should be carried out in general dental practice – but if there are not enough dentists, dental therapists will bear the fallout of a broken service yet again.
Also where is the mention of dental hygienists and clinical dental technicians in this plan? Surely we need to bring more than half of the team into the conversation when we talk about the bigger picture.
I am grateful to be able to watch this unfold and excited for the future of our profession. However, I do hope our policymakers really, truly understand the magnitude of these changes and what is required to make it work.
Rhiannon Jones, BSDHT president
We are particularly pleased to see our skills and passion for prevention recognised. For too long, the preventive potential of the wider dental team has been held back by outdated structures. This plan rightly acknowledges the vital role we can play in neighbourhood health teams, delivering check-ups, treatment, referrals and health education directly within communities.
We are especially encouraged by the focus on prevention, upskilling and enabling professionals to work at the top of their scope. Expanding the use of fluoride varnish and fissure sealants for children and embedding dental therapists in primary care are practical steps that can make a real difference. The commitment to retaining newly qualified dentists within the NHS is also a welcome move to strengthen continuity of care.
The BSDHT looks forward to working with the NHS and wider stakeholders to ensure this vision becomes reality. To support long-term success, we are calling for a fair system that includes access to NHS pensions and benefits, improved remuneration to attract and retain skilled professionals, and investment in initiatives such as supervised toothbrushing and BSDHT’s First Smiles programme.
These measures align with our mission to promote health and prevent disease, and we are committed to helping ensure they are implemented effectively and equitably.
Gemma Cowen, dental therapist
However, the recent introduction of the personal identification numbers has opened the option for dental care professionals (DCPs) to offer direct access making NHS service more accessible. I must stress that DCPs, including dental therapists, deserve a remuneration package comparable to dentists when applying the same standard operating procedures (SOPs).
Currently we are considered inexpensive labor rather than valuable team members with essential skills. This misunderstanding is not only prevalent among dental teams but also among the general public, many of whom have limited knowledge about what constitutes the scope of practice for a dental therapist. Such perceptions can undermine the critical role we play in patient care and education.
Additionally, while the proposed business models leverage the expertise of dental nurses positively, it’s vital to acknowledge that these plans require adequate clinic space and staffing, elements that have not been sufficiently addressed.
I urge policymakers to recognise the importance of all roles within the dental team, enhance public understanding of the diverse contributions of dental therapists, and ensure that our healthcare system not only improves access but also respects and enables those who provide the care.
I am looking forward to clarity surrounding how the model utilising dental therapists will present in reality.
Debbie Hemington, BADT president
Will dental therapists be employed by the NHS, on an appropriate scale, so they can benefit from a pension and other standard benefits?
As an educator it is positive to see there may be more opportunities for our graduates going forward. However, we are in a climate of established courses shutting down and a shortage of appropriate teaching staff which will need to be addressed before graduate numbers can increase.
Refresher courses will be needed for those dental therapists who have deskilled through lack of job opportunities.
There is no clarity yet on where the money is going to come from – dentistry and dental training are not cheap!
Robbie Stewart, dental therapist
However that had really already happened with the recent exemptions training. Unless there’s a bigger plan which I’m not aware of, this is not news. If what they’ve said has actually already been done, perhaps including it in the plan is just to make them look a little bit better.
I think expanding community outreach programs is absolutely brilliant, especially for reaching lower socio-economic backgrounds and those who have limited access to care.
It’s not quite clear what is meant by the use of AI for diagnostics. They could potentially be talking about X rays, but I don’t know what else they’re planning on doing with the data that they collect. I’m not sure how the data sharing would work with dentistry because dental records are not part of the same system as NHS medical records. They have their own system.
Is there enough training capacity for new dental therapists?
The plan also suggests they’re investing to increase the workforce by 40%, training more than 500 new dental therapists each year. That’s a lot! I’m not sure where they’re going to get all that training capacity from, although we heard recently that new schools are being developed – we could be seeing the bigger strategy behind that here.
Overall, I think they’re missing a big trick here. The reality is actually a lot of dental therapists would probably go back to university to become dentists if they were offered a two or three year program. That would then contribute to the workforce and the need for more dentists in the community. Instead, they’re not really thinking laterally.
I know that Liverpool already do do a course like that, but you have to have graduated from there. I think expanding that course would be a big motivator for people to expand their scope and skills.
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