Advancing Dental Care
Adult oral health in England has significantly improved in recent decades; a trend which is expected to continue in to the future. At the same time, our population is ageing.
In line with our Mandate to deliver the right workforce for the future, we are looking at reforming dental education and training so it can meet these new and continued expectations.
This project will explore and test the future direction of dental education and training through widespread engagement with stakeholders across the system. The project will build consensus and develop recommendations for potential reforms, informing a future decision-making process by our Executive Team.
This is an opportunity for stakeholders to shape reforms to dental education and training and ensure that we fulfil our overall purpose of supporting the delivery of excellent healthcare and health improvement to the patients and public of England.
We have been holding engagement events to develop future models and test out ideas with key stakeholders. During our second event, which was attended by over 150 delegates including young dentists, there was strong support for promoting flexibility, enhancing early careers support and recognising the skills of the whole dental team. We are considering these views.
To support this work, we welcome the views of the existing and future workforce on the existing models and how these can be improved. Contact us by email at email@example.com. Further updates on this work will be provided on this page.
A version of the above film is available with subtitles on youtube.com.
A number of FAQs have been prepared providing feedback to comments received during the course of the project so far.
Advancing Dental Care: Education and Training Review
Frequently Asked Questions
This document captures the questions and provides feedback to these and general feedback received during the course of the project so far. These questions below include those raised by attendees at the National Stakeholder Event on Friday 29th September via the online interaction tool, Sli.do.
1. What is the purpose of the Advancing Dentistry Education and Training Reform project?
Health Education England (HEE) exists for one reason only: to support the delivery of excellent healthcare and health improvement to the patients and public of England by ensuring that the workforce of today and tomorrow has the right numbers, skills, values and behaviours, at the right time and in the right place.
For the practice of dentistry and its related professions, the composition of the workforce and the training structure in place to deliver that workforce, are the product of historical developments and decisions. Consequently, to fulfil our remit, we believe the time is right to consider whether these existing models are the way to deliver the workforce best placed to meet future patient demand in the most effective and efficient way. Many factors will need to be taken into account, but critically this project will consider:
• the need for a more holistic strategy to meet current and future healthcare needs;
• demographic, technological and geographic factors; and
• future models of the commissioning and provision of services.
This project will explore, model and test the future direction for dental education and training, build consensus and develop recommendations for potential reforms through engagement with key stakeholders across the oral healthcare system.
2. What are the intended outputs of the project?
Our review does not have a pre-determined conclusion and will be open to suggestions and debate. That said, we will put forward some ideas as a starting point to work from based on early discussions within HEE, with the Chief Dental Officer and with a range of stakeholders.
The purpose of this exercise is to share our thinking as widely as possible; engage with stakeholders to receive feedback and develop the proposals; and assess the feasibility of such proposals from a variety of perspectives (educational, service, quality, economic, patient, legislative etc). The intention is to compile the stakeholder responses and evidence gathered to produce a report that will inform a decision on whether to proceed with such reform.
All outcomes of the project will be evaluated against patient care outcomes and pathways to ensure that the impact to patients is fully realised and at the centre of proposed reforms.
3. How will HEE deliver this project?
The stakeholder event held on 29th September enabled HEE to engage with key stakeholders to start conversations about education and training reform for the oral healthcare workforce in England. The outcomes from the workshops have been used to shape the Workstream for the project to develop ideas further and test their suitability to reform dental services for the future.
The following Project Workstreams have been identified:
1. Dental Training pathways
2. Post-Foundation Workforce Training & Development
3. Building on the Scope of practice – the future dental team
4. The Economic models for training
5. Short term adjustments to dental education and training
Working Groups will be established to explore each of the Project Workstreams. We will establish an evidence-base and conduct robust analysis by seeking views from the members of each Working Group, employing the expertise from the project team and consulting with stakeholders across the oral healthcare system.
The Workstream outcomes will inform and shape discussions at a second stakeholder event in early 2018. The final project outcome is a final report with evidence-base recommendations that will inform a future decision-making process by HEE’s Executive Team.
4. Will the General Dental Services or Personal Dental Services Agreement (PDS) contracts be considered as part of the dental reform project?
The project will focus on the potential future training pathways for the oral healthcare workforce in England, to ensure that we have the correct workforce profile to meet future patient demand in the most effective and efficient way. Other than changing commissions for training in each profession, this review provides an opportunity to explore new training structures and pathways with the aim of increasing flexibility and efficacy.
The evidence and advice that we hope to receive about the scope and make-up of the future dental team has the potential to impact on the contract for NHS dental services. HEE will be open-minded to the information that will form part of its evidence base to ensure that we assess the feasibility of a future model of the dental workforce and the training required to deliver it.
5. Will HEE invite all the four UK nations to participate in this project?
HEE’s remit is for training, education and workforce supply in England only. Nevertheless, it is recognised that the reforming the composition of the dental healthcare workforce and the training structures for delivering that workforce are likely to have a wider impact across the whole of the UK.
We are committed to consulting, sharing and discussing ideas with colleagues from Scotland, Wales and Northern Ireland. We have developed our Workstream to deliver our project objectives and propose that key stakeholders from the four nations participate in the working groups. We are of the view that representation from each of the four nations will ensure that we identify feedback, interdependencies and areas of impact across the UK.
Whilst HEE will be consulting with all four nations to ensure co-production throughout this project, any regulatory matters that arise will be a UK-wide issue and must be determined by the General Dental Council (GDC).
6. Does the Project Team have sufficient public health, multi-professional and educational input to ensure breadth of knowledge and robustness?
The Advancing Dentistry Project Team is led by the Chair of English Dental Deans & COPDEND. To ensure a sufficient breath of knowledge and expertise across the dental healthcare system in running the project, the team consists of a Specialty Consultant, a Registered Dental Nurse, therapist, educators, General Dental Practitioners and Research Academics. The project will also be supported by HEE programme and policy expertise.
Our working groups for each area of the review will also include a broad cross-section of the oral health professions and patient representation.
We will continue to consult with patients, experts, dental professionals, trainees and employers to capture views and ensure co-production throughout this project. The project team will map stakeholders to make sure that HEE builds consensus across the oral healthcare system, developing support and recommendations for potential reforms, and informing a future decision-making process by HEE’s Executive Team.
7. Following the publication of the Lancet’s article ‘How will Brexit affect health and health services in the UK? Evaluating three possible scenarios’ – what new workforce research will HEE be planning?
The project team have received several different opinions as to the effect on the United Kingdom’s exit from the European Economic Area and Union. These range from those that think the restriction of movement of EEA dentists will lead to a workforce shortage to those that think it is an opportunity to expand dental professional training and become self-sufficient in workforce supply. We envisage that speculation about the issues will be raised in each of the Project Workstreams, but until the exact terms of the UK leaving are made public we can only surmise.
The bigger role of HEE in research on this matter is outside the scope of this project.
8. If HEE is proposing to move towards a multi-disciplinary dental team approach, is it anticipated that Dental Care Practitioners will be required to be entered onto a performers list?
The performers list regulations play an central role in the management of the workforce delivery in primary care dental services and are part of the governance structure to ensure patient safety and financial management. We would envisage that this subject will be tackled in several Workstream and, whilst we unable to mandate legislative change, we will be able to make recommendations within the scope of this project.
9. Will HEE be looking at the Liverpool University 2018 pilot of dental education?
The “common training” model, which will be piloted by Liverpool University from 2018 will be one of the potential approaches considered within Workstream one: exploring the options for dental training pathways. More information about Liverpool University’s BDS integrated undergraduate degree pilot will be available as the curriculum takes shape.
Alongside the examination of Liverpool’s integrated training pathway, we will also identify and examine alternative options, such as the modular approach; changing commissions in isolation; and developing of a skills escalator across all roles. We will also consider feasibility of these models.
All outcomes of the project will be evaluated against patient care outcomes and pathways to ensure that the impact to patients is fully realised and at the centre of proposed reforms.
10. How will HEE ensure quality evidence will be produced for this project?
The Project Team will establish a broad evidence base through several means, drawing information and feedback from literature sources, stakeholder engagement and scoping of existing good practice. The Project Team will also seek advice from educationalists and academics from within the oral healthcare industry to gather insight and expertise.
We will produce quality evidence by ensuring that any proposals are tested by relevant stakeholders and by collating of a wide variety of views and a robust analysis. The evidence produced will inform a decision-making process, by HEE’s Executive Team on implementation and next steps.
11. it is understood that the project will address long term developments for the oral healthcare workforce. Are HEE considering any Workstream for the next 5 years to explore short term measurements that can be implemented too?
HEE is committed to explore the immediate changes that could be made in the short term, alongside the consideration for long term reforms of the training and education system. As part of this project, we have established a Workstream dedicated to exploring and testing options that could be potentially be implemented quickly, for example whether only changing commissions would be preferable. This Workstream will run alongside the consideration and discussions for long term reform, which will form part of the Project Team’s recommendations to the HEE Executive Team.
We will ensure that all options are evaluated against patient care outcomes and pathways to ensure that the impact on patients remain at the heart of the project.
12. Who do I contact if I have any further questions?
Any further queries can be addressed to our team at firstname.lastname@example.org.
1 May 2018
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The Faculty of General Dental Practice (FGDP(UK)) has welcomed the new sugar tax as a ‘game-changer’ for oral health, and says the latest data on childhood tooth extractions highlight its necessity.
The Faculty was among the organisations which campaigned for the Soft Drinks Industry Levy, which comes into force today and taxes manufacturers 18 pence per litre for drinks with total sugar content above 5 grams per 100ml, and 24 pence per litre for those above 8 grams per 100ml.
A quarter of 5 year olds have tooth decay, and the latest release of figures by Public Health England shows that tooth extraction remains the number one cause of hospitalisation among 5-9 year olds, with over 35,000 children admitted each year for the procedure and 60,000 school days missed as a result.
A typical 330ml can of fizzy drink contains 35g (nine teaspoons) of sugar, well in excess of the recommended maximum total intakes of 19g a day for 4 to 6 year olds, 24g for 7 to 10 year olds, and 30g for those aged 11 or over. However, reformulation since the new tax was announced is already estimated to have removed 45 million kilograms of sugar from the UK’s annual drinks consumption, and such has been the desire of firms to avoid it that the Treasury has had to revise down its forecast annual revenue by more than half.
However with tooth decay costing the NHS £3.4bn a year, FGDP(UK) says the £240m raised by the levy should be spent on oral health promotion. The Faculty has also called for the tax to be extended to milk-based drinks, and for further restrictions on the marketing and price promotion of high sugar food and drink.
Dr Mick Horton, Dean of FGDP(UK), said:
“British adults consume three times as much sugar as we should be, and drinks remain our children’s biggest dietary source of sugar. While the latest official figures on hospital admissions of children for tooth extraction are cause enough for concern, they are only the tip of the iceberg, as tooth decay affects millions and the vast majority of treatment for this almost entirely preventable disease takes place in general dental practice.
“The Sugar Tax is a game-changer which will reinforce the message that diet is of critical importance to oral and wider health, and dentists will be delighted to finally see it in effect. Hitting the manufacturers where it hurts has already proved effective, and having to pay extra for the highest sugar drinks should also persuade more consumers to make healthier choices.”
Notes to editors 1. The Faculty of General Dental Practice (UK) is based at the Royal College of Surgeons of England. It provides services to help those in general dental practice raise standards of patient care. It does this through standards setting, providing education courses and assessments, CPD, policy development, research and publications. Membership of FGDP(UK) is open to dentists and other registered dental professionals. 2. Data on tooth extractions is available from Public Health England at http://www.nwph.net/dentalhealth/ 3. Estimates of levy revenue and reformulation effects from HM Treasury at https://www.gov.uk/government/news/soft-drinks-industry-levy-comes-into-effect 4. For FGDP(UK) enquiries, please contact Jamie Woodward, Head of Professional Affairs, on 020 7869 6759 or email email@example.com. 5. Receive the latest news and updates from FGDP(UK) by following us @FGDP_UK on Twitter or on Facebook, Google+, Instagram and Linkedin.
Dementia guidance goes online
The Faculty of General Dental Practice UK (FGDP(UK)) has made its guidance on the practice of dentistry for patients with dementia available free of charge online.
Dementia-Friendly Dentistry: Good Practice Guidelines covers the epidemiology of dementia and a wide range of implications for dental professionals, including patient identification, competence and referrals, communication, consent and capacity, history taking, treatment planning, care delivery, prescribing and site-specific considerations for dental practices, care homes and domiciliary practice.
Developed in conjunction with the British Dental Association and the Alzheimer’s Society, it contains over 50 recommendations for practitioners, categorised using the Faculty’s ‘ABC’ (Aspirational, Basic, Conditional) notation, and was first published in hard copy in October 2017.
Dementia-Friendly Dentistry has now been added to the Standards Online portal, which already includes Clinical Examination and Record-Keeping, Selection Criteria for Dental Radiography and Antimicrobial Prescribing for General Dental Practitioners, and which has received over half a million page views since it launched in 2015. Dental professionals can register free of charge at www.fgdp.org.uk/standards-online, and the publications are also available to buy in hard copy at www.fgdp.org.uk/shop.
Dr Mick Horton, Dean of FGDP(UK), and Paul Batchelor, Vice-Dean of FGDP(UK) and Editor of Dementia-Friendly Dentistry, commented:
“In the UK, dementia affects one person in twenty, and its incidence among general dental patients is only likely to increase as the population ages. It’s vital that as a profession we understand it, and adapt our patient management and clinical decisions accordingly. FGDP(UK) guidance is developed by dentists and for dentists, and we’re delighted to be able to make Dementia-Friendly Dentistry freely available for the benefit of all dentists, dental practices and their patients.”
The Faculty, which is working to establish an independent College for general dental practice, recently announced that it will be publishing new national standards for implant dentistry later this year.
Notes to editors 1. The Faculty of General Dental Practice (UK) is based at the Royal College of Surgeons of England. It provides services to help those in general dental practice raise standards of patient care. It does this through standards setting, providing education courses and assessments, CPD, policy development, research and publications. Membership of FGDP(UK) is open to dentists and other registered dental professionals. 2. Standards Online was previously known as the Open Standards Initiative. 3. For FGDP(UK) enquiries, please contact Jamie Woodward, Head of Professional Affairs, on 020 7869 6759 or email firstname.lastname@example.org. 4. Receive the latest news and updates from FGDP(UK) by following us @FGDP_UK on Twitter or on Facebook, Google+, Instagram and Linkedin.
The European Federation of Periodontology (EFP) is promoting a European initiative to shed light on the interactions and similarities between tooth decay and gum disease.