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Margaret Ross British Dental Journal 2012; 213: E13

Editor's summary

Managing change is important. Indeed 'change management' is a multi-million pound business. Why? Because change is constant; it's everywhere but if it's not implemented carefully it can cause a backlash and in a business, this runs the risk of losing staff and money. As Woodrow Wilson said, 'If you want to make enemies, try to change something.'

It goes without saying that the introduction of GDC registration and CPD for UK dental technicians (DTs) was a major change. As this paper outlines, there were good reasons their introduction.

We all know that changes take time to bed down, but the immediate negative impact of registration and mandatory CPD for DTs is impossibleto ignore. In this survey 80% of DTs reported that it had either no effect or a negative effect on their own view of their career; 66% did not agree that training helped them do their job better and 51% of people were not satisfied with their job!

Even if you were to ignore the survey results, we can't ignore the decline in the number of registered DTs: 11% in three years. This is not due to lack of work. In fact the workload is on the increase, for example there has been a 5% increase in NHS treatment in England involving dentures and bridges between 2009/10 and 2010/11. It's also not because there are plenty other jobs to do – since April 2008 there has been a rise of over 50% in the number of UK unemployed. The decrease in DT numbers must be largely connected to discontentment amongst this profession in the face of registration and mandatory CPD. Perhaps further investigation is needed to prove this connection but if so, it must happen quickly. In this BDJ report 20% of those surveyed said they intended to leave the profession – not a healthy turnover.

If dental technicians in the UK leave the profession, who is going to do this work? Personally I don't agree with protectionist policies but at the same time if we have skilled and trained people in the UK I would rather they are employed than overseas labs. Change happens but we should try our best to make it happen happily. The GDC must engage with DTs to make changes to halt the exodus.

The full paper can be accessed from the BDJ website ( www.bdj.co.uk ), under 'Research' in the table of contents for Volume 213 issue 8.

Ruth Doherty

Managing Editor

Author questions and answers

1. Why did you undertake this research?

We were very aware that despite some controversy surrounding the 2006 changes to GDC regulations which made DCP registration and CPD mandatory, no independent representative studies of the experiences and views of the new registrant groups, including dental technicians and dental nurses, had been published in the following five years. Because of the non-clinical nature of much of their work, dental technicians may be perceived, and perceive themselves, as peripheral to the dental team. We thought it important to investigate whether GDC registration and mandatory CPD had impacted on their role, and what the implications might be for future efforts to promote team work in dental services.

2. What would you like to do next in this area to follow on from this work?

There are indications that the profile of the dental technician workforce is changing, with more women coming into the profession and many of the men approaching retirement age. We have an opportunity to follow up this study (and parallel surveys of dental hygienists, hygienist-therapists and nurses), by examining the actual pattern of attrition from these professions since our surveys were undertaken, and how this might relate to age, employment sector and views on their current role.

Commentary

Registration of DCPs in 2008 was met with great enthusiasm in some quarters and some antipathy in others. This is the second paper in this series, the first for dental nurses published recently, and its timing is apposite with the approach of DCPs' first five-year CPD audit cycle with its attendant consequences for non-compliance.

Registration demands engagement, but this necessitates participants seeing its value. Unfortunately, dental technicians often feel and are seen, as on the fringe of the dental team because they have little or no direct patient contact, and this paper regrettably demonstrates that dental technicians see little value in registration.

The study offered online and paper-based questionnaire options, with a representative sample from a variety of working environments. Ten percent (605) of the 6,636 on the register were contacted, approximately 30% responding. Gender, age and employment status were explored, with 70% being employees and 39% working in commercial sector.

Half the sample endorsed the principle of registration, but there were many negatives. Like dental nurses, dental technicians are very aggrieved at the fee level, and there is a strong belief their money is being unfairly used to support the cost of Fitness to Practice proceedings against dentists.

Asked if registration had affected their career view, their role or status, the responses were broadly negative. Only a minority gave positive responses, seeing cost, more red tape, lower morale and status as negatives. Mandatory CPD fared no better with comments citing increased time pressure and costs, poor quality courses and frequently not being paid to attend. Many saw CPD as a 'have to do' not 'want to do', and of little value. According with the GDC's own survey where only 15% found CPD easy to undertake in work-time, only 36% were motivated to do any and a third found it no value.

Fortunately, there were a couple of major positives. Few were thinking of leaving the profession or moving to other jobs and the reporters feel that there may be slight bias due to possible unrepresentation of newly qualified dental technicians.

Dentistry needs good dental technicians and dental technology is clearly a profession in crisis. The advent of clinical dental technology and increased scope of practice have helped greatly but more effort is needed by dental technicians themselves, and by dentists and DCPs, to help them feel valued and become more closely integrated. If this problem remains unresolved, we will lose this profession, more laboratory work will go overseas to what may be unregulated laboratories and patients' best interest will not be served.