Recruitment and retention trends in UK dentistry: 2015 - 2023

Access to an NHS dentist, wait times, DIY dentistry are all topics frequenting in the UK news headlines, all as a direct result of workforce and recruitment and retention issues within UK dentistry. Whilst government attempts to tackle issues with the NHS Long Term Workforce plan and NHS dental recovery plan published in June 2023 and February 2024, respectively, have been likened to ‘filling a leaky bucket' and ‘unworthy of its title' given government's failure to embrace the need for fundamental reform.¹

Each year the British Dental Association (BDA) conducts a survey with General Dental Practitioner (GDP) members across the UK to understand more about the pressures facing the workforce. Data show that over the last eight years, the proportion of practice owners seeking to recruit associates has doubled from 30% in 2015, to 61% in 2023. Of those seeking to recruit, the proportion who experienced difficulties in doing so has also increased by more than 50%, with almost all practice owners (93%) experiencing difficulties recruiting associates. Figure 1 summarises the trends in associate recruitment and difficulties over time.

Fig. 1

Proportion of practice owners who sought to recruit any associates and proportion of those who experienced difficulties

But why are these difficulties arising? One of the main reasons cited by practice owners was the reluctance among associates to work within the NHS/HS, with the proportion highlighting this as a difficulty when recruiting, rising from 35% in 2018, to 72% in 2023, as shown in Figure 2. This shift among associates from NHS to private is mirrored by future career intentions and NHS commitment data, which found that over the last eight years, the proportion of associates wanting to increase the proportion of private work in the next five years increased from 34% in 2015, to 48% in 2023, and the proportion of associates in the sample treating 75% or more NHS patients, reduced from 67% in 2015 to 48% in 2023.

Fig. 2

Proportion of practice owners finding that there is a reluctance among associates to work in the NHS / HS when trying to recruit

A similar shift to private dentistry was also observed among practice owners, with the proportion wanting to increase their private commitment in the next five years, more than doubling from 18% in 2015, to 38% in 2023. A trend among the proportion of GDPs wishing to reduce the number of hours they work or move out of dentistry entirely by retiring or selling their practice was also found, with the proportions wishing to do so over the next five years increasing from 2015 to 2023, as summarised in Figure 3 a and b. The observed shift of GDP future career intentions potentially reflects some of the broader recruitment and retentions issues, UK dentistry is facing.

Fig. 3a and 3b

Proportion of practice owners and associates, respectively, selecting future career intention for the next five years

But why the shift away from NHS dentistry? Qualitative interviews with UK GDPs found that the majority felt they were operating at a loss based on purely their NHS income alone and were not able to provide the best quality of treatment to their patients, as they would like, under the current NHS system. Given that they do not feel it to be feasible to run a business under the current NHS model and funding, many do not see the future in NHS dentistry, so feel they have no choice but to leave, despite the hard moral dilemma of wanting to provide the service for their patients.

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‘It was always my intention to completely stay within the NHS. But it's unaffordable to do so. This is me wanting to pay my mortgage. You can't make a living without doing private work. Your private work is what allows you to do NHS dentistry.' Associate, England

‘The NHS side of things, some months it doesn't even cover the costs of running the practice and you'll find that the private side of things keeps it going. So, we actually run the two practices with two separate bank accounts so that we can keep an eye… some months it will be a case of going to transfer, you know, £10,000 over to the NHS account just to sort of keep it in credit and pay the bills, to be honest and that's not right really.' Practice owner, England

‘We try our best and put our patients' best interests first, trying to provide the best treatment for patients as possible, but at the end of the day resources are limited when on NHS.' Associate, England

However, recruitment issues within dentistry are not just limited to associates with the proportion of practice owners seeking to recruit dental nurses increasing by roughly 30% over the last eight years, from 53% in 2015 to 80% in 2023. Of those seeking to recruit the proportion experiencing difficulties almost doubled from 48% to 85% in the same period. Qualitative interviews with practice owners highlighted some of the difficulties. Similar to associates, dental nurses are moving from NHS to private practices, and many are moving out of dentistry entirely for better pay and conditions. Whilst practice owners try to pass uplifts onto dental nurses to retain them, they cannot compete with the pay other industries are able to offer.

‘Dental nursing is an incredibly hard job. They deserve a very good wage for it, but when you are generating the revenue that you get by doing NHS dentistry, you don't have it in the tanks to give it to them. You just don't have it. Therefore, again, the law of diminishing returns, you pay them what you've got, and they will go and do a job that's easier for probably more money.' Practice owner, Northern Ireland

‘Tesco don't ask you to register with the Shelf Stacking Council and do CPD on how to shelf stack. So you go, you do your nine to five job, you get paid at the end of the week, happy days. So again, the practice that I was in, all the nurses have asked me to provide references for them, and none of them want to work in dental practices. Why would you work that hard when there are much easier jobs to do that pay exactly the same amount?' Practice owner, Northern Ireland

Data from the BDA also showed that over the last eight years morale within general dental practice has substantially declined, with Figure 4 showing that the proportion of practice owners and associates who rated their morale as either high or very high in 2015 (40%), halved by 2023, to 20%. Similarly, the proportion of practice owners and associates who would recommend a career as a dentist in 2015 (47%) reduced by over 10%, to 37% and 36%, respectively in 2023. Qualitative findings further emphasised the struggles and stress among GDPs, specifically those working within the NHS.

Fig. 4

Proportion of GDPs rating their morale as high or very high

‘It's at rock bottom. I've only had a week's holiday in the last year, and have not taken two weeks off since 2000, because as soon as you do, you get behind on your UDAs and you'll never catch up again, and I can't afford the clawback.' Practice owner, England

‘ Similar to associates, dental nurses are moving from NHS to private practices, and many are moving out of dentistry entirely for better pay and conditions'

‘I've never known stress levels so high and morale so low. The fact is that morale is on a downward trajectory and the perception is nobody is listening and there is no light at the end of the tunnel, that is actually increasing the morale sink.' Practice owner, Northern Ireland

‘NHS dentists are exhausted. I think they're physically and emotionally exhausted because to make a living you have to work like a dog to do it. NHS dentist morale is going through the floor. I think you're going to get some dentists who are going to leave dentistry full stop because of the way things are.' Associate, England

‘I want quality of life, to be honest, and you can't get that as an NHS dentist.' Associate, England

If morale remains low and the proportion wishing to reduce their hours or leave NHS dentistry or the profession as a whole, continues to increase, the recruitment issues within UK dentistry, and the impact this then causes, such as reduced patient care and access, will only heighten.

Conclusion

These data give a snapshot into the recruitment and retention trends over the last eight years, demonstrating the challenges NHS general dental practices face when seeking to recruit not only associates, but also wider members of the team, including dental nurses.

Morale within the profession is low and with GDPs no longer seeing a future within NHS dentistry, many have already started to make the move into private, in order to provide a better service for their patients and allowing them to make ends meet. More needs to be done to address the fundamental issues within NHS dentistry or these downward trends within recruitment and retention of our dental workforce will continue. The ‘leaky bucket needs to be fixed, rather than filled'!¹ ◆