By Kate Quinlan

Introduction

As BDJ Team celebrates its tenth anniversary in 2024, to help mark the occasion we caught up with some important people within dentistry to reflect on the past decade and look forward to the next.

This month we meet Pam Swain, the Chief Executive of the British Association of Dental Nurses (BADN), the professional association for dental nurses in the UK. Pam's involvement with BADN began in 1992 when BADN was called the Association of British Dental Surgery Assistants (ABDSA). Pam has now been Chief Executive for over 30 years and is also Editor of the British Dental Nurses' Journal. In autumn 2023, BDJ Team collaborated with BADN to product a special dental nurse themed issue (https://go.nature.com/401DNp1).

Interview

How did you first become involved with ABDSA, which later became BADN?

Pam: I had returned home to the UK after living in Vienna, Brussels, Bermuda and Boston and saw an advert in the local paper that ABDSA were looking for an ‘Executive Secretary' - since uptitled to ‘Chief Executive'.

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Were your experiences of attending the dentist and looking after your oral health positive up to that point?

My childhood experiences were with the school dentist, so not good! Consequently, I am fairly phobic about visiting the dentist - I understand that many people of my generation have the same problem for the same reason! Before I joined the Association, I hadn't visited a dentist for… well, I am not going to admit to how many years it was. But the dental nurses involved in the Association's Council kept me on the straight and narrow, making sure I went every six months… although, at the moment, like many people, I'm struggling to find an NHS dentist.

I love my job! Going to the Shows and meeting dental nurses. Meeting such supportive and dedicated women over the years...

Have you enjoyed being involved with the dental industry over the years?

I love my job! As I have frequently pointed out to people who object to me not being a dental nurse myself, my job isn't primarily in dentistry, it's in association management.

What have been the highlights for you?

Going to the Shows and meeting dental nurses. In the past, I always used to enjoy going to the Presentation Dinners for newly qualified dental nurses receiving their certificates. Meeting such supportive and dedicated women over the years - Paula Sleight, Pat Harle, Angie McBain, Barbara McRury, Jane Dalgarno, Joan Hatchard… to name but a few Past Presidents - but hundreds of women have supported dental nurses on BADN Council, Executive Committee and various Committees over the 32 years I have been doing this job. And, of course, the late, great Dame Margaret Seward - the only woman to have held high office in the GDC and been Chief Dental Officer not to have been shafted by the old boy network!

BDJ Team is ten years old this year. What are the most significant developments you have seen for dental nurses over the past ten years?

I don't know that we have seen significant developments over the last ten years. The last significant development was the introduction of statutory registration, and we have been treading water ever since, trying to make the GDC understand that dental nurses are a completely different registrant group (as are dental technicians). The GDC insists on regarding dental nurses as an add-on to dentists, instead of as a disparate group with their own requirements. Again, it is a neglected gender issue - predominately female, often working part time, paid minimum wage, not afforded professional recognition…

COVID was a significant happening - so many dental nurses in NHS practices were treated so abominably by their employers they decided to quit. This really highlighted the fact that dental nurses working in NHS practices are not considered to be NHS employees - they don't have access to salary scales, NHS ID, pension schemes - and their contribution to the crisis was completely ignored by the NHS. This whole attitude to practice dental nurses is what triggered the current recruitment and retention crisis.

The formation of the College of General Dentistry (CGDent) may very well turn out to be a significant development. They started well, with intentions to support all members of the dental team; and the Dental Nurse Faculty, chaired by Dr Debbie Reed, a dental nurse herself, is a step forward. Let's hope the College continues to regard dental nurses as valued members of the dental team and to support them.

Do you think statutory registration for dental nurses has earned dental nurses the status, working conditions and recognition within the dental team that they deserve, or is there still a long way to go?

There is still a very long way to go! Until dentists, and other members of the dental team, recognise dental nurses as fellow registered dental professionals and treat them accordingly, and they are paid salaries commensurate with their vital role in the dental team and registered professional status, we will have recruitment and retention problems. A Registered Dental Nurse can earn more stacking shelves in a budget supermarket than they often can in dentistry - and they don't have to pay the GDC fee, indemnity costs, CPD costs… Okay, they probably won't get the same job satisfaction. Dental nursing is 99% female - and salary levels, recognition as professionals and so on are definitely gender issues.

And dental nurses working in hospitals still have to battle with nurse (ie general nurse) managers who refuse to recognise them as fellow registered healthcare professionals. BADN have had dialogue with at least three Trusts over the last few years (and the Nursing and Midwifery Council [NMC]) regarding dental nurses who have been told by their general nurse managers that ‘their registration doesn't count as its only with the GDC', that ‘dental nurses can't go on courses because they aren't NMC registered' or that ‘dental nurses are equivalent to HCAs [healthcare assistants] and so have to perform HCA tasks'. Needless to say, these Trusts have been rapidly disabused of these archaic notions (not, I have to say, ideas held by the NMC themselves - we are working with them to educate general nurses regarding dental nurses).

Are you proud to have led BADN and supported dental nurses in the UK for so many years?

Definitely! After my year in the States (Box 1), I didn't want to return to the corporate world. One of my soapbox issues is female empowerment - encouraging young women to be warriors, not princesses waiting for someone to rescue them - and this job offered an opportunity to support women (mostly - dental nursing is 99% female) in the workplace, although BADN offers support in personal lives as well. But I don't ‘lead' BADN - I'm the hired help. BADN is led by the President and Executive Committee (formerly Council) with direction from the AGM - in other words, the members themselves.

What are your hopes and aspirations for dental nurses and dentistry over the next ten years?

We need a culture change in dentistry, away from the misogyny of the old ‘pale, stale and male' patriarchal attitudes of those running dentistry to a world where everyone is included, represented and respected. Dentistry is currently well over 50% female, with DCPs being on average over 90% female - but who is running the show? Old blokes, that's who! We need more women (by which I mean women supportive of other women - not all are!) to stand for office in the GDC, the BDA, NHS England, the Department of Health - but they are reluctant to do so because they see how Sara Hurley, for example, or Alison Lockyer, Evlynne Gilvarry and others, as far back as Ros Hepplewhite, have been treated by the old boy network and so don't want to poke their heads above the parapet.

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Pam celebrating 30 years at BADN Chief Executive in May 2022. Left to right: Jacqui Elsden, Pam, Joan Hatchard

Are you pleased with what BADN has achieved for all the dental nurses it represents?

Yes I am. As I said above, the benefits of BADN membership have increased enormously in the 32 years I have been doing this job. In 1992, we charged £28 per year and offered a quarterly student ragmag/parish magazine type Journal… and nothing else! Now we charge £45 and offer an online Journal with CPD, a Legal Helpline, a Health & Wellness Hub with counselling helpline, access to an indemnity scheme, help/advice/support, advice sheets… As well as BADN Rewards which is a wide range of special offers and discounts on insurance, travel, holidays, shopping, days out, cinema.

We've tackled HMRC and got tax relief on the GDC fee, our fee and laundry costs for dental nurses; we're still fighting for tax relief on CPD costs for employees. We've tackled the GDC on matters too numerous to mention! More recently, we've tackled both the Nuffield Foundation and the Department of Health about their failure to consider dental nurses in their long terms plans for dentistry. Over 32 years, there have been so many things - it becomes a bit of a blur! In 1992, dental nurses and those representing them weren't expected to speak up at meetings - if they were invited to meetings at all. We changed that.

It is actually the personal stuff which matters the most [...] the member who thanked me for always being there in the background so she could turn to us at any time… that made me cry!

But BADN receives no funding other than membership fees so our ability to support dental nurses is dependent on dental nurses actually joining! BADN are recognised as the UK's association for dental nurses, with the same status as the BDA, listed with the Certification Office - which means we have to be independently audited each year, our accounts published, our officials elected according to legislation/only able to serve specific terms of office and that we are accountable to our members and the Certification Officer. We've been around 80+ years, have an office and staff - we're not some tinpot organisation run from someone's kitchen table!

But it is actually the personal stuff which matters the most - the member who called because she had been sexually assaulted and didn't know where to go… we contacted her local police and rape crisis centre; the member who was a victim of domestic abuse… we put her in touch with her local women's aid; the member who told me at a recent Show that she had been a member since she was a student dental nurse and thanked me for always being there in the background so she could turn to us at any time… that made me cry!

Do you think the future is bright for the dental team, despite the crisis within NHS dentistry and other problems affecting dentistry in the UK?

I really don't know. I am very cynical about all the political parties - I don't think any politician does the job for altruistic reasons anymore, they are all just out for themselves. My personal opinion is that the NHS, as a whole, needs a good shake up and somebody to actually be in charge. Whether it needs more funding I don't know - but I do know that it needs to use the funding it does have more sensibly, become less bureaucratic and cut out all the nonsense.

I think that one of the problems in dentistry is the media-fuelled perception of it - greedy dentists charging exorbitant fees to patients to fund their lavish jet set lifestyle (whilst paying their dental nurses minimum wage!). I understand why dentists are leaving the NHS. I think one of the problems is that dentists receive no, or very little, business training, no leadership or management training, no people management training - and yet they are expected to lead a dental team and run a business, without being provided with any of the skills.

In the US, dental practice managers usually have business degrees and so they run the practice/business whilst the dentist concentrates on clinical matters. But here, it's often the dental nurse who has been there the longest who is practice manager - again without the requisite skills.

But the major problem is principal dentists/practice owners refusing to accept that they have to invest in their staff - pay them appropriate salaries, offer employee benefits, pay for training and CPD, support their staff. If this message doesn't get through, and if dentists continue to believe that any money spent on staff means less money for themselves, instead of seeing it as an investment - then the future is bleak!

Of course, there are practices which do exactly that - it's just that I rarely get to hear of them. Nobody rings me up and says ‘My boss is very supportive, pays well, supports me in my career' - so perhaps I have a very cynical view of things!

Thank you so much to you and all of your Presidents and members who have contributed to BDJ Team these past ten years!