Foreword

The 2021 dental workforce report is the latest in a series of dental workforce reports that aim to inform workforce planning for dental services in Scotland and has been supported by NHS NSS and the Health Workforce directorate of the Scottish Government Health and Social Care directorates.

The report examines past trends in the supply of dentists and DCPs to inform estimates of the supply of dental services. Estimates of the demand for dental services are informed by past trends in access to dental services. These past trends are used to inform forecasts of the supply of and demand for dentists and dental services in the future.

The latest data and forecasts indicate that while demand for dental services is forecast to increase, the capacity of the system to deliver dental services to the people of Scotland is forecast to decrease in the future.

Executive summary

This report is the latest in a series of dental workforce reports that aim to inform workforce planning for dental services in Scotland.

Dentists

In Scotland there continues to be considerable demand for BDS places relative to supply, although demand levels have differed within and between each of the three providers in recent years.
Disruption to dental education and training caused by COVID-19 resulted in reduced intake targets to BDS courses for academic years 2021 and 2022. This reduction in intake will have an impact on the inflow to the dental workforce in 2025 and 2026.
Almost all students who start a BDS course in Scotland graduate within six years.
The number of VTNs issued to EEA dentists saw a large decrease in 2019, with the largest decreases in dentists from EEA 1994 and EEA 2007 countries.
The number of dentists that were registered with the GDC continues to increase each year.
The number of GDS-PDS dentists decreased in 2020 for the first time since 2000. This was due to a large decrease in the number of dentists entering the workforce in 2020 and this inflow being slightly lower than the outflow from the workforce in the previous year.
Real taxable income of dentists decreased between 2018 and 2019 in Scotland, England and Northern Ireland.

Dental Care Professionals

Dental Nurse certifications increased by 13.6% between 2019 and 2020. Dental Technology certifications decreased by 33.3% between 2016 and 2018.
The demand for places on the OHS degree has decreased slightly since 2015 but is still relatively high.
Intakes to the OHS degree increased in academic year 2019 to around 50 students.
Around 83% of students starting an OHS degree complete within four years.
The number of WTE DCPs employed in the HCHS has been decreasing since 2013.
In 2020 median gross hourly pay for dental nurses in Scotland decreased for the first time in three years.

Access

Between September 2018 and September 2019 the adult registration rate surpassed the child registration rate for the first time.
The registration rate for children decreased between 2019 and 2020, likely due to COVID-19 causing a drop in the number of children registered with a dentist for the first time.
Within NHS boards, the all-age registration rate varied between 84.5% and 99.2%. The distibution of registration rates between SIMD quintiles tends to be uniform in each board.
Younger dentists register more patients than older dentists and male dentists register more patients than female dentists.
73% of adults visited a dentist less than a year ago and 77% received NHS treatment.

Forecasts

The projected changes in the size and composition of the population are forecast to increase the demand for dental services during the forecast period.
Based on the current number of registered patients per dentist, the forecast increase in the demand for dental services is forecast to increase the demand for dentists.
Based on a series of estimates and assumptions, the supply of dentists is forecast to fall short of the number of dentists required to maintain current registration rates.
There is considerable uncertainty over the inflows from other, typically non-UK, sources that have an immediate impact on the number of dentists in Scotland.

1 Introduction

This report is the latest in a series of dental workforce reports that aim to inform workforce planning for dental services in Scotland.

The supply of dental services depends on the supply of dentists. The report examines trends in the education, training and labour markets for dentists from application to undergraduate BDS courses, through BDS courses, registration with the GDC, through DVT, into the dental workforce, specialty training and admission to GDC specialty registers.

The supply of dental services also depends on the supply of Dental Care Professionals. While there is less routinely collected information on DCPs than on dentists, the report examines trends in the education of dental hygienists and therapists, the number of DCPs on the GDC register, their employment in the HCHS of NHSScotland and the earnings of dental nurses.

A key dimension of the demand for dental services is access. The report examines trends in access measured by NHSScotland registration rates, the frequency of visits to public and private dental services and registration with Denplan.

The duration of education and training for dentists and DCPs means that workforce planning involves making forecasts of the future demand and supply of dental services. These forecasts draw on current trends in the supply of and demand for dental services that are presented throughout the report.

The report is intended to complement other sources of information on dental services including those on participation, fees and treatments and the oral health of children and adults.

2 Dentists

2.1 BDS courses

2.1.1 Background

Each year the Chief Dental Officer writes to the SFC with a recommendation for the number of students taken into BDS courses in Scotland.

The SFC announces these intake targets and the total number of FTE students it will fund during the academic year. If there are either too many or too few FTE students compared to the number of SFC funded students then universities may have to transfer money back to the SFC.

Intake targets for dental schools in Scotland are set to ensure that the right number of people are in the right place at the right time as set out in the Scottish Government’s 2020 Workforce Vision.

In recent years the intake targets for EU students have decreased. The reduction in the intake targets for EU students has a direct effect on the revenue of universities and the intake targets for non-EU students have increased to allow universities to offset the reduction in revenue from EU students.

As a result of the UK leaving the European Union (EU) and the transitional period ending in January 2021, students have been reclassified in the intake target numbers. EU students are now treated as international students, and the intake number distinction is now between “Home Fee” / Rest of UK / Republic Of Ireland students, and all international students.

Covid restrictions in 2020 reduced the availability of clinical training facilities and experience, with the result that students have had to extend the duration of their training. This in turn impacted Universities’ training capacity and feasible intake sizes in academic years 2021 and 2022. The Scottish Funding Council wrote to Dental Schools in May 2021 advising that the intake for AY 2022 should be split evenly across AYs 2021 and 2022.

The revenue to universities from undergraduate education depends on the number of funded students and the price per student.

The number of funded students in each academic year depends on the minimum of the actual and target intakes in each of the four previous academic years and the rate of progression between each course year.

The price per student depends upon whether students are Scottish, from the RUK, or from the rest of the world. Students from EU countries are now classified as international students, although Students with EU Settled or pre-settled status can apply to SAAS to have their fees paid by the Scottish Government.

For home students the price per student in academic year 2021-22 was £8,756 per pre-clinical FTE and £17,412 per clinical FTE. These prices are paid by the SFC.

For RUK students the price per FTE is set by each university up to a maximum of £9,250: Dundee, Glasgow and Aberdeen charged £9,250 per FTE for entry in academic year 2021.

For EU and international students the price per FTE is set by each university: in 2021-22 Dundee charged £35,650 for the first year and £49,200 for each of the remaining four years and Glasgow charged £46,950 for each year.

2.1.2 Applications and acceptances

The number of accepted places provides a measure of the number of students that have been offered and intend to start a BDS programme.

The number of accepted places on BDS programmes since 2012 increased by 3.80% in the UK and decreased by -11.11%% in Scotland. The UK increase appears to have been driven by a recent increase in accepted places at English dental schools.

The ratio of applications to accepted places is an indicator of the demand for BDS places relative to the supply of these places. In Scotland there continues to be considerable demand for BDS places relative to supply, although demand levels have differed within and between each of the three providers in recent years.

2.1.3 Intakes

The latest data from HESA for academic year 2019-20 shows that intakes decreased after 2012-13 in line with the intake targets.

Actual and target intakes are very similar during the sample period.

2.1.4 Student demographics

The supply of dentists in the future may be associated with the demographics of current students.

The age distributions of Dundee and Glasgow dental school students are similar. The median age of students who started a BDS course in 2019-20 was 18.5 at Dundee and 19 at Glasgow. Median age at Aberdeen dental school was 23. Aberdeen students are typically older than students at Dundee and Glasgow dental schools because the four-year BDS course at Aberdeen is a graduate entry programme.

In academic year 2019-20 there were more female than male students starting a BDS course. Female students accounted for 65.0% of those commencing programmes.

In academic year 2019-20 54.4% of students starting a BDS course were domiciled in Scotland.

All universities are subject to the recommendations in the Scottish Government’s report on widening access to Higher Education. These recommendations include that: by 2021 students from the 20% most deprived backgrounds should represent at least 10% of full-time first degree entrants to every individual Scottish university; and by 2030 students from the 20% most deprived backgrounds should represent 20% of entrants to higher education.

In academic year 2019-20 8.0% of the Scottish domiciled BDS intake came from the most deprived SIMD quintile.

2.1.5 Completion probabilities

The number of BDS graduates depends upon whether and when students complete. Almost all BDS students eventually complete but some take longer than the minimum duration of the course, which is four years at Aberdeen Dental School and five years at Dundee and Glasgow dental schools. One reason for this delay in completion is that some students undertake an intercalated degree, which is a one-year honours degree studied during a break in BDS education.

2.2 Visas and immigration

Visa and immigration rules affect the inflow of dentists to Scotland. Overseas BDS students need a Student visa (formerly a Tier 4 (general) student visa) to study at a UK university. Students from the EU/EEA may be eligible to apply to the EU Settlement Scheme. Dentists who qualify from a UK university can apply for an extension to their student visa to undertake a recognised foundation programme for postgraduate dentists. A further option is a Graduate visa allowing further study for two years following a degree or foundation programme. Dentists can stay in the UK for a further five years with a Skilled Worker Visa (formerly the Tier 2 (General) work Visa) or a Health and Social Care Worker Visa. Therefore international students may be able to work as a dentist in the UK for up to eight years after graduation.

2.3 The Dental Student Support Grant

Since academic year 2017-18 BDS students in Scotland with an annual household income of less than £34,000 and the ability to live and work in Scotland after graduation have been able to apply for the Dental Student Support Grant, which is a grant of £4,000 to help with study costs. This means-tested grant replaced the Dental Undergraduate Bursary Scheme which had previously been available to students at Scottish Dental Schools starting a course before academic year 2017-18.

Support Grant recipients must agree to work for one year in Scotland for every year they received a grant. This must start within a year of graduation and at least 80% of earnings must be from NHS work.

In academic year 2017-18 12 students were awarded the support grant. This number increased to 115 in academic year 2020-21.

2.4 Dentists on the General Dental Council register

Dentists are entitled to register with the GDC after successfully completing a BDS course.

In September 2020 there were 42,909 registrants in the UK and 4,136 in Scotland.

The percentage of female registrants in Scotland has increased from 48.4% in 2013 to 54.2% in 2020.

2.5 Specialty training

Dentists who hold full GDC registration and have received ARCP outcome 6, which indicates they have completed the training programme, may apply for the award of a CCST and entry onto the relevant specialist list. The structure of dental specialty training in the UK is set out in the Dental Gold Guide. The GDC maintains 13 lists of specialist dentists: endodontics, oral medicine, oral microbiology, oral and maxillofacial pathology, oral surgery, orthodontics, paediatric dentistry, periodontics, prosthodontics, dental public health, dental and maxillofacial radiology, restorative dentistry and special care dentistry.

The total number of specialty trainees in Scotland averages 45 and therefore the number recommended for the award of a CCST in any year is quite small.

2.6 Registered dental specialists

The GDC’s Specialist lists are lists of registered dentists who are entitled to use a specialist title. Dentists don’t have to join a Specialist List to practise in a specialty but a dentist can only use the title if they are on the list.

In September 2020 the number of registered dentists on the GDC’s Specialist lists in the UK ranged from 7 in Oral Microbiology to 1,385 in Orthodontics.

2.7 Dental Vocational Training

New or recent graduates from UK dental schools must complete a one-year programme of DVT in order to be eligible to hold an NHS board list number, which allows dentists to work as associates or principals in NHS General Dental Practice.

The number of DVT places is linked to the output from Scottish dental schools. The number of VDPs has been decreasing since 2018. This reduction had been anticipated as a result of a reduction in intake numbers at Scottish dental schools and a subsequent reduction in the number of graduates from June 2018.

In 2020 85.4% of VDPs qualified in Scotland.

Each year NES asks VDPs to complete an end of year survey which looks at immediate post-training career intentions. However, due to the impact of Covid on dental training and service delivery, the current cohort of VDPs have been offered an extension of their training until 2022 and will be surveyed on their post-training career intentions in June 2022.

The proportion of VDPs retained in NHSScotland follows a similar pattern between cohorts: decreasing sharply in the first couple of years after DVT and then remaining constant.
The initial reduction in retention may be a result of dentists working wholly in the private sector in Scotland, remaining in Scotland but taking a career break or changing careers, or leaving Scotland. After 10 years more than half of VDPs remain in NHSScotland. The reduction in the number of DVT places from 2018-19 resulted in a reduction in the inflow into the dental workforce from 2019 onwards.

2.8 Vocational Training Numbers

In order to obtain an NHS board list number to practise as an associate or practice principal in NHSScotland, or to provide GDS as part of their PDS duties, dentists need to be issued with a VTN from NES to indicate they either have satisfactorily completed DVT or are exempt from the requirement to complete DVT because:

they are from an EEA Member State (other than the UK) and hold a recognised European diploma;
they have had a NHS Board or Performer number within the past five years;
they have practised in primary dental care in the CDS or the Armed Forces for four years full-time, or part-time equivalent, and for not less than four months during the past four years;
they have completed a course of vocational training under the voluntary scheme; or
their experience or training during the past five years is equivalent to DVT.

VTNs are therefore a lead indicator of inflow to the GDS and PDS in Scotland.

There was a large increase in VTNs issued to EEA nationals during VT year October 2005 to September 2006, which partly reflected the Scottish Government’s policy at that time to recruit dentists from Poland to address access issues. Since then fewer VTNs were issued to EEA nationals and more VTNs were issued to dentists who completed DVT in the UK. The increase in VTNs issued during VT year 2013-14 reflected the requirement for CDS dentists to apply for a list number before January 1st 2014 following the introduction of the PDS

The country of qualification of VTN recipients from the EEA has changed over time. Before 2004 most VTN recipients were from countries that joined the EU in 1994: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain and Sweden. There was a large increase in VTNs issued after the expansion of the EU to include the EU 2004 countries: Cyprus, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Slovakia and Slovenia. The number of VTNs issued to dentists from EU 2004 countries has decreased considerably since 2005-06. There was also an increase in VTNs issued after the expansion of the EU to include the EU 2007 countries: Bulgaria and Romania. VTNs issued to dentists from EU 2007 countries has decreased considerably since 2008-09.

The number of VTNs issued to EEA dentists has decreased in recent years and saw a particular drop in 2019, when the largest decreases were in dentists from EEA 1994 and EEA 2007 countries.

Not all dentists who are issued with a VTN exercise their option to work in NHSScotland. Modelling the retention of dentists with a VTN in the NHS workforce indicates that dentists who completed DVT in the UK have a higher probability of remaining in the workforce at five years compared to dentists who entered NHSScotland after being issued with a VTN as an EEA national (0.78 compared to 0.48).

2.9 Dentists in NHSScotland

The number of dentists in NHSScotland is a subset of those registered with the GDC. In Scotland NHS dentists are classified as GDS dentists, PDS dentists or HDS dentists. Dentists may provide treatment in one or more of these services.

In April 2013 the Salaried GDS and the CDS combined to form the PDS. This change affected the way dental workforce data were classified. Before April 2013 the GDS consisted of the salaried and non-salaried GDS. After April 2013 the GDS consisted of only the non-salaried GDS. To ensure a consistent time series, the non-salaried GDS, the salaried GDS and the CDS were combined before April 2013 and the non-salaried GDS and the PDS were combined after April 2013. This consistent time series is referred to as the GDS-PDS.

The number of GDS-PDS dentists decreased in 2020 for the first time since 2000, albeit very slightly. This was due to a large decrease in the number of dentists entering the workforce in 2020 and the inflow being slightly lower than outflow from the workforce in the previous year.

The number of HDS dentists increased between 2019 and 2020 but has been decreasing overall since 2010.

There is some variation between boards in how the number of dentists has changed over time (Board-level breakdown is available from 2008).

2.9.1 Demographics of dentists in NHSScotland

The composition of dentists in NHSScotland by age, sex and country of qualification has changed since 1995.

The age distribution of dentists in 2020 is quite different to the age distribution of dentists in 1995, reflecting the ageing of the dentists who remained in the workforce from 1995 and the inflow of younger dentists since 2005: in 1995 6% of GDS-PDS dentists were older than 55 compared to 11% in 2020.

The sex distribution of dentists has changed considerably since 1995: on September 30th 2020 54.6% of dentists in NHSScotland were female compared to 33.6% in 1995.

The percentage of dentists who qualified from the EEA or the rest of the world increased between 2005 and 2010 and has remained relatively stable since then. The percentage of dentists qualifying in Scotland has likewise been stable since 2010. About 76.0% of dentists in 2020 qualified in Scotland.

2.10 Earnings

Earnings are a key labour market outcome and are likely to affect decisions about whether to train and where to practice as a dentist.

NHS Digital publishes information on gross earnings, expenses and taxable income, i.e. gross earnings minus expenses, for primary care dentists in the UK. This information is based on anonymised tax data for full- and part-time principal and associate dentists with some self-employment earnings from the GDS and is expressed in 2020-21 prices using the Gross Domestic Product deflator.

Recent methodological changes in the NHS Digital data have resulted in a break in the time series for England and Wales and separate reporting of the two countries from financial year 2017 onwards. England and Wales data for 2017 and 2018 in the chart below cannot be viewed as continuous with the countries’ combined data for the previous years.

Real taxable income of dentists decreased considerably between financial years 2008-09 and 2016-17 in both Scotland and England and Wales. Following slight rises in Northern Ireland and Scotland between 2017 and 2018, real taxable income decreased between 2018 and 2019 in Scotland, England and Northern Ireland (2019 GDS data for Wales was not available).

There may be several reasons for this long-term reduction in real taxable income and more work is required to identify these determinants.

2.11 Summary

In Scotland there continues to be considerable demand for BDS places relative to supply, although demand levels have differed within and between each of the three providers in recent years.
Disruption to dental education and training caused by COVID-19 resulted in reduced intake targets to BDS courses for academic years 2021 and 2022. This reduction in intake will have an impact on the inflow to the dental workforce in 2025 and 2026.
Almost all students who start a BDS course in Scotland graduate within six years.
The number of VTNs issued to EEA dentists saw a large decrease in 2019, with the largest decreases in dentists from EEA 1994 and EEA 2007 countries.
The number of dentists that were registered with the GDC continues to increase each year.
The number of GDS-PDS dentists decreased in 2020 for the first time since 2000. This was due to a large decrease in the number of dentists entering the workforce in 2020 and this inflow being slightly lower than the outflow from the workforce in the previous year.
Real taxable income of dentists decreased between 2018 and 2019 in Scotland, England and Northern Ireland.

3 Dental Care Professionals

Six DCP titles require registration with the GDC: Dental Nurse, Dental Hygienist, Dental Therapist, Dental Technician, Orthodontic Therapist and Clinical Dental Technician. Each title has a Scope of Practice that describes what each profession is trained and competent to do.

3.1 DCPs in education and training

The number of DCPs in training in Scotland continues to be guided by the 2005 Dental Action Plan, which set an annual target of 250 dental nurses and 45 dental therapists in training.

3.1.1 Further Education

The GDC requires that trainee dental nurses are either employed and enrolled or waiting to start on a recognised programme that will lead to GDC registration, or studying on a recognised programme that leads directly to GDC registration. A trainee dental nurse must successfully complete one of the following qualifications to register with the GDC as a dental nurse: a SVQ Level 3 in Dental Nursing together with a PDA in Dental Nursing, awarded by the Scottish Qualifications Authority; or a National Diploma in Dental Nursing, awarded by the National Examining Board for Dental Nurses

Dental Nursing certifications include Dental Nursing, SVQ in Dental Nursing, Oral Health Care: Dental Nursing, Dental Nursing: Delivering Oral Health Interventions, Dental Nursing: Supporting Special Care Provision, and Orthodontic Dental Nursing.

Dental Technology certification previously included college-level courses. However, dental technician certification has shifted over the reporting period to University DipHE courses. There are currently no Scottish colleges offering dental technology and only one University, which explains the large decrease in certifications seen since 2015. The DipHE qualifications are included below alongside the dental technology Further Education qualifications.

Dental Nurse certifications increased by 13.6% between 2019 and 2020. Dental Technology certifications decreased by -33.3% between 2016 and 2018. According to the latest available data there were no Dental Technology certifications awarded in academic year 2019.

3.1.2 Higher Education

3.1.2.1 Oral Health Science

Four Scottish universities are certified by the GDC to deliver a BSc in OHS leading to registration as both a dental therapist and hygienist: Dundee, Edinburgh, GCU and UHI.

3.1.2.2 Applications and acceptances

Following a previous increase in the ratio of applications to accepted places, the demand for places has decreased slightly since 2014 but is still relatively high.

The relatively high ratio for Dundee in 2015 may reflect the low numbers and rounded data made available from UCAS.

3.1.2.3 Intakes

The number of students starting an OHS course in Scotland has remained stable since academic year 2012-13 at around 45 students each year.

3.1.2.4 Student demographics

The future supply of DCPs may be associated with the demographics of current OHS students.

The median age of students on entry in academic year 2019-20 was 23.

Most OHS students were female. In academic year 2019-20 93.75% of students that started an OHS course in Scotland were female.

Most OHS students were domiciled in Scotland. In academic year 2019-20 81.25% of students that started an OHS course in Scotland were domiciled in Scotland.

In academic year 2019-20 12.82% of the Scottish domiciled OHS intake came from the most deprived 20% of postcodes.

3.1.2.5 Completion probabilities

The University of Dundee, GCU and UHI offer a three-year BSc course and the University of Edinburgh offers a four-year BSc honours course. Most Dundee, GCU and UHI students complete after three years and most Edinburgh students complete after four years. Some students complete earlier and receive other qualifications such as a Certificate or Diploma of Higher Education.

Around 85% of students starting an OHS course complete within 5 years.

3.2 Dental Care Professionals on the General Dental Council register

The number of DCPs that were registered with the GDC in September each year has been increasing in the UK and in Scotland, though at a slower rate in recent years.

UK figures are sourced from individual-level register extracts and assign the title “Dental Hygienist-Therapist” to DCPs who have registered as both a Hygienist and a Therapist. The Scotland-only figures also allow for registrations in more than one professional category.

The Number of professionals registered as a Dental Technician has been decreasing in Scotland since 2013, while the number of those registered as a Dental Therapist has increased.

3.3 Direct Access

Direct Access to DCPs was introduced in 2013. Direct Access permits dental hygienists and therapists to work entirely independently of a dentist, while dental nurses and orthodontic therapists can carry out selected aspects of their scope of practice independently. Clinical Dental Technicians already tend to work independently on edentulous patients or with technicians in private laboratories. To date there are rare reports of direct access in Scotland occurring in private practice.

The Scottish Government continues to work on developing the required amendments to the regulations to facilitate direct access within the public sector. Currently DCPs cannot register patients as they cannot supply the full range of dental services. Amended regulations will allow DCPs who wish to offer dental services via direct access to apply for a list number under a dental contractor, as is the case for dental assistants, and for payment to be claimed.

3.4 Employment in the NHSScotland Hospital Dental Service and Public Dental Service

The NHSScotland HCHS data classifies dental support staff into several groups. This report aggregates support staff into one of four groups: nurse; technician, which includes dental technicians and clinical dental technicians; OHP; or therapist, which includes dental therapists, orthodontic therapists and hygienists.

The data are reported in WTE, which allows the change in WTE between years to be decomposed into the change in WTE resulting from staff who exit, outflow, the change in WTE resulting from staff who enter, inflow, and the change in WTE for staff who neither exit nor enter, delta.

The overall WTE of DCPs employed in the HCHS increased rapidly between 2007 and 2013 and then decreased at a slower rate until 2018.

The reversal of this trend in 2019 was accounted for by recent reductions in the outflow from all four DCP professions and increases in the inflow to dental nurses and therapists. In 2020 there were 1450.79 WTE DCPs employed in HCHS.

3.4.1 Agenda for Change band

Agenda for Change is the system of terms and conditions for all NHS staff apart from medical and dental staff and senior managers. The majority of dental nurses employed in the HCHS were employed at Agenda for Change band 4. While the distribution of posts remained constant for dental nurses during recent years, the distribution of posts for technicians and therapists changed considerably.

3.4.2 Demographics of HCHS staff

Between 2007 and 2020 94.7% of DCPs employed in NHSScotland were female.

The age distributions for DCPs in 2020 indicate that technicians were slightly older than nurses and therapists, which may indicate higher outflow rates of technicians in the future. Oral Health Practitioners were older still, again potentially indicating a higher outflow from this professional group in the future.

3.5 Earnings of dental nurses

Information on the labour market outcomes of dental nurses can be acquired from the ASHE. ASHE is based on a 1% sample of employee jobs taken from HM Revenue and Customs PAYE records. These data will therefore include people employed in the HCHS and in public and private sector dental practices. Earnings are expressed in 2020-21 prices using the Gross Domestic Product deflator.

In 2020 median gross hourly pay for dental nurses in Scotland decreased to (£10.2) following three consecutive years of increase. Gross hourly pay for nursing auxiliaries and assistants also decreased between 2019 and 2020, ambulance staff pay has remained relatively stable between 2018 and 2019.

From April 1st 2018 the National Living Wage entitles people aged 25 or over and not in the first year of an apprenticeship to £7.83 per hour. Younger people and people in the first year of an apprenticeship are entitled to the national minimum wage rates.

3.6 Summary

Dental Nurse certifications increased by 13.6% between 2019 and 2020. Dental Technology certifications decreased by 33.3% between 2016 and 2018.
The demand for places on the OHS degree has decreased slightly since 2015 but is still relatively high.
Intakes to the OHS degree increased in academic year 2019 to around 50 students.
Around 83% of students starting an OHS degree complete within four years.
The number of WTE DCPs employed in the HCHS has been decreasing since 2013.
In 2020 median gross hourly pay for dental nurses in Scotland decreased for the first time in three years.

4 Access to dental services

4.1 General Dental Service registration rates

Registration with a GDP entitles patients to the full range of dental treatment available under the GDS. Registration rates therefore provide a key measure of access to the GDS.

The registration period, which is the period during which patients are entitled to receive the full range of dental treatment available under the GDS, was extended from 15 to 36 months from April 1st 2006. The registration period was extended from 36 to 48 months for all patients registered with a dentist from April 1st 2009 and was extended to non-time-limited registration for all patients registered at April 1st 2010.

Between September 2018 and September 2019 the adult registration rate surpassed the child registration rate for the first time. The registration rate for children decreased between 2019 and 2020. Public Health Scotland report that the decrease was largest in the 0-2 year age group, with COVID-19 likely to have caused a drop in the number of children registered with a dentist for the first time. However, registration for both children and adults remains above 90%.

The distribution of GDS registration rates is relatively uniform across the reported SIMD quintiles, likely due to the high overall national registration rate.

There are several other points of access to NHS dental care that are not captured by registration data such as the PDS, specialist primary care dental services, Emergency Dental Services, Teach and Treat Centres, dental schools, the HDS and Occasional Treatment arrangements. Therefore, total access to NHS dental services is likely to be greater than the registration rates reported.

4.1.1 Registered patients per dentist

The mean number of registered patients is associated with the age and sex of dentists: younger dentists register more patients than older dentists and male dentists register more patients than female dentists.

4.2 Frequency of visits to public and private sector dentists

4.2.1 The Scottish Health Survey

Each SHeS questionnaire consists of a core module of questions that are asked every year and a rotating module of questions that are asked every two years. The core module includes questions about oral health. The rotating module includes questions on the duration since the respondent’s last visit to a dentist and whether the treatment was provided by the public or private sector.

Based on combined information from the 2015 and 2017 SHeSs 73% of adults visited a dentist less than a year ago and 77% received NHS treatment.

4.3 Denplan Care registration

After a detailed assessment of their oral health, patients registered with Denplan Care (which is one of the payment plans available through Denplan), are allocated to a Denplan Care category (A, B, C, D or E). The Denplan Care category is mainly determined by the oral health and estimated future dental care needs of the patient: category A corresponds to relatively good oral health and low future dental care needs; and category E corresponds to relatively poor oral health and high future dental care needs.

In April 2018 the number of patients registered with Denplan Care in Scotland accounted for 0.9% of the mid-2018 population projection for Scotland.

4.4 Summary

Between September 2018 and September 2019 the adult registration rate surpassed the child registration rate for the first time.
The registration rate for children decreased between 2019 and 2020, likely due to COVID-19 causing a drop in the number of children registered with a dentist for the first time.
Within NHS boards the all-age registration rate varied between 84.5% and 99.2%. The distribution of registration rates between SIMD quintiles tends to be uniform in each board.
Younger dentists register more patients than older dentists and male dentists register more patients than female dentists.
73% of adults visited a dentist less than a year ago and 77% received NHS treatment.

5 Forecasts

5.1 Demand forecasts

The demand for GDS-PDS dentists is derived from the demand for dental services. One aspect of the demand for services is access to NHS dental services, which can be measured by the registration rate.
The registration rate depends on the size of the population, which means that one measure of the demand for GDS-PDS dentists depends on the forecast size of the population of Scotland.

5.1.1 Population forecasts

The latest 2018-based population projections from the NRS show the projected size and composition of the population.

Between 2020 and 2030 the population of Scotland is projected to increase by 84,831.0 (1.55%). By contrast, between 2020 and 2030 the population of Scotland aged 70 and over is projected to increase by 16.99%.

5.1.2 Demand targets

There are four GDS-PDS demand forecasts. Each of the four forecasts corresponds to a particular access target:

DAP Registration is the number of patients consistent with the registration rates set out in the Dental Action Plan Monitoring Forms for NHS boards ie, 85% of children aged 0-17, 65% of adults aged 18-64, and 50% of adults aged 65 and over;
All children registered is the number of patients consistent with registration rates of 100% for children aged 0-17, 65% for adults aged 18-64 and 50% for adults aged 65 and over;
100% registered is the number of patients consistent with a registration rate of 100% for children and adults; and
Current registration is the number of patients consistent with the registration rate on September 30th 2020.

The number of registered patients associated with each of these targets is forecast to increase during the forecast period because of the changes in the projected size and composition of the population.

These registration targets are converted into GDS-PDS dentist targets by dividing the number of registered patients associated with each target by the number of registered patients per dentist.

The number of registered patients per GDS-PDS dentist has changed over time from 1271.4 on September 30th 2000 to 1029.71 on September 30th 2007 and to 1602.9 on September 30th 2020. This increase is a reflection of the number of registered patients increasing faster than the number of GDS-PDS dentists since 30th September 2007.

The number of GDS-PDS dentists consistent with each of these targets is forecast to increase during the forecast period.

5.2 Supply forecasts

The GDS-PDS supply forecast uses age and sex adjusted estimates of inflows and outflows to forecast future inflows and outflows. These age and sex adjusted estimates of the number of dentists during the forecast period are then multiplied by the estimated number of patients registered by dentists to forecast the number of patients registered during the forecast period.

5.2.1 Forecast outflows

Forecast outflows depend on the age and sex composition of dentists and age and sex outflow probabilities. Higher outflow probabilities result in fewer dentists and fewer registered patients. The outflow probability is relatively high for young dentists, which may reflect younger dentists taking career breaks. The outflow probability increases for dentists older than 54, which may reflect dentists retiring. For the purpose of the forecast, the outflow probability for dentists aged 75 and over is assumed to be 1.

5.2.2 Forecast inflows of dentists who return to the workforce

The forecast inflow of dentists who return to the workforce depends on the age and sex composition of dentists who left the workforce in previous years and the probability of returning. The probability of returning to the GDS-PDS is highest two years after leaving and then decreases with each additional year out of the GDS-PDS workforce. The probability of returning after two years is highest in the 20 to 24 and 40 to 44 age groups for females and in the 20 to 24 and 25 to 29 age groups for males. Higher inflow probabilities result in more dentists and more registered patients.

5.2.3 Forecast inflows from other sources

Inflows from other sources consist of dentists who had not previously been in the GDS-PDS workforce and did not enter following DVT. The inflow from other sources each year is closely related to the number of VTNs issued by NES other than VTNs issued to dentists who completed DVT in Scotland. Higher estimated inflows from other sources result in more dentists and more registered patients. The forecast inflow from other sources is based on the inflows from other sources in 2020: 45.

5.2.4 Forecast inflows from Dental Vocational Training

The forecast number of dentists who join after DVT in Scotland depends on: the output of BDS courses in Scotland; the relationship between the output of BDS courses in Scotland and the number of DVT places; and the probability that VDPs enter the GDS or PDS.

For the purpose of the forecast the intake to BDS courses is assumed to remain at 2018-19 levels apart from in 2021-22 and 2022-23 which reflect the reduced intake targets. Changes in intake in any academic year have an impact four, five and six years in the future because students at Aberdeen Dental School graduate four or five years after starting a course and students at Dundee and Glasgow dental schools graduate five or six years after starting a course.

In the past the number of DVT places has been matched to the output of the Scottish dental schools. If the number of DVT places continues to match the total output of the Scottish dental schools then the number of DVT places will decrease in line with the decrease in intakes.

Higher probabilities of joining the GDS or PDS after DVT results in more dentists and more registered patients.

The probability of joining the GDS-PDS after DVT in Scotland is highest in the year following DVT and decreases with each following year. This probability varies between age groups and between males and females and is close to zero from the sixth year after completing DVT onwards.

5.2.5 GDS-PDS supply forecast

The number of GDS-PDS dentists is forecast to decrease during the forecast period. This forecast reduction in the size of the GDS-PDS workforce is a result of relatively high outflows and relatively low inflows from DVT and from other sources. The chart shows the effect that the lower intake targets in 2021-22 and 2022-23 have on the forecast inflow from DVT and the forecast number of GDS-PDS dentists in 2027 and 2028.

The outflow from GDS-PDS in 2019 was much lower than would have been expected based on the number of GDS-PDS dentists in 2019 and the estimated outflow rates reported in section 5.2.1. As a result the forecast outflows in 2020 are relatively high compared to 2019. Similarly the inflow from DVT in 2020 was much lower than would have been expected based on the number of VDPs reported in section 2.7 and the probability of joining the GDS-PDS following DVT reported in 5.2.4. As a result the forecast inflow from DVT in 2021 looks relatively high compared to 2020. These lower-than-expected outflows and inflows from DVT are likely to be an effect of the COVID-19 pandemic.

5.3 A comparison of supply and demand forecasts

As a result of the reduction in the forecast number of GDS-PDS dentists and a forecast increase in the population, during the 10-year forecast period it is unlikely there will be enough GDS-PDS dentists to ensure that the current registration rates are maintained.

5.4 Age-sex adjusted supply and demand forecasts

The supply and demand forecasts can also be measured in terms of registered patients. The GDS-PDS unadjusted forecast illustrates the number of patients registered by GDS-PDS dentists without adjusting for the relationship between the number of registered patients per dentist and the age and sex composition of dentists. By contrast, the GDS-PDS adjusted forecast accounts for the relationship between the number of registered patients per dentist and the age and sex composition of dentists. The adjusted forecast results in fewer registered patients than the unadjusted forecast.

There are several sources of uncertainty in these forecasts including:

the impact of the changing age, sex and country of qualification of dentists, which is likely to affect the supply of dental services in the long run;
changes in the number of VTNs issued to EEA dentists, which may have an immediate impact on the inflow of dentists from EEA countries;
the impact of increasing numbers of people aged 60 and over on the demand for dental services;
the impact of changes in the system of dental services in Scotland resulting from the outcome of the Scottish Government’s Oral Health Improvement Plan to help shape NHS dental services in the future;
the impact of changes in the composition of the dental team, which affects the demand for dentists;
the impact of Direct Access, which is likely to affect the demand for dentists; and
The impact of the Covid-19 pandemic and any recovery measures.

5.5 Summary

The projected changes in the size and composition of the population are forecast to increase the demand for dental services during the forecast period.
Based on the current number of registered patients per dentist the forecast increase in the demand for dental services is forecast to increase the demand for dentists.
Based on a series of estimates and assumptions, the supply of dentists is forecast to fall short of the number of dentists required to maintain current registration rates.
There is considerable uncertainty over the inflows from other, typically non-UK, sources that have an immediate impact on the number of dentists in Scotland.

The Dental Workforce in Scotland 2021

NHS Education for Scotland