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.