Foreword

The 2016 dental workforce report is the latest in a series of biennial 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.

These past trends and forecasts indicate that the capacity of the system to deliver dental services to the people of Scotland is greater than ever before and is forecast to increase in the future.

Executive summary

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

Dentists

  • There continues to be considerable demand for BDS places relative to supply.
  • Almost all students who start a BDS course in Scotland graduate within six years.
  • The reductions in intake targets that began in academic year 2013-14 will result in reductions in the number of graduates from Scottish dental schools from June 2018 onwards, in the number of DVT places from 2018-19 onwards and in the inflow to the dental workforce from 2019 onwards.
  • The number of VTNs issued to EEA dentists has decreased during recent years and the number likely to be issued in the future is uncertain.
  • The number of dentists that were registered with the GDC and had a Scottish postcode continues to increase but at a much slower rate than in the past.
  • The number of dentists in NHSScotland continues to increase but at a much slower rate than in the past as a result of lower inflows rather than higher outflows.
  • Real taxable income of dentists decreased considerably between financial years 2008-09 and 2014-15.

Dental Care Professionals

  • The ratio of applications to accepted places has increased since 2008 indicating increasing demand for OHS places.
  • The 45 students starting OHS courses each year is likely to result in about 40 OHS graduates each year.
  • The number of DCPs that were registered with the GDC and had a Scottish postcode continues to rise and at a faster rate than registrants without a Scottish postcode.
  • The number of DCPs employed in the HCHS decreased slightly in 2014 and 2015 as a result of relatively large reductions in the number of technicians, relatively small reductions in the number of nurses and relatively large increases in the number of therapists.
  • Median gross hourly pay for dental nurses decreased between 2014 and 2015 both in real terms and relative to other comparable occupations.

Access

  • NHSScotland registration rates continue to increase and in September 2015 were at record levels.
  • There is variation in the registration rate between NHS boards but the lowest registration rate was almost 75%.
  • Younger dentists register more patients than older dentists and male dentists register more patients than female dentists.
  • People are visiting a dentist more frequently and are more likely to see an NHS dentist when they do.

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 increases the demand for dentists.
  • Based on a series of estimates and assumptions, the supply of dentists is forecast to exceed the number 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 biennial 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. These other sources of information show that: an increasing number of patients are seeing an NHS dentist within two years; the oral health of adults as measured by the percentage of adults with at least some natural teeth improved between 2008 and 2015; and the oral health of P7 children with no obvious decay continues to improve.

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.

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, from the EU or from outside the EU.

For EU non-RUK students the price per student in academic year 2016-17 was £8,274 per pre-clinical FTE and £16,454 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 £9,000: Dundee, Glasgow and Aberdeen charged £9,000 per FTE.

For non-EU students the price per FTE is set by each university: Aberdeen charged £29,425 per year, Dundee charged £28,600 for the first year and £40,000 for each of the remaining four years and Glasgow charged £39,000 for each year.

2.1.2 Applications and acceptances

The number of accepted places on BDS programmes in the UK has decreased since 2010.

Between 2010 and 2015 the number of accepted places decreased by 18% in England compared to 12% in Scotland.

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.

2.1.3 Intakes

The latest data from HESA for academic year 2014-15 shows that intakes decreased after 2012-13 in line with the intake targets.

Actual and target intakes are very similar during the sample period. The actual intake into BDS in 2014-15 was lower than the target intake, which means that the number of graduates from that cohort will be slightly lower than expected. The reductions in intake targets beginning in academic year 2013-14 will result in reductions in the number of graduates from Scottish dental schools from June 2018 onwards.

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. Aberdeen Dental School 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. The mean age of students who started a BDS course in 2014-15 was 24, 18 and 19 at Aberdeen, Dundee and Glasgow. The median age of students was 23, 19 and 18 respectively.

In academic year 2014-15 there were more female than male students starting a BDS course. Female students accounted for 52%, 56% and 58% of those commencing programmes at Aberdeen, Dundee and Glasgow respectively.

In academic year 2014-15 52.63%, 40.28% and 71.23% of students starting a BDS course at Aberdeen, Dundee and Glasgow were domciled 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 2014-15 8.99% 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 Tier 4 (General) student visa to study at a UK university. Dentists who qualify from a UK university are allowed to apply for a Tier 4 (General) student visa to undertake a recognised Foundation Programme for a maximum of three years. Dentists can stay in the UK for a further five years with a Tier 2 (General) 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 Undergraduate Bursary Scheme

Undergraduate students at Scottish dental schools who are eligible to live and work in Scotland indefinitely after graduation can apply to DUBS for a bursary of £4,000 for each clinical year of their course. In return for the bursary students must commit to up to five years FTE work as a dentist in NHSScotland.

2.3.2 The estimated impact of DUBS

The impact of DUBS can be estimated by comparing the retention rate of VDPs who qualified from a dental school in Scotland with the retention rate of VDPs who qualified from a dental school outside Scotland before and after the introduction of DUBS.

There were 210 VDPs who qualified outside Scotland before the introduction of DUBS, 980 VDPs who qualified in Scotland before the introduction of DUBS, 207 VDPs who qualified outside Scotland after the introduction of DUBS, and 1247 VDPs who qualified in Scotland after the introduction of DUBS.

The difference in the retention rates of VDPs who qualified in Scotland before and after the introduction of DUBS is smaller than the difference in the retention rates of VDPs who qualified outside Scotland before and after the introduction of DUBS. This indicates that DUBS did not have a positive effect on the post-DVT retention rates of dentists in NHSScotland.

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 2015 there were 3,939 registrants with a Scottish postcode and 36,974 registrants without one. In recent years the rate of increase of dentists on the GDC register has slowed.

The percentage of female registrants with a Scottish postcode increased from 46.05% in 2010 to 49.65% in 2015.

2.5 Specialty training

Dentists who hold full GDC registration and have completed a specialist training programme approved by the GDC 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. In Scotland very few dentists are awarded a CCST each year.

2.6 Registered dental specialists

In September 2016 the number of specialists in Scotland ranged from fewer than five in dental and maxillofacial radiology, oral microbiology and oral pathology to over 100 in orthodontics. The number of special care dentists has almost doubled in the last five years while the number of prosthodontists has decreased by 20%.

In September 2015 there were 371 registered dental specialists with a Scottish postcode compared with 351 in 2010.

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 the GDS.

The number of DVT places is linked to the output from Scottish dental schools. The number of VDPs has decreased since 2011 but was still greater in 2015 than in 2009. The expected reduction in the number of graduates from Scottish dental schools from June 2018 onwards as a result of the reduction in intake numbers will result in a reduction in the number of DVT places from 2018-19 onwards.

In 2015 92.4% of VDPs qualified in Scotland. It was not possible to acquire the country of qualification for a small number of VDPs, who were classified as missing.

Each year NES asks VDPs to complete an end of year survey. Among other things, the survey asks VDPs whether they have secured a post for the following year. If they have secured a post, they are asked about the location of that post. If they have not secured a post, they are asked about where they intend to work.

The results of the 2016 questionnaire show that 86.1% of respondents had secured a post, 89.8% of respondents that had secured a post would be working in Scotland and 44.5% of respondents that had not secured a post intended to work in Scotland.

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 will result 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 a principal dentist 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 in 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. 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 during recent years and the number likely to be issued in the future is uncertain.

Not all dentists who are issued with a VTN exercise their option to work in NHSScotland. Of those that did, the proportion of dentists that were retained in Scotland was much higher for dentists who completed DVT in the UK compared to EEA nationals: 75.11% of dentists who entered NHSScotland after being issued with a VTN as a result of completing DVT in the UK were in NHSScotland six years later compared with 41.49% of the dentists who entered NHSScotland after being issued with a VTN as an EEA national.

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 in 2015 is about the same as in 2014. This is a result of a reduction in the inflow rather than an increase in the outflow of dentists.

2.9.1 Demographics of dentists in NHSScotland

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

The age distribution of dentists in 2015 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 2015.

The sex distribution of dentists has changed considerably since 1995: on September 30th 2015 49.86% of dentists in NHSScotland were female compared to 33.51% in 1995.

While the percentage of dentists who qualified from the EEA or the rest of the world has increased since 2005, about 75% of dentists in 2015 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.

The HSCIC publishes information on gross earnings, expenses and taxable income ie, gross earnings minus expenses, for primary care dentists in Scotland. 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 2015-16 prices using the Gross Domestic Product deflator.

Real taxable income of dentists decreased considerably between financial years 2008-09 and 2014-15 in both Scotland and England and Wales. Similar reductions in real taxable income in Scotland were reported for principals and associates, young and old dentists, female and male dentists, and dentists who spent a little or a lot of time on NHS dentistry.

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

2.11 Summary

  • There continues to be considerable demand for BDS places relative to supply.
  • Almost all students who start a BDS course in Scotland graduate within six years.
  • The reductions in intake targets that began in academic year 2013-14 will result in reductions in the number of graduates from Scottish dental schools from June 2018 onwards, in the number of DVT places from 2018-19 onwards and in the inflow to the dental workforce from 2019 onwards.
  • The number of VTNs issued to EEA dentists has decreased during recent years and the number likely to be issued in the future is uncertain.
  • The number of dentists that were registered with the GDC and had a Scottish postcode continues to increase but at a much slower rate than in the past.
  • The number of dentists in NHSScotland continues to increase but at a much slower rate than in the past as a result of lower inflows rather than higher outflows.
  • Real taxable income of dentists decreased considerably between financial years 2008-09 and 2014-15.

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 require 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 of one of the following qualifications to register with the GDC as a dental nurse: a SVQ Level 3 in Dental Nursing and 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

The mean age of students completing the SVQ decreased from 27 in 2010 to 24 in 2015, and more than 98% were female.

Accredited dental technician training in Scotland is available at Edinburgh College and the University of the Highlands and Islands. Data from the SQA reports between 30 and 65 HND certifications in Scotland each year between 2010 and 2015. The mean age of individuals completing this course increased from 28 in 2010 to 31 in 2015 and overall 56% were female.

Between 2008 and 2016 NES trained 46 orthodontic therapists of whom 40 are reported to be currently working in Scotland.

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

The ratio of applications to accepted places has increased since 2008 indicating increasing demand for OHS places relative to supply. The relatively high ratio for Dundee in 2015 may be an artefact of 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 doubled between academic year 2008-09 and the latest available academic year 2014-15. Since 2011-12 about 45 students have taken up places on OHS courses in Scotland each year.

3.1.2.4 Student demographics

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

The mean age of first year students entering OHS programmes in academic year 2014-15 was 20, 21, 21 and 21 at Dundee, Edinburgh, GCU and UHI respectively. The median age on entry was 19, 19, 19 and 21.

Most OHS students were female. In academic year 2014-15 97.83% of students that started an OHS course in Scotland were female.

Most OHS students were domiciled in Scotland. In academic year 2014-15 78.26% of students that started an OHS course in Scotland were domiciled in Scotland.

In academic year 2014-15 8.57% 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 HNC or HND. The 45 students starting OHS courses each year is likely to result in about 40 OHS graduates each year.

3.2 Dental Care Professionals on the General Dental Council register

The number of DCPs that were registered with the GDC and had a Scottish postcode continues to rise and at a faster rate than registrants without a Scottish postcode.

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, Community and Public Health Service

The NHSScotland HCHS data classifies DCPs into one of three groups: nurse; technician, which includes dental technicians and clinical dental technicians; or therapist, which includes dental therapists, orthodontic therapists and hygienists.

In 2015 the number of DCPs employed in the HCHS accounted for 28% of DCPs registered with a Scottish postcode.

The number of DCPs employed in the HCHS decreased slightly in 2014 and 2015 because outflows were greater than inflows. This decrease was accounted for by relatively large reductions in the number of technicians, relatively small reductions in the number of nurses and relatively large increases in the number of therapists.

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 2015 94% of DCPs employed in NHSScotland were female.

The age distributions for DCPs in 2015 indicate that technicians and therapists were slightly older than nurses, which may indicate higher outflow rates if technicians and therapists 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.

Median gross hourly pay for dental nurses decreased between 2014 and 2015 both in real terms and relative to other comparable occupations.
In 2015 median gross hourly pay for dental nurses was £9.24. From April 1st 2016 the National Living Wage entitles people aged 25 or over and not in the first year of an apprenticeship to £7.20 per hour. Younger people and people in the first year of an apprenticeship are entitled to the national minimum wage rates.

3.6 The demand for Dental Care Professionals

Several factors emerging over recent years have led to the exploration of new models of care which more efficiently use the skill mix available in the dental team in various countries eg, Wing (2014), Wanyoni (2015) and Simmer-Beck (2015). Factors which may lead to an increased demand for DCPs include: direct access to DCPs whose scope of practice includes most items required during routine care eg, Evans (2007); the identification of persistent areas of inequality and unmet oral health care needs in which DCPs’ skills are reported to be well suited including preventative care and domiciliary visits, particularly for elderly eg, Monaghan (2015) or paediatric patients eg, Simmer-Beck (2015); and a general improvement in oral health and the associated reduction in the requirement for complex care in general practice eg, Macey 2015.

The future demand for DCPs in Scotland is still uncertain however with ongoing reports of DCPs being under-used in practice, and an ageing population with fewer edentulous patients which may increase the complexity of care required over time.

3.7 Summary

  • The ratio of applications to accepted places has increased since 2008 indicating increasing demand for OHS places.
  • The 45 students starting OHS courses each year is likely to result in about 40 OHS graduates each year.
  • The number of DCPs that were registered with the GDC and had a Scottish postcode continues to rise and at a faster rate than registrants without a Scottish postcode.
  • The number of DCPs employed in the HCHS decreased slightly in 2014 and 2015 as a result of relatively large reductions in the number of technicians, relatively small reductions in the number of nurses and relatively large increases in the number of therapists.
  • Median gross hourly pay for dental nurses decreased between 2014 and 2015 both in real terms and relative to other comparable occupations.

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.

There is variation in the registration rate between NHS boards and between SIMD quintiles within NHS boards. The lowest registration rate, 71.53%, is in the least deprived quintile in NHS Grampian and the highest registration rate, 96.79%, is in the least deprived quintile in NHS Ayrshire and Arran.

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.

The percentage of adults who reported visiting a dentist less than a year ago increased from 70.05% in SHeS 2011 to 73.78% in SHeS 2013.

The percentage of people who reported receiving treatment from only the private sector decreased between SHeSs: 23.36% in SHeS 2011 and 20.33% in SHeS 2013.

4.3 Denplan Care registration

After a detailed assessment of their oral health patients registered with Denplan Care, which is one of 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.

There were reductions in the number of patients registered with Denplan Care in all Denplan Care categories since 2009.

In March 2016 the number of patients registered with Denplan Care in Scotland accounted for 1.24% of the mid-2015 population estimate for Scotland.

4.4 Summary

  • NHSScotland registration rates continue to increase and in September 2015 were at record levels.
  • There is variation in the registration rate between NHS boards but the lowest registration rate was almost 75%.
  • Younger dentists register more patients than older dentists and male dentists register more patients than female dentists.
  • People are visiting a dentist more frequently and are more likely to see an NHS dentist when they do.

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 2014-based population projections from the NRS show the projected size and composition of the population.

Between 2016 and 2025 the population of Scotland is projected to increase by 151303 or 2.81%. By contrast, between 2016 and 2025 the population of Scotland aged 60 and over is projected to increase by 254206 or 19.23%.

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 2015.

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. The number of registered patients per GDS-PDS dentist decreased from 1275.58 on September 30th 2000 to 1040.93 September 30th 2007 and then increased to 1521.61. This increase is a reflection of the number of registered patients increasing faster than the number of GDS-PDS dentists since 30th September 2007.

In September 2015 there were 4780901 registered patients and 3142 GDS-PDS dentists. Therefore the number of registered patients per dentist in September 2015 was 1521.61.

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. With the exception of the high return probability for females age 70 to 74, which is explained by very small numbers of female dentists in this age group, the probability of returning after two years is highest in the 40 to 44 and 45 to 49 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 2015: 64.

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 2016-17 levels. 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 in four or five years and students at Dundee and Glasgow dental schools graduate in five or six years.

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 increase during the forecast period. The rate of increase during the forecast period, however, is lower than the rate of increase between 2005 and 2015. This reduction in the rate of increase of GDS-PDS dentists is a result of lower inflows from other sources during the forecast period and lower inflows from DVT from 2019 onwards.

5.3 A comparison of supply and demand forecasts

During most of the 10-year forecast period there are likely to be more GDS-PDS dentists than are necessary ensure that the current registration rates are maintained but fewer GDS-PDS dentists than are necessary to ensure that everyone in Scotland is registered.

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 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 the system of dental services in Scotland resulting from the outcome of the Scottish Government’s consultation exercise 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; and
  • the impact of Direct Access, which is likely to affect the demand for dentists.

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 increases the demand for dentists.
  • Based on a series of estimates and assumptions, the supply of dentists is forecast to exceed the number 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.