The 2024 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, PHS 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.
AcronymsARCP - Annual review of progression
BDS - Bachelor of Dental Surgery
DCP - Dental Care Practitioner
GDS - General Dental Service
PDS - Public Dental Service
HDS - Hospital Dental Service
VDP - Vocational Dental Practitioner
DVT - Dental Vocational Training
VTN - Vocational Training Number
GDC - General Dental Council
PDQ - Primary Dental Qualification
SQA - Scottish Qualification Agency
SFC - Scottish Funding Council
HESA - Higher Education Statistics Authority
HCHS - Hospital and Community Health Service
NHS Education for Scotland is an education and training body and a special health board within NHSScotland, with responsibility for developing and delivering education and training for the healthcare workforce in Scotland.
HESA and UCAS numbers are rounded to the nearest 5.
- 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.
- 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.
- Most students who start a BDS course in Scotland graduate within five years, with almost all graduating within 6 years.
- The number of VTNs issued to EEA dentists saw a large decrease in 2019, however this has since increased again to a similar level pre-2019
- The number of dentists that were registered with the GDC has stabilised over the past few years after a period of increasing numbers of registrants.
- The number of GDS-PDS dentists decreased between September 2020 and September 2022. This was due to a large decrease in the number of dentists entering the workforce in 2020 and large increase in the number of dentists leaving the workforce. Between September 2022 and September 2023 the number of GDS-PDS dentists was steady.
- After a long period of declining earnings between 2006-2019, real earnings have started to increase.
- Dental Nurse certifications fell between 2022 and 2023.
- The demand for places on Oral Health Science degrees has decreased slightly since 2015
- There was a reduced intake of OHS students in 2021 due to the COVID-19 pandemic.
- Around 83% of students starting an OHS degree complete within four years.
- The number of WTE DCPs employed in the HCHS after a decrease between 2014 and 2020 has levelled off.
- The registration rate for children decreased between 2019 and 2021, likely due to COVID-19 causing a drop in the number of children registered with a dentist for the first time. The rate has begun to rise again slightly.
- 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.
- In the 2021 Scottish Health Survey 73% of adults reported having visited a dentist less than a year ago and 77% received NHS treatment.
- 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 in the short term but by the end of the 10 year projection period, return to a similar level to that prior to the pandemic.
- 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.
Data on the numbers of applications and commencements of students can give us a sense of the supply of dentists from Scottish dental schools.
Each year the Chief Dental Officer writes to the SFC with a recommendation for the number of students taken into Bachelor of Dental Surgery (BDS) courses in Scotland.
There are 3 universities in Scotland that offer a BDS, Glasgow, Aberdeen and Dundee. A BDS typically takes 5 years.
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.
Source: Scottish Funding Council
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.
As a result of the UK leaving the European Union (EU) 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.
Source: UCAS
The number of accepted places provides a measure of the number of students that have been offered and intend to start a BDS programme.
Source: UCAS
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.
Source: HESA
Note: Counts are rounded to nearest 5
HESA data is used to analyse trends of student characteristics. The supply of dentists in the future may be associated with the demographics of current students.
There has been a delay in the provision of HESA data for academic year 2022/23 which is usually provided by the SFC in early 2024, so the latest available data is for 2021/22 academic year.
Source: Scottish Funding Council, HESA
Note: Counts are rounded to nearest 5
Despite an intake target being set for academic year 2021-22 HESA recorded no intake in that year. The 2020-21 BDS students remained in their year groups in 2021-22.
Source: HESA
Note: Counts are rounded to nearest 5
Source: HESA
Note: Counts are rounded to nearest 5
Source: HESA
Note: Counts are rounded to nearest 5
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.
Source: HESA
Note: Counts are rounded to nearest 5
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.
Source: Scottish Government
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.
Graduates of a BDS course from a UK university are entitled to full registration with the GDC.
The dental register can give a broader picture of the dentists currently registered to work, who may not be picked up through other sources. It can be used to identify which countries dentists working in scotland obtained their Primary Dental Qualification (PDQ) and information on the number of Vocational Training Numbers (VTNs) issued.
Source: General Dental Council
Source: General Dental Council
Date: September 2023
Source: General Dental Council
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.
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.
Source: NHS Education for Scotland
New or recent graduates from UK dental schools must complete a one-year Vocational Dental Programme (VDP) to allow them to work as a an Associate or Principal in General Dental Practice in NHS Scotland. On completion of their training they receive a Vocational Training Number (VTN).
Most of the VDPs in the VDP year between August 2020 and July 2021 were retained in DVT in Scotland between August 2021 and July 2022.
Source: NHS Education for Scotland
Due to the COVID_19 pandemic there was no 2020 VDP cohort.
Source: NHS Education for Scotland
Source: NHS Education for Scotland
Source: NHS Education for Scotland, Public Health Scotland
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.
Source: NHS Education for Scotland, Public Health Scotland
Source: NHS Education for Scotland, Public Health Scotland
The left hand side of the chart shows the Inflows and outflows into the Dental Workforce. When the Inflow (Light blue) is greater than the Outflow(Dark Blue) the Stock (Green) will increase, and if the Inflow is less than the Outflow the Stock will decrease.
The inflow into the dental workforce in September 2021 was relatively low because there were fewer VTNs issued in the VT year between October 2020 and September 2021. At the same time the outflow of dentists increased.
Source: NHS Education for Scotland, Public Health Scotland
Source: NHS Education for Scotland, Public Health Scotland
Source: NHS Education for Scotland, Public Health Scotland
Source: NHS Education for Scotland, Public Health Scotland, General Dental Council
Source: NHS Digital, UK Gov
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.
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.
Source: SQA, HESA
Source: UCAS
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.
Source: HESA
Note: Intake counts are rounded to nearest 5
Unlike BDS students there was a recorded intake into OHS in 2021
Source: HESA
Note: Intake counts are rounded to nearest 5
Source: HESA
Note: Intake counts are rounded to nearest 5
Source: HESA
Note: Intake counts are rounded to nearest 5
Source: HESA
Note: Intake counts are rounded to nearest 5
Source: HESA
Note: Intake counts are rounded to nearest 5
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.
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.
Source: General Dental Council
Source: NHS Education for Scotland
Source: NHS Education for Scotland
The majority of the DCP workforce is outwith the NHS and so this is only a subset of the total workforce.
Source: NHS Education for Scotland
Source: ASHE
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 2022-23 prices using the Gross Domestic Product deflator.
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 to non-time-limited registration for all patients registered at April 1st 2010.
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.
Source: ASHE
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.
Source: Public Health Scotland
Source: Public Health Scotland
Source: Public Health Scotland
The number of patients that are registered to a dentist varies by the age of the dentist. We can use this information to estimate, using forecasts of the age of the dental workforce, how many patients will be registered to that dental population.
Source: Scottish Health Survey 2021
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.
Source: Scottish Health Survey 2021
To forecast the number of dentists that will be present in the workforce we can decompose several inflows and outflows into the workforce.
- The probability that a dentist will leave the workforce based on their Age and Sex
- The probability that a dentist will return to the workforce after leaving based on the Age and Sex they were when they left
- The expected number of dentists who will join the workforce from other sources.
- The expected number of dentists who will join the workforce from Dental Vocational Training, based on the expected number of dentists who will graduate from dental school and the transition probabilities from VDP to GDS/PDS
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.
Source: National Records of Scotland
Dashed lines indicate population aged 60 and over
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.
The latest 2018-based population projections from the NRS show the projected size and composition of the population.
Number of registered patients associated with each registration target
Source: NHS Education for Scotland, Public Health Scotland, NRS
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.
Source: NHS Education for Scotland, Public Health Scotland, NRS
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.
Source: NHS Education for Scotland, Public Health Scotland
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.
Source: NHS Education for Scotland, Public Health Scotland
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.
Higher inflow probabilities result in more dentists and more registered patients.
Source: NHS Education for Scotland, Public Health Scotland
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.
Source: SFC, HESA
Source: NHS Education for Scotland, Public Health Scotland
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.
Source: NHS Education for Scotland, Public Health Scotland
Following a reduction in the number of GDS-PDS dentists over the past few years, the stock of dentists is forecast to increase over the next 10 years, returning to pre-pandemic levels.
The drop in the number dentists was caused by a steep rise in the number of dentists leaving the GDS-PDS workforce, and a reduction in the inflow of dentists from DVT. The inflows and outflows are forecast to return to a similar levels seen in the workforce pre-pandemic, which results in a small annual increase in the stock of GDS-PDS Dentists.
Source: NHS Education for Scotland, Public Health Scotland
Source: NHS Education for Scotland, Public Health Scotland
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.
This scenario models the impact of an extra 5 places at each of Glasgow and Dundee universities (10 places in total) in the years 2025 and 2026. These students would begin to graduate in 2030, and complete their vdp year in 2031, where we would begin to see them transition into the GDS_PDS workforce.
This scenario models the impact of a reduction of 5% in the number of patients that are registered with each dentist.