Things are changing again in my profession and in my country in my profession.
When I started to work in healthcare, it was as a hospital practitioner in a dental hospital and school in Glasgow.
After a year, I moved to work in a very large teaching hospital in Nottingham. In fact, one of the largest and busiest in Western Europe at that stage.
Following that, I moved to a small local District general hospital and continued to work in the overall healthcare sphere before I went back into dental practice, but maintaining links to the hospital.
I've therefore worked across different aspects of dentistry in different spheres, both within the NHS and out of the NHS, but also in the broader healthcare environment.
Back in the late 90s, one of the major pushes moving forwards was to enhance and embolden the role of the nurse in healthcare.
I have much personal insight into this as my wife is a children's cancer nurse; she is a Macmillan nurse who looks after who provides palliative care for children and has done for over 30 years.
The role that my wife carries out now as a nurse in that position is utterly and completely different to the role of the nurse in 1994 when I qualified in dentistry.
This was a political agenda which has moved forwards dramatically over the past 25 to 30 years, because that is the timescale that long-term policy takes to enact.
For many years now (but not as many as general healthcare), there has been discussion about enhancing the role of the dental care professional in dentistry, and now we're in a position where this is starting to tip over itself and reach a critical mass.
If you add to this the potential will of the government and the regulatory bodies to increase registrations in dentistry, you will find that there is a 3-point threat to the current associate model, which will be extraordinary for people who own practices and extraordinary for people who are beneath the associate level, but awful for 90% of associates.
Here's why.
Number one, the expanded role of the dental nurse, allowing them to apply fluoride varnish, take IOS scans, CBCT scans and provide diagnostic planning for all manner of work, will push associates out of work in certain areas, particularly in aligner orthodontics and aspects of digital planning.
This is best seen in the new dental contract, which allows 10% of the contract to be taken up by fluoride application, which will be carried out by nurses. Imagine you were a practice that had 100 dentists; 10 of them have just lost their job.
The second is the expansion of the dental therapy role; this has been a much vaunted, much talked about development in dentistry, but our perception here is that this is about to tip over the edge. We are actively investigating the prospect of providing full therapist courses to upskill therapists and to make them into these extraordinary clinicians who can provide a wide range of treatment.
What you find about therapy (and enhanced nurses) is they are much more enthusiastic, much more detailed, and much more committed than the average associate.
If this changes and people cotton onto this as a model, it will put greater threat on the associate model and attach itself to Number one.
Number three, it is now the stated aim of the General Dental Council and the Department of Health to register 1000 extra dentists per year for the next 5 years by expanding the examination formats, both the overseas examination and the licence examination for dentistry.
You may not have seen this, and you may not think it will come to pass, but if it does come to pass, it's liable to increase the number of associates in the market by 20% in 5 years' time.
Imagine that.
Nurses doing more work than associates were doing, therapists doing a lot more work than associates were doing, and more associates for fewer jobs in the competition market.
For years we've talked about the antidote to this, and the antidote to this is just to be in the top 10% of dentists. 10% skill level, 10% commitment, 10% attitude, 10% working pattern; you're never going to get where you're going on 3 days a week.
Blog Post Number 4585