What does the hospital junior doctors contract mean for trainee dentists?

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The recent hospital junior doctors contract negotiations have caused a lot of controversy in the popular press, but what rarely gets mentioned is the impact of these on hospital dentists. Here’s my view on what it might mean for those currently working or, considering a career in, hospital dentistry.

The current outlook

The current outlook for dental core training (DCT) and careers within secondary care dentistry can appear bleak, as hospital budgets get smaller and waiting lists get longer.

It continues to be an underappreciated, under-resourced and over-burdened sector. This combined with the regular media bashing of the NHS and public dissatisfaction with waiting times, despite receiving world class treatment free at the point of care, means that remaining upbeat about secondary care can be difficult.

However, those (like myself) who work in the sector remain optimistic, hard-working and consistently focused on delivering the best possible patient care – no contract changes are ever likely to alter that.

My concern is whether future young dentists will appreciate the value of undertaking DCT or having a career in secondary care. According to COPDEND, 55% of trainees who complete a DCT year will then leave secondary care.

Is there a lack of sufficient training and support?

Even if, miraculously, in the future the NHS dental contract will be changed significantly to sufficiently remunerate for complex treatment, I am concerned we may not have the workforce with the right skillset to carry it out.

Undergraduate training is not producing dentists with the level of experience that was expected in the past. New dentists graduate with competence in basic dental procedures, but not necessarily confidence.

Newly-qualified dentists’ experience in complex work can be minimal or non-existent. Further training and nurturing is essential if they are to develop.

This is not rectified in a single foundation training year and is a great challenge to tackle as an associate with the pressures of UDA targets and the fear of litigation being ever present.

There are alternative postgraduate training opportunities for young dentists other than DCT posts, however many will struggle to finance these. And, even if they could, many will fail to be able to justify the spend, as successful completion is no guarantee of increasing your NHS earnings in practice: it’s a big financial gamble.

How will the new terms and conditions affect us?

So how will the “Terms and Conditions of Service for NHS Doctors and Dentists in Training 2016” affect hospital dentists? DCTs in oral surgery are the ones most likely to see a substantial change.

Though their base salary will increase, the banding supplement paid for out of hours work will be greatly reduced. OS DCTs often work inside OMFS units and hence provide a lot of out of hours cover.

On the old contract, many DCTs working in OMFS units would have been receiving 50% banding on top of their salary due to the significant number of antisocial hours worked on-call.

This banding has now been reduced to between 3 and 10% on top of their base salary for work outside of “normal working hours”.

Having said this, the new contract should benefit dental specialty trainees. With no on-call commitments, the changes mentioned above are of little consequence, and their salary too, should see an increase.

Current trainees on the old contract with a fixed-term may be in the frustrating position of having new junior colleagues receiving a higher salary than them.

A potential negative relates to the change in “normal working hours”.  This could mean, depending on local arrangements, that trainees could potentially be expected to work evenings and Saturdays as part of their standard timetable with no, or in some cases, little extra pay.

There have been negotiations between the BMA and the Department of Health regarding the consultant contract and it would seem likely that any significant changes captured in the trainee and consultant contracts would be eventually replicated in the Staff and Associate Specialist (SAS) grade contracts.

Robbie Williams, Specialty Dentist in Oral Surgery & Clinical Fellow in Oral and Maxillofacial Surgery

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Help us be the voice of the profession

At the 2016 British Dental Conference and Exhibition, you told us that the voice of hospital dentists was not getting heard enough, so we are offering you a chance to discuss your views and share your experience.

We’d love to hear your views: please give feedback on our articles by tweeting @TheBDA, using the hashtag #youngdentists – if you’d like to write an article for our next e-newsletter, please email us.

 

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