Trainee dentists benefit from taxpayers' cash, it's only fair they work for the NHS

Dentists could be banned from ditching NHS commitments for more lucrative work in the private sector under plans to tackle shortages, Rishi Sunak has said.

Millions of people have struggled to access the services amid an exodus of staff dissatisfied with funding and pay.

Recent health service data showed 23,577 dentists performed NHS work in 2022-23, down by almost 700 on the previous year.

The Prime Minister was questioned about the problem as he unveiled the NHS Long Term Workforce Plan. It sets out measures to recruit 300,000 extra healthcare staff and slash reliance on overseas and agency staff.

Asked if more dentists should work in the NHS rather than the private sector, and whether the plan would address this issue, Mr Sunak said: “The simple answer is yes and yes.”

READ MORE: Sunak to launch ‘largest expansion in training and workforce in NHS history’

Handcuff

He told a Downing Street briefing it was “reasonable” to force recently qualified staff who benefit from subsidised training to work for the NHS.

He added: “Around two-thirds of dentists after they finish that speciality training end up not doing work in the NHS. It may be that the appropriate thing to do is to introduce a tie so that people are performing more NHS work after they qualify.

“They’ve benefited from a very significant subsidy from the taxpayer worth hundreds of thousands of pounds. And that seems a reasonable approach.” Mr Sunak said reports of doctors leaving for better paid jobs in Australia were “not as widespread…as people assume” and the same approach was not needed for them. But the British Dental Association said the Government should not “handcuff the next generation to a sinking ship.”

The group’s chairman, Eddie Crouch, said: “Ministers need to make the NHS a place young dentists would choose to work.

“Seeing the detail, nothing changes our view that Government is trying to fill a leaky bucket. It’s an exercise in futility – training more dentists who don’t want to work in the NHS.”

The landmark plan, published yesterday, also warned that the health service had “relied too much on temporary staff.”

It said the proportion of workers recruited from om abroad will drop from almost a quarter to around 10 per cent in 15 years. And use of expensive temporary staff will be cut from nine to five per cent within a decade.

NHS chief Amanda Pritchard said: “We’ve relied on the skills and dedication of staff who came here from the four corners of the globe to care for patients, and there will always be a place for them in the NHS. But demand for healthcare workers fo is increasing and will continue to increase across the world, so doing nothing is not an option.”

The bill for bank and agency staff soared due to the pandemic to £8.1billion in 2021-22. Reducing their use is expected to save £10bn between 2030/31 and 2036-37. Ms Pritchard said the NHS would make “the boldest set of changes for workforce” in its history to increase home-grown staff and expand routes into the profession.

Record numbers will join the ranks following a doubling of medical school training places to 15,000 a year by 2031/32. GP training places will increase by half to 6,000 in that time, and places for adult nursing will almost double to 38,000.

Trainees will be allowed to start working on wards and in practices sooner, and the NHS will work with regulators to explore how training can be shortened while meeting the same standards.

The health service will also make more use of newer roles including physician and nursing associates, who receive training to work alongside more qualified staff.

By 2036/37, more than 10,000 physician associates and 64,000 nursing associates are expected to be working. Some medical leaders have cautioned against “mission creep” in the use of non-doctor roles. Dr Naru Narayanan, of the Hospital Consultants and Specialists Association, said associate professionals and advanced practitioners were an asset but “must not be seen as a shortcut or silver bullet for patient care”.

However, Mr Sunak insisted boosting their numbers would allow the most qualified staff to “focus on patients with the most complex needs.” The £2.4bn plan also summarised the challenges posed by the growing and ageing population.

Life expectancy has increased by 13 years since the health service was founded in 1948 and the number of people aged over 85 is estimated to rise by 55 per cent by 2037. Without action, the NHS staffing shortfall could soar from around 112,000 now to 360,000. The PM said governments had “ducked” the workforce challenge for decades and “overcoming this won’t be quick or easy.”

He went on: “It’s only possible because of the difficult decisions we’re taking elsewhere to cut the debt and by prioritising the NHS there will be other things that we can’t afford. But the NHS is too important. So we’re making the tough calls to protect the long term future of the NHS and this country.”

The Royal College of Physicians said the plan was “an important first step towards a more sustainably resourced NHS.” The Royal Pharmaceutical Society in England said: “How this plan is put into practice, backed by long-term funding, will be key to its success.”

Key points of NHS overhaul

• To cope with the ageing population there will be 60,000 doctors, 170,000 more nurses and 71,000 more allied health professionals in place by 2036/37.
• The NHS will also retain 130,000 extra staff.
• A total of 22 per cent of NHS staff will be trained via apprenticeship schemes by 2031/32, allowing opportunities for people from underserved communities to join the NHS.
• It pledges 2,000 medical degree apprenticeships by 2031/32.
• More NHS staff will be trained domestically, which will mean it can reduce reliance on international recruitment and agency staff.
• This will mean that in 15 years, only nine to 10.5 per cent of the workforce will recruited from overseas, compared with nearly a quarter now.
• By contrast, in 2021, 50 per cent of doctors were international medical graduates and in 2022/23 around half of new nurses were trained overseas.
• Since 2017 there’s been a two per cent increase in UK-trained medical graduates entering the workforce – compared with 121 per cent of those trained overseas.
• Mental health staff across primary and community care will go up by 73 per cent by 2036/37.
• Current shortfalls in mental healthcare nursing are of ‘particular concern… impacting on patient safety and quality of care’.
• Retired doctors will be brought back into the service via an NHS Emeritus Doctors Scheme.
• Technological innovations will be introduced including AI and robot-assisted surgery.
• The plan is ‘predicated on access to social care services remaining broadly in line with current levels – or improving’. It says the NHS and social care are interdependent, so if the plan is to succeed capacity across both must increase.
• It also depends on a ‘sustained increase in capital investment in the ageing NHS estate’ and ‘investment in digital infrastructure throughout the NHS’.

Comment by Richard Murray

This plan could well be a landmark moment in NHS history.

It combines a major increase in training places alongside renewed efforts to retain staff once they have qualified.

It also adds proposals to reform training and the skills of staff, so that they provide value-for-money for the taxpayer and equip workers for the evolving needs of patients and changing technology.

The plan holds the potential to be a long-term answer to the NHS workforce crisis. So where, if anywhere, is the catch?

Firstly, this all needs to be delivered and it is a large agenda at a time when the NHS is already deeply stressed. It must not get squeezed to one side by the immediate challenge of running the service.

Secondly, this all needs to be paid for and the biggest cheques will have to be found by the next government (and the ones after).

Thirdly, it builds on a number of optimistic assumptions that may well prove unrealistic, not least a big turnaround in productivity growth. It is welcome, then, that the plan also commits to a two-yearly refresh.

This would be a chance to look again and test the progress that has been made.

If future governments commit to this series of updates, then it may well prove to be a solution for the repeated workforce shortages that have plagued the NHS since its inception.

One way to give greater certainty that future governments won’t just ignore these updates would be to take forward an idea once proposed by Jeremy Hunt, just before becoming Chancellor – and that idea was to place a commitment to renewing NHS workforce plans into legislation.

‘Many junior docs are not behind 35% pay bid,’ writes Sam Lister

Health Secretary Steve Barclay says even some junior doctors believe they are asking for too much with a 35% pay claim.

Repeating his call for compromise by strikers, he said: “I think many will recognise that is not something that is fair and reasonable.

“So, there has got to be movement on both sides.

“We have shown that can be done through our negotiations with the paramedics, the nurses, the porters, the cleaners, 1.3 million people – the biggest staff group within the NHS – where a deal was reached.”

Yesterday health chiefs echoed No10’s warning to junior medics not to take on private sector work during their industrial action.The British Medical Association said members will be allowed to earn extra money by doing so during walkouts.

But Professor Sir Stephen Powis, NHS Medical Director for England, said: “They have a professional responsibility to manage emergencies and if they are providing a Christmas day level of cover in the NHS then they should not go beyond that in any other setting.

“Clearly they have a duty to look after patients but they should not do additional work beyond that.”

Junior medics are due to strike for five days this month, from July 13 – the longest in NHS history.