Development and retention of the dental workforce: findings from a regional workforce survey and symposium in England.

BACKGROUND: To help promote a flexible and sustainable workforce in dentistry, it is necessary to access accurate and timely data about the structure and nature of the evolving dental team. This paper considers the results and learning from a region-wide dental workforce survey conducted in one area of Health Education England and how the team has changed since the last survey a decade earlier. METHODS: A mixed-methods approach comprised two phases. In Phase 1 a customised workforce questionnaire was sent to all dental practices registered with the Care Quality Commission in the North East of England and North Cumbria in March 2016. Findings then informed Phase 2, a regional symposium held in October 2016, where interactive workshops generated qualitative data that elaborated on factors influencing workforce development. RESULTS: Of 431 primary dental care practices identified, 228 questionnaires were returned - a 53% response rate. The largest professional groups were dental nurses (n = 1269, 53% by headcount; 50% of fte) and dentists (34% by headcount; 42% by fte), though there had been increases in numbers of all staff groups over the decade, which was most marked for dental therapists (from 1 per 39 dentists to 1 per 8 dentists). The dental team predominantly fell into 'younger' age groups (< 46 years age), with evidence of a significant increase in the number of dentists reporting part-time working in a practice since the last survey. Around one third of dental practices reported employing dental nurses with additional skills (n = 74, 32.5%) or dental therapists (n = 73, 32%), and nearly half employed a dental hygienist (n = 104, 46%). However, there was considerable variability in whether these staff actually carried out the range of skills within their scope of practice. Factors shaping workforce development were identified as, the national context, loss of expertise, patients' health needs and expectations, surgery premises and financial constraints. CONCLUSIONS: The composition and work patterns of the primary care dental workforce have changed markedly over the last decade, though utilisation of skill-mix continues to be constrained. Consideration of factors determining career progression of dentists and dental care professionals is needed to optimise a sustainable future workforce.

Psychology of behaviour change is key to effective oral health promotion.

Data sourcesAMED, CINAHL, Cochrane Library, Embase, Medline, PsycINFO, PsycARTICLES, ScienceDirect, SocINDEX, ASSIA, Social Policy and Practice, HMIC (Health Management Information Consortium), The Knowledge Network, Intute, MedNar, Copac, EPPI-Centre, EThOS, OpenGrey and TRIP databases. Searches were limited to publications in the English language published after 1994.Study selectionStudies set in general practice that investigated promoting good oral health in adult or child patients were considered. Study quality was assessed using NICE public health guidance checklists.Data extraction and synthesisStudies were grouped according to the evidence they offered in relation to the research questions and key findings and themes identified. No meta-analysis was conducted. Qualitative studies underwent thematic analysis. The evidence was synthesised after considering the studies' homogeneity, quality and applicability and studying the evidence tables.ResultsForty-four studies reported in 52 papers were considered. Fifteen studies were randomised controlled trials (RCTs), two cluster RCTs and one controlled trial. Five quasi-experimental studies, two before and after studies without controls, three surveys, 11 qualitative studies, three mixed methods studies, one audit and one pilot study were included.The studies were very heterogeneous; the quality of reporting highly variable with many using patient reported behaviours rather than objective measures. Follow-up periods were also short. Narrative summaries of psychological and behavioural models, verbal advice, written advice, other methods of conveying advice, message content, sender characteristics, receiver factors, 'framing' of advice, barriers and facilitators and patient satisfaction were provided.ConclusionsThe results of this review suggest that the psychology of behaviour change is the key to oral health promotion, and greater emphasis on teaching oral health professionals about health psychology would make oral health promotion in the dental surgery more effective.