Will expanding dental school places improve access to NHS dentistry?

Who gets the opportunity to study dentistry – an AI-proof career with high employment and a good income?

Admissions are sometimes characterised as a straightforward assessment of academic attainment. In practice, schools consider much more than grades. At a recent Dental Schools Council Admissions Committee meeting, external stakeholders heard about the extensive work schools undertake to widen participation, including contextual admissions and assessments of applicants’ understanding of dentistry as a profession serving patients and the public, alongside their values and suitability for the profession. Admissions leads are cognisant that their choices help shape the future profession.

Meanwhile, DSC’s preliminary analysis of geographical access to dental education suggests that some areas send far fewer students into dentistry relative to their 18-year-old population. These areas also tend to have a more socioeconomically advantaged intake. In some communities, geographical inequalities in access to university overlap with health deprivation, educational disadvantage and low participation in the dental and wider NHS workforce, leaving fewer opportunities for young people to meet dental professional role models. The clustering of these factors makes geographical inequalities particularly challenging to address through admissions measures alone.

Dentistry can provide an important route for social mobility. However, we should be cautious about expecting admissions processes to predict where graduates will choose to practise years later, or assuming that students from disadvantaged backgrounds will necessarily be more likely to serve disadvantaged communities. Financial pressures may also constrain their career choices.

Instead, the DSC and its stakeholders should focus on widening opportunities to study dentistry and creating the conditions in which working in underserved areas remains an attractive option.

Where students train and where graduates practise

There are good reasons to consider geography when expanding dental education. Dental schools provide patient care as well as training, and can contribute directly to access to services in their local areas.

However, training in an underserved area does not necessarily mean graduates will remain there. Where students come from, the clinical settings and patient populations they encounter during training, their professional connections and the attractiveness of local practice opportunities after graduation can all influence their eventual choices.

Addressing geographical inequalities in access to dental education and dental care therefore requires more than allocating additional places to particular locations.

Dental schools are already pursuing measures to widen access to education and improve access to healthcare. These include outreach initiatives, contextual and geographical admissions measures, and placements in primary care, community and underserved settings.

With additional student places and appropriate capital funding, there is also scope to explore distributed and satellite models of dental education. These could bring dental education and patient care closer to more communities while retaining a critical mass of dental educators and specialist expertise.

No single intervention is likely to address geographical inequalities. A combination of educational opportunities, training locations and incentives for graduates will be needed. DSC is eager to work with governments and other stakeholders to identify which approaches are most effective.

Who is responsible for improving access?

Universities cannot reform NHS dental contracts or determine the financial incentives graduates face when choosing where and how to practise. Equally, government departments responsible for allocating training places do not deliver dental education or necessarily have the same understanding of factors affecting student progression.

Governments and dental schools therefore need to agree what workforce expansion is intended to achieve, share data to understand students’ journeys from application through to professional practice, and evaluate interventions using sufficiently large datasets. This should include examining how educational opportunities, training experiences and financial incentives affect where graduates eventually practise.

Dental schools bring expertise in education, admissions and training the future workforce. If the UK chooses to train more of its dental workforce domestically, there are talented applicants who want these opportunities and the prospect of fulfilling careers in dentistry.

The challenge now is to create the places, funding and working conditions that can deliver for patients.