17 June 2016

Next Thursday Britain goes to the polls to make one of the important political decisions in modern history. Whether or not to leave the European Union has dominated the news channels, papers and dinner table conversation for months with countless arguments, most sensible, some not so, being made on both sides of the campaign.

This is also true within the world of dentistry, a recent survey by the Dental Tribune1 found that more than 55 per cent of dentists intended voting for Britain to remain in the EU, while 44 per cent were in favour of a Brexit.

Dentistry is a profession which often is at the forefront of trends, it innovates, evolves and matures to whatever circumstances it faces. We therefore thought it would be a good idea to get a dentist's professional view on what effects leaving the EU may have on a dentist's day to day work.

We sat down with Dr Ben Atkins, Oral Health Foundation Trustee and principal dentist at Revive Dental Care, to get his view on how leaving the EU will affect dentistry.

Q. How will leaving the European Union affect NHS dental services?

We cannot say for sure as everything is hypothetical, but one of the major impacts we could foresee would be a change in where dentists working within the UK come from.

There are over 40,000 registered dentists in the UK and of this 17 per cent, almost 7,000, are trained outside the UK in the European Economic Area2. This is a huge proportion of working dentists that may not be able to be filled with UK dentists in the short term. One thing which may happen is following similar employment criteria as the Australian or Swiss points method which assesses the skills of worker and see's if it is beneficial for them to work in the UK.

A negative impact to leaving the EU may be a reduction in access to NHS dentistry, if overseas dentists practicing in the UK are required to leave or staffing levels fall short due to a lack of quality dentists entering the country. But I initially would expect nothing to happen and a grand fathering clause.

An issue that often goes unacknowledged is that regarding the possibility, though remote, of returning expats. According to the United Nations there are approximately 1.3 million British expats currently living in the EU3.

Some sources suggest expats could be barred from EU healthcare if the UK leaved the UK and they may be forced to return to the UK for healthcare treatment, if this turns out to be the case what are their dental needs?

Potentially these could be very high due to their age, i.e. an increase in the heavy metal generation (those aged between 30 and 65 who have retained much of their natural dentition but with high levels of dental disease treated by fillings and other restorations), and the level of care they have received in other countries.

From an industry perspective there could potentially be an increase cost for dental materials, which are often manufactured abroad. This puts a real strain on dental services and a possibility of passing on some portion of this cost onto the patient.

Q. How will leaving the European Union affect private dental services?

The UK private dentistry market is very strong and continually growing, I do not envisage leaving the EU to have too much of an impact on this. Apart from the potential impacts highlighted above.

In the long term, there is the potential for a positive effect on private dentistry if we do leave the EU. This would be due to a possible decrease in access to NHS dental care and more people turning to private as their option. But we have to make sure this does not become detrimental to the health and wellbeing of patients.

Q. What affect will leaving the EU have on European dentists practicing in the UK?

I can't see there being much change, due to the NHS relying heavily on EU dentists. I envisage the government will have to allow for workers traveling and qualifying from other countries to have opportunities to continue working in the UK.

A Brexit may increase the need for more vocational training places to be made available in the UK to ensure staffing levels and quality of practice are maintained.

Within dentistry we do use EU dental nurses, who I have only had the experience of hard working members of the team, often very proactive. Again I would expect a grand fathering clause to allow to work over here.

Dental teams in the UK are increasing and diversifying so if we were to loose dentists, this may be more of an opportunity for hygienists and therapists to increase take on more responsibility and take these roles over.

Q. What affect will an EU exit have on patients?

I don't think that it will be an immediate threat. As I mentioned in the long run access to NHS dental services may be impacted if staff levels are hit and they will have to turn to private practices.

One thing we can be sure of is that patients will continue to receive the same high level of service and quality dental work as they do now.

In the UK currently dentistry accounts for only 3% of the total health budget and like rest of healthcare this is facing being cut even further. Cuts that mean NHS dental practices cannot financially cope with, ultimately becoming potentially detrimental to their patients.

Will saving money we pay to EU by leaving mean more investment into NHS dentistry? Possibly but this is sheer speculation and certainly no guarantee, some of the figures banded around on savings vs costs currently make it a very dark art.

Whether we stay in or come out, there is an urgent need for more funding of NHS dentistry so there can be greater access to dental services for people in need of basic levels of care.

Q. Will there be an impact on dental education if the UK leaves the EU?

Yes, I believe there may be. As mentioned there is the potential for the need to increased places for vocational training of non-UK qualified dentists and other members of the dental team. They may be required to have a year or two of vocational training before they are permitted to work in NHS dental services. This could potentially improve their ability to work within the UK systems and therefore provide a better level of care for patients.

Leaving the European Union has huge potential to make some big changes to the day to day work of those practicing dentistry in the UK. The industry could flourish or be left horribly-under resourced if we do choose to leave. We have to look first and foremost on the impact that it will have on patients and it could indeed mean EU nationals leaving the UK or British people returning do not know what will happen. The balance here is simply unknown.

Private dentistry will probably be fine either way but NHS dentistry remains on a dangerous tipping point, and this could put it over the edge, whether we stay in or out, this cannot be ignored either way.