Improving the sustainability of the dental workforce in Cumbria: a mixed methods study

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Background Patients are increasingly unable to access NHS dental care in the UK. This is more marked in rural and coastal communities, where challenges of attracting and retaining dental professionals contribute to the problem. However, despite being a well-recognised issue, there is relatively little research to guide meaningful interventions in under-served locations. Accordingly, this study sought to examine challenges to the sustainability of the NHS dental workforce in one remote and rural area of the UK and identify opportunities to improve recruitment and retention. Methods Staff working in primary care dentistry across Cumbria were invited to complete a survey that asked what had attracted them to the region and about any intentions to change their working pattern, to leave dentistry, or the region. Factors affecting workforce sustainability and ideas for change were explored in workshops held at a regional symposium. Results Survey responses (n=136 across staff groups, including 40 dentists) showed that 70% (n=90) of respondents (85% of dentists, n=40) were intending to change their working pattern within 5 years, whether by reducing their working hours (n=50, 38%), change the NHS/private mix (n=36, 26%) or leave their current job for another post or further training in dentistry (n=41, 30%). Thirty-two percent of dentists (n=15) were planning to leave dentistry altogether. Free text responses suggested ‘personal’ (including family, quality of life, finance) and ‘professional’ factors (including career development, job satisfaction) influenced plans. Workshop data (20 dentists, 10 nurses/practice managers, 8 other stakeholders) identified themes relating to the rural community, as well as educational systems supporting entry to a dental career and enabling career progression. There were also profession-related systems that had financial impact at a local level. Potential interventions included bespoke marketing strategies, education and training initiatives to support local populations enter dentistry, host undergraduate placements and promote career development. Conclusions The sustainability of the dental workforce in Cumbria is at risk. Locally-led interventions should seek to capitalise on the strengths of the geography and create a positive learning experience that builds a community of practitioners. National solutions will require financial investment and educational reform to bring about effective change.