Interview: “We need to consider carefully how to plan for the future workforce”

Dental Tribune Online: In the EU referendum, the majority of Brits voted for the UK to leave the EU. What impact could an upcoming Brexit have on the British health care sector and dentistry in particular?
Edward Sinclair: To give an exact and short answer to your question would be difficult. I would say that in the short term very little will change. After that it will really depend on the outcome of any negotiations. One would hope that there would be minimal disruption to the existing systems.

One of the areas that could be affected is workforce. At the moment, the UK has many workers from other EU countries who fall under the freedom of movement arrangement and benefit from mutual recognition of their professional qualifications. One of the reasons the leave vote triumphed was because a lot of people seemed unhappy with the whole concept of freedom of movement. In the future, it is possible that it will be restricted in some way. What we might end up with is something like the arrangement in North America where professionals are able to come to the UK if they have a job offer.

Sam Shah: There is a whole myriad of legislation that will need to be unravelled, reinstated or recreated. Those responsible for the workforce will need to consider both the existing EU migrant workforce and various UK residents that are currently training in other EU countries. They will probably be planning to return to the UK in the hope that their qualifications are going to be recognised.

As a nation we also benefit from products and material being manufactured elsewhere in Europe that get imported in the UK for use in dentistry, for example in the fields of implant dentistry or endodontics. If there are going to be changes, there will need to be trade agreements in place between the EU and the UK. Inevitably this is likely to have an impact on price which in turn will have affect supply and demand.

Last year alone, more EU dentists registered with the General Dental Council than the number of dentists that graduated from UK dental schools. How dependent is dentistry on the migrant workforce and would the UK be able to cope with the potential loss of this workforce through stricter immigration regulation?
Shah: The workforce is an important aspect of the way dentistry as a clinical service operates. There will be implications regarding the workforce because at the moment we have the benefit of both the EU workforce combined with the UK workforce which provide us with stable services to meet the needs of our population.

The likelihood is that future barriers to movement will have an impact on supply and demand within the workforce. This means that for us in the UK we need to consider carefully how to plan for the future workforce because our modelling has been based on what happened over the last 10 to 15 years. The implications on dentistry will not be seen for some years to come and it will probably take at least 5 to 10 years before we see any real impact from the Brexit.

Sinclair: There was a time 15 years ago when it was more difficult for people in rural areas to find an NHS dentist. Recently, that has become less of a problem and this could be because a lot of EU dentists were willing to work in those areas.

Whilst the economic problems of the eurozone remain, there will still be demand from dentists from EU countries to work in the UK. We know that certain countries like Spain and Romania produce far more dentists than they may actually need. Even if we erect barriers to entry, the UK is still an attractive place for postgraduate training or just to work.

In addition to immigration, one of the topics that leavers put forward in the referendum was regulation. To what extent is the dental industry in the UK regulated by EU laws?
Sinclair: As an example, the Health and Safety (Sharps Instruments in Healthcare) Regulations 2013 became UK regulation in 2013. This originates from EU Council Directive 2010/32/EU on the prevention of sharps injuries in the hospital and healthcare sector. For something like this it would now be up to the UK legislature to decide upon. It’s important to note however, that there are some countries in the EU that have a much lower regulatory burden. I think it was a distortion in the run-up to the referendum to state that leaving the EU would somehow reduce the amount of red tape.

Shah: You also have to consider other European rules for example on ionising radiation or the transfer of clinical images. The reality is whether we are part of the EU or not, there will need to be something whether it is a policy or regulation that addresses matters such as these. It is unlikely that the State would just dismantle the rules without any replacement because there have to be some safeguards in place for society.

The type of regulation that dentists may be more familiar with are EU competition laws. The UK has its own version of competition laws in any event. There is a chance that we will need an alteration of these rules however they will probably still exist. At the moment, I am yet to be convinced that any EU regulation would not continue to apply in some form if the UK does continue to leave the EU.

Do you see any benefits of the Brexit for dentistry in the UK?
Sinclair: There may be an opportunity to standardise English language requirements, if we start recruiting more heavily from countries where English is the primary language of instruction. It may be argued that it could be easier to introduce people to the workforce and keep standards at a consistent level, but this is only speculation.

Shah: From a competition point of view, there are potential benefits for local workers who through the influx of dentists and other professionals might have been less willing to work at a specific rate or found accessing work more competitive. At the individual level, some of the people in our existing workforce may be more likely to find work post-Brexit but I think immigration of professionals will continue provided the UK remains an attractive place to work for people from the EU.

What aspects do you think will be important to consider in the upcoming negotiations with the EU regarding dentistry?
Sinclair: We know that the NHS (not just dentistry) really benefitted from the flexibility of being able to recruit from other EU countries, so ideally negotiators want need to establish a similar arrangement, even if it is a special visa for health care workers to come to the UK or work in EU countries. That seems to be a sensible thing to lobby the government on so that we do not lose that flexibility.

It would not have a huge effect on general immigration either because health care workers are only a small portion of net immigration. The government does not have to fear that it would distort the figures too much and it would allow this very important section of the workforce to remain in the country. I expect that the public would support that, whichever side they are on in the whole debate.

Shah: There certainly does need to be some sort of trade agreement for medical devices and health care products. Drugs will probably need to fall into a special category as we know a lot of medicinal drugs already move back and forth across the EU.

Similarly there will need to be some rules for things as basic as data sharing between the UK and EU states, particularly in relation to offsite data backup that often uses sites in other parts of the EU where space is often more affordable.

One of the most important aspects is continued collaboration in respect of the public health agenda, which includes oral health. Broader public health initiatives do not necessarily need a formal agreement as it is unlikely that any single EU state will be affected. However, it is more likely that the region as a whole will be affected by issues relating to both general disease and oral diseases. There will need to be continued collaboration between dental and oral policy makers across the European region.

Thank you very much for the interview.