Valuing and retaining the dental workforce: a mixed-methods exploration of workforce sustainability in the North East of England

Abstract

Background
NHS dentistry is experiencing significant recruitment and retention challenges, particularly in rural, coastal, and deprived urban areas. Issues have been exacerbated by the Covid-19 pandemic, leading to unequal distribution of dental professionals across UK geographies. Despite workforce policy initiatives, issues persist. This study explores factors influencing workforce sustainability in the North East of England – an under-served region of the UK.

Methods
Forty-six participants, including 30 dentists, 3 dental care professionals, and 13 managers, contributed to this study. Four focus groups were held at two events in July 2023 – one in the north of the region, and one in the south to enable broad stakeholder engagement and reflect the different geographies within the region. These groups generated qualitative data to elaborate on the factors influencing workforce sustainability and ideas for change. Analysis involved a codebook approach to thematic analysis.

Results
Thematic analysis identified four key factors influencing workforce sustainability: careers, collaboration, costs, and contentment. Career development in a supportive learning environment was essential for professional growth and retention, yet systemic barriers hindered progression. Collaboration, both within dental teams and across regulatory bodies, played a vital role in improving job satisfaction and service delivery, but fragmented communication remained a challenge. Financial pressures, particularly rigid NHS contracts and inadequate remuneration, emerged as significant concerns impacting recruitment and retention. Contentment was shaped by work-life balance, professional recognition, and the ability to provide high-quality care without excessive bureaucracy. These systemic challenges collectively contribute to workforce instability, particularly in the North East.

Conclusion
Findings highlight critical systemic barriers that threaten workforce sustainability in NHS dentistry. Addressing career progression pathways, improving collaboration, reforming contracts, and enhancing professional support systems are essential for sector stability. Without coordinated action from employers and policymakers, NHS dentistry will remain unsustainable, necessitating urgent interventions to support workforce retention and service provision.

Full text

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Stelling et al. BMC Health Services Research (2025) 25:672
https://doi.org/10.1186/s12913-025-12803-9 BMC Health Services Research
*Correspondence:
Gillian Vance
gillian.vance@newcastle.ac.uk
1School of Medicine, Newcastle University, Newcastle, UK
2School of Dental Sciences, Newcastle University, Newcastle, UK
Abstract
Background NHS dentistry is experiencing signicant recruitment and retention challenges, particularly in rural,
coastal, and deprived urban areas. Issues have been exacerbated by the Covid-19 pandemic, leading to unequal
distribution of dental professionals across UK geographies. Despite workforce policy initiatives, issues persist. This
study explores factors inuencing workforce sustainability in the North East of England – an under-served region of
the UK.
Methods Forty-six participants, including 30 dentists, 3 dental care professionals, and 13 managers, contributed to
this study. Four focus groups were held at two events in July 2023 – one in the north of the region, and one in the
south to enable broad stakeholder engagement and reect the dierent geographies within the region. These groups
generated qualitative data to elaborate on the factors inuencing workforce sustainability and ideas for change.
Analysis involved a codebook approach to thematic analysis.
Results Thematic analysis identied four key factors inuencing workforce sustainability: careers, collaboration,
costs, and contentment. Career development in a supportive learning environment was essential for professional
growth and retention, yet systemic barriers hindered progression. Collaboration, both within dental teams and
across regulatory bodies, played a vital role in improving job satisfaction and service delivery, but fragmented
communication remained a challenge. Financial pressures, particularly rigid NHS contracts and inadequate
remuneration, emerged as signicant concerns impacting recruitment and retention. Contentment was shaped by
work-life balance, professional recognition, and the ability to provide high-quality care without excessive bureaucracy.
These systemic challenges collectively contribute to workforce instability, particularly in the North East.
Conclusion Findings highlight critical systemic barriers that threaten workforce sustainability in NHS dentistry.
Addressing career progression pathways, improving collaboration, reforming contracts, and enhancing professional
support systems are essential for sector stability. Without coordinated action from employers and policymakers, NHS
dentistry will remain unsustainable, necessitating urgent interventions to support workforce retention and service
provision.
Keywords Workforce, Retention, Workforce sustainability, Dentistry, Dental, Value, Values
Valuing and retaining the dental workforce:
a mixed-methods exploration of workforce
sustainability in the North East of England
HeidiStelling1, MeganBrown1, BryanBurford1, PaulBlaylock2 and GillianVance1*
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Stelling et al. BMC Health Services Research (2025) 25:672
Introduction
NHS dentistry is under threat. Across the UK, there are
wide-ranging recruitment and retention issues for both
dentists, and dental care professionals (including dental
nurses, hygienists, therapists, and technicians). ere are
a variety of challenges which have led to an unequal dis-
tribution of dental professionals, with rural and coastal
areas being particularly under-served [8]. Workforce
shortages have a negative impact on patient care, through
reduced access to care and longer wait times for treat-
ment [7]. In deprived areas, where patients’ dental care
needs are likely to be higher, the loss of NHS dental care
is particularly damaging [8, 19].
Recently, there have been policy changes intended to
address the dental workforce crisis. In 2021 Health Edu-
cation England's Advancing Dental Care (ADC) Review
[10] recommended exible training pathways in den-
tistry, localised workforce development through appren-
ticeships, and aligning postgraduate training with areas
of the most signicant oral health inequalities. In 2023,
NHS England unveiled its Long-Term Workforce Plan
(LTWP; [14, 15]), which outlines a national strategy for
ensuring workforce sustainability, including within den-
tistry. e plan, which recommends increasing training
places for dentists, therapists, and hygienists, and tenta-
tively suggests developing a ‘tie-in’ period where dental
professionals would be required to spend a minimum
portion of their time delivering NHS care, is a step for-
wards, but questions remain about its practical applica-
tion, and feasibility in resolving the crisis.
Recently, retention has emerged as a priority issue.
A 2022 survey of 2,204 dentists revealed that 45% had
reduced their NHS commitment since the onset of the
pandemic [3]. is report also went on to reveal that two
thirds of practices have unlled dental vacancies, with
30% of these in remote, rural, or deprived communities
[3]. Further, attrition is aecting the entire dental work-
force – 39% of dental nurses have indicated wanting to
leave dentistry in the next two years [1].
Our own work [5, 12] has identied challenges to work-
force retention and suggested targeted interventions for
under-served areas. However, there is ongoing need to
understand the work experience of dental professionals,
in dierent roles and settings, in order to design work-
force strategies that meet eectively the needs of sta in
those communities.
The North East of England
e North East of England is a large, geographically and
socially distinct part of the country, but which contains
diverse contexts across the counties of Northumberland
and Durham, and the conurbations of Tyne & Wear and
Teesside. While it is contiguous with Cumbria, and some
areas share similar issues of remote and rural settings,
it also has very dierent urban and coastal settlements,
including former mining, shing and shipbuilding cen-
tres, and active commercial ports along its coast.
Indices of deprivation collated by the UK Govern-
ment [13], further illustrate the distinct context of the
North East. Based on income deprivation, of the 12
local authorities comprising the North East in 2019, all
but three were in the most deprived quintile, compared
to one of the six authorities in Cumbria. e North East
contained the most deprived, and the fth most deprived
local authorities in the country. In contrast, two of Cum-
bria’s local authorities, and none in the North East, were
in the least deprived quintile [17]. is highlights how the
North East deals with pronounced socio-economic chal-
lenges, especially in its urban centres, and particularly in
comparison to the more mixed urban–rural characteris-
tics of Cumbria.
Given this inter-regional diversity, the North East is an
ideal testbed for studying the dynamics of dental work-
force sustainability, and developing transferable recom-
mendations for changes in policy and practice. is paper
provides a companion to our earlier work in Cumbria [5],
exploring how challenges to recruitment and retention
are experienced in a dierent setting. As in the Cumbria
paper, our interest was in all sta working in dental pri-
mary care. is included all dental professions required
to be registered with the General Dental Council (GDC;
dentists, and dental care professionals (DCPs) including
dental nurses, dental hygienists, dental therapists, orth-
odontic therapists, dental technicians, and clinical dental
technicians), and non-clinical sta in support and mana-
gerial roles, such as practice managers and receptionists.
ese non-clinical roles are essential for the eective
running of dental practices, and so the eective delivery
of care.
e work on which this paper is based was commis-
sioned by Health Education England, which merged with
NHS England in 2023. It aimed to investigate the current
state of the multi-professional dental workforce in both
general and community dental services in the North East.
is paper addresses two research questions:
1. What factors inuence the career decisions of dental
professionals currently working in the North East?
2. What strategies may improve recruitment and
retention of dental professionals in the North East?
Methods
is study incorporated both an individual and practice
survey (Supplementary le 1 and 2) and focus group
component, with the complete results available in Bur-
ford et al. [5]. e following section presents only the
qualitative data obtained from the focus groups.
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Stelling et al. BMC Health Services Research (2025) 25:672
Data collection
Four focus groups were held at two events in the North
East in July 2023 – one in the north of the region, and one
in the south to enable broad stakeholder engagement and
reect the dierent geographies within the region. e
outline for the workshops is provided in Supplementary
le 3.
ese groups generated qualitative data to elaborate on
the factors inuencing workforce sustainability and ideas
for change. e ‘driver diagram’ (Supplementary le 4),
commonly employed in quality improvement practices
[16] served as a focal point for workshop discussions. e
research team provided facilitators and participants with
a copy of a blank driver diagram as a visual cue to focus
attention on the ‘drivers’, or causes, that might facilitate
or hinder the desired outcome of improving dental care
in the North East. In addition, the driver diagram directs
participants to consider strategies, or the solutions,
required to have a positive impact on identied drivers.
All members of the research team acted as facilita-
tors or co-facilitators, with co-facilitators taking detailed
notes regarding discussions and analytical thoughts. Dis-
cussions ranged between 55 and 67 min.
Analysis
Audio recordings were manually transcribed verbatim
to facilitate analysis. Braun and Clarke’s [2] codebook
approach to qualitative analysis was followed, a middle-
ground between highly structured analyses, and fully
exploratory methods. Our codebook approach allowed
us to organise data using a systematic structure but also
remain attuned and sensitive to new insights grounded in
our participants’ experiences.
Our codebook was created from codes utilised within
our previous 2022 Cumbria report [5], given the fact
this study builds on these previous ndings at a regional
level.. Researchers (HS, MB, BB, GV) collaboratively
applied the codebook to the data, allowing for its rene-
ment. Descriptions of each code were included to ensure
dierent researchers could code transcripts in similar
ways. ese codes are listed in full, with their corre-
sponding descriptions, in Supplementary le 5. To ensure
coherency and transferability of the codebook, two tran-
scripts were double coded, and outputs compared. e
codebook was used to organise all data, connecting it to
create a thematic narrative, and extracting relevant illus-
trative quotes. Results were discussed, agreed, and pre-
sentation nalised by all authors.
Reexivity
Our research team consists of experienced qualitative
and mixed-methods researchers and dental workforce
experts from Newcastle University. Our team includes
clinical academics, and academics with backgrounds
in medicine, medical education, dentistry, and work-
force policy. We are a mixture of genders and ages. We
acknowledge that our professional experiences and prior
research on workforce sustainability may have inuenced
our interpretation of the data. To this end, we held regu-
lar discussions to support reexive results interpretation
throughout analysis.
Quality
To enhance the transparency and completeness of our
study reporting, the Consolidated Criteria for Reporting
Qualitative Research (COREQ) checklist [20] has been
used. e COREQ checklist provides a structured frame-
work for supporting rigor in qualitative research and can
be reviewed in full in Supplementary le 6.
Results
irty dentists, 3 dental care professionals, and 13 man-
agers participated in our four focus groups (46 par-
ticipants in total). Four themes were generated by the
analysis to capture key ndings:
1. Careers: Career development, nurtured in a safe,
supported, and learning-focussed space, enables
professional advancement.
2. Collaboration: Working collaboratively improves
oral health outcomes, which in turn supports a
sustainable dental workforce.
3. Costs: Fair pay and contracts, guided by policies, play
a role in retaining dental professionals.
4. Contentment: Dental professionals’ satisfaction with
their jobs leads to a more sustainable workforce.
Participant quotes are labelled with focus group num-
ber (e.g., FG1), and participant number within the focus
group (e.g., P5).
Careers
Across professional groups, sta were motivated to
develop and learn. is learning was even more critical
against a backdrop of increasingly complex patient care
post-Covid-19. Cultures supportive of learning were pos-
itive driving factors towards workforce sustainability.
For example, practitioners described wanting to diver-
sify their skills and achieve more variety in their working
week.
FG1 P3: “…retention comes with variety and if you
haven't got variety, you're struggling. [It] goes back to
changes in NHS practice… you go in and you're just
doing amalgams or extractions, people don't want
that anymore.”
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Many felt strongly about the need to host undergradu-
ate students in general dental practices, noting how this
would benet the career insights of the student and could
stimulate interest in teaching amongst the sta.
FG4 P2: “Nurses would enjoy the variety of working
with a student.”
Similarly, being an Educational Supervisor for the
Foundation Dentist [FD] programme was viewed posi-
tively. However, the national recruitment process was a
source of concern. Being ‘allocated’ a Foundation Den-
tist removed the autonomy of practices around recruit-
ment. e autonomy to establish a team based on ‘t’ and
trust provided a solid foundation for a positive working
environment. e challenges of national recruitment
and poor sta allocation were highlighted, particularly in
relation to their disproportionate impact on dental prac-
tices as small businesses, where a single unsuitable hire
could jeopardise the practice's stability and success.
FG4 P6: “[National recruitment] could break your
practice... If I'm a hospital consultant and my
trainee is not very good when they've left, I'm still a
hospital consultant.”
Participants discussed additional barriers to the career
development of all professional groups. Many of these
related to practical issues, such as costs (of training, and
from loss of income in attending an event), and a lack of
physical space and time to facilitate best use of skill-mix.
FG1 P5: [ey (DCPs) have] additional skills that
can be used utilised. But I haven't got a room for you
to see patients to do oral health education. If I did, I
would pay you to do it. I physically don't have space.”
Participants expressed desires to create learning-focused
cultures, where open dialogue about mistakes, chal-
lenges, and improvement was encouraged.
FG4 P6: “We sat and we problem solved. And we
talked about your dicult cases. Which is great to
do, and that's fewer complaints and better dentistry
and everybody wins on that.. So it's a really positive
thing to do.”
Collaboration
Collaborations were central to enhancing the experi-
ence of dental professionals, shaping clinical practice,
and optimising care. is theme explores the nature of
collaboration, and its relationship with dental workforce
sustainability.
Participants identied the importance of creat-
ing strong professional relationships with other team
members. is was particularly critical for those new
to NHS dentistry or considering leaving it. Establishing
these connections was seen as essential in providing the
necessary support, guidance, and career development
opportunities to help retain sta. Measures that facili-
tated mentoring, open discussions about challenges, and
targeted professional development were viewed as key
to sustaining engagement and condence within the
workforce.
FG4 P6: “So what do I do if I've got a group of asso-
ciates who are really struggling to hang on to NHS
dentistry, I take them out to do that and I say, where
are your problems? How can I assist? How can I sup-
port? How can I give you that career development
support that you need?”
Some participants described the loneliness of working
in remote or small practices, and expressed a desire for
regional networking events that would encourage profes-
sional dialogue and social connection.
FG4 P5: “Attracting people away from the cities
where their comfort zone is, where their social net-
work might be and where their peer network is. And
if we had a more formal structure of professional
networking around [we] might be more attractive to
be able to help us recruit in those areas”
ere was a suggestion that a more collaborative rela-
tionship with commissioners and regulators built on
shared understanding and mutual respect would enhance
workforce sustainability. For example, improved lines of
communication between agencies (for example, NHS-
England and the Care Quality Commission) could dra-
matically reduce the administrative burden created
through duplication of documentation in NHS dentistry.
FG2 P4: “It just seems to be a lot of duplicate work
and nobody's sharing the information with each
other. So then we have to submit it again…You don't
have to do that if you're a private practice.”
Collaboration also extended to the public and ways of
changing negative perceptions of dentistry and oral
health. Many participants emphasised their willingness
to create meaningful, and important connections within
local communities and cited an example of how positive
an outreach education activity had been for a sta mem-
ber. However, these motivations were hindered by sys-
temic barriers (e.g., nancial constraints).
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Stelling et al. BMC Health Services Research (2025) 25:672
FG2 P7: “I went to a school the other day and it was
the best day of my life…[But] there's no funding for
it... It's all based around private dentistry, earning
the money, earning the money. ere's no commu-
nity. ere's no education.”
Costs
Funding issues – relating to nancial pressures, commis-
sioning, and contractual constraints – were a large focus
of discussions. ese factors were central to the opera-
tional viability of dental practices and the retention of
practitioners within the NHS.
e NHS General Dental Services (GDS) contract was
negatively perceived. One participant described a col-
league earning more money outside of dentistry, commu-
nicating a sense of unfairness about the current system of
renumeration.
FG2 P4: “I've got a dentist who worked full time and
has reduced her NHS commitment to not go and
work in a private practice. She's actually opened a
pizza restaurant and is earning more money through
the pizza restaurant than she is in, in dentistry.”
Commissioning was felt to be too restrictive, failing to
value health promotion. e current contractual frame-
work, with a pressure to deliver mandatory services as
Units of Dental Activity (UDAs), discouraged use of skill-
mix or any professional activities outside of direct patient
care. Participants described feeling like a “hamster on the
wheel” [FG1 P5] constantly chasing ‘UDAs’.
Additionally, contractual arrangements meant that
practices sometimes felt restricted in hiring Founda-
tion Dentists: they could not justify the space needed for
a Foundation Dentist when their UDAs did not count
towards practice targets. Practices accepted this was
short-sighted for workforce sustainability, but the imme-
diate pressures for the practice to survive outweighed
longer-term concerns.
FG2 P4: ”In my practice, I can't aord to have a sur-
gery given to an FD because of their UDAs, we have
such a high target their UDAs don't count towards
the targets. I couldn't aord to have an FD in there.”
ere was broad agreement that additional funding is
required to sustain NHS dentistry. While practitioners
may remain committed to NHS clinical care, practice
managers saw NHS business as being nancially non-
viable. ere was a clear tension between the provision
of NHS care and the functioning of a practice as a viable
business.
FG2 P4: “[I’m] pushing to say the practice cannot
continue as an NHS practice. Financially, it can't
do it. e accountants are telling us, the bank is tell-
ing us, I'm telling them, they're [practitioners] are
the ones who are telling me saying, no, we want to
stay NHS… I keep telling them that we're not charity
workers.”
Contentment
e multi-dimensional factors that contribute to, or
detract from, contentment, and the implication of these
factors for workforce sustainability are explored in this
theme. is section also explores the close relationship
between contentment and the decision to transition to
private practice.
Central to this theme was the recognition that living
and working in the North East oers a high ‘quality of
life’. Many felt this could be better promoted.
FG4 P1: “e North East is a great place to live and
work and we should acknowledge that… well sup-
plied with schooling, housing, interconnected trans-
port links…If we’re looking to enhance the workforce,
we should be selling that.”
ere was pride in working for the NHS, especially relat-
ing to the provision of continuity for patients and com-
munities. is pride was central to contentment and
fuelled practitioner resilience.
FG2 P4: “ey've seen those patients grow up from
being a child to an adult who's bringing their kids to
the practice now…if it was money orientated, they
would have jumped ship a long time ago.”
However, several barriers to job satisfaction or content-
ment were identied, including challenges in maintain-
ing work-life balance, lack of career opportunities in the
North East for practitioners’ family members, and not
feeling valued in the same way as other NHS sta.
FG2 P8: “I think people were quite put down during
Covid because dental nurses were not considered
part of NHS, because there were all these NHS perks
which was not available for dental nurses.”
In relation to private practice, many seemed defensive
regarding their engagement, and eager to express that
the primary incentive for transitioning to private prac-
tice was not always nancial. Rather, it was frequently the
desire to sidestep the bureaucratic burden of the NHS
and provide higher quality care for patients.
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Stelling et al. BMC Health Services Research (2025) 25:672
FG4 P5: “It's stick after, stick after stick after stick.
And as a practice owner you go, why am I putting
myself through all of this regulation when with one
simple manoeuvre I go, I'm not playing this game
anymore?”
Discussion
e North East presents unique challenges for the dental
workforce, with our ndings identifying multiple factors
inuencing recruitment, retention, and workforce distri-
bution. is discussion reects on these ndings, consid-
ering key implications for policymakers and employers.
ese new ndings allow for the development of recom-
mendations that build on our earlier dental workforce
work in Cumbria, which identied measures to improve
recruitment and enhance individuals’ sense of purpose
at work. is paper extends those recommendations by
oering a more in-depth analysis of retention, and focus-
ing on system-level solutions, which are necessary to sus-
tain NHS dentistry in the region.
Feeling valued as a professional
A key factor inuencing sustainability was the extent
to which dental professionals felt valued, both nan-
cially, and professionally. While job satisfaction and
career development opportunities are important across
all healthcare roles, these ndings suggest that in the
North East, where workforce shortages are acute, feel-
ings of being undervalued exacerbate attrition. Younger
dentists and DCPs were often demotivated because of
limited opportunities for progression, and the absence
of formal support programmes. is echoes our ndings
in Cumbria [5], where dental professionals felt isolated,
and wider literature showing high attrition rates among
young dental nurses, for whom progression opportuni-
ties are especially limited [9]. Importantly, these frustra-
tions contribute to challenges of workforce distribution,
as professionals opt to leave NHS practice for private
roles, or relocate to regions perceived as oering better
career prospects.
A signicant nding was the perception that NHS den-
tal professionals, particularly dental nurses, were not
fully integrated into the wider NHS workforce. Unlike
their counterparts in other NHS settings, many dental
nurses lack access to NHS pensions and other benets.
e impact of this as a barrier may be particularly pro-
nounced in the North East (indeed, this was not found
in the earlier work in Cumbria), given high levels of
income deprivation in the North East which may make
NHS employment benets critical. Some nurses there-
fore seek employment in hospital-based roles, or outside
the NHS altogether. Addressing these disparities requires
systemic change, including policy interventions to extend
NHS employment benets to all dental professionals and
ensure parity with other NHS roles.
Collaboration and workforce sustainability
Our ndings reinforce that a strong, collaborative team
culture is vital for retaining dental professionals. Partici-
pants described how mentorship and professional net-
working could mitigate feelings of isolation, particularly
for those working in smaller, remote practices. A lack of
regional networking opportunities was cited as a reason
for leaving NHS roles in the North East, with some pro-
fessionals relocating to more urban areas where stron-
ger professional support systems exist. While previous
research [9] has identied collaboration as a positive
workplace factor, our study highlights its direct impact
on regional workforce distribution – practitioners are
more likely to remain in NHS roles if they feel profession-
ally connected and supported.
Additionally, these ndings indicate that systemic col-
laboration – between dental professionals, commis-
sioners, and regulators – could alleviate some of the
administrative burdens driving workforce attrition. Par-
ticipants expressed frustration with duplicated regula-
tory processes, which increase workload and reduce job
satisfaction.
While specic administrative challenges have been
documented for international dentists navigating cre-
dentialing and licensing [6], and for international medical
educators where heavy administrative burden contribute
to work-life imbalance and burnout, negatively aecting
retention [18], the impact of varying administrative bur-
dens on retention within NHS dentistry has not yet been
explored. Consideration of processes and policy mea-
sures that streamline administration, reduce duplicative
regulatory requirements, and improve communication
could signicantly improve eciency and enhance job
satisfaction.
Financial pressures and workforce distribution
In relation to nancial considerations, our participants
reported a lack of exible commissioning and rigid con-
tract terms that contributed to feelings of being under-
valued. e NHS General Dental Services (GDS) contract
was frequently criticised by participants for discourag-
ing skill-mix utilisation and creating nancial pressures
on practices. While dissatisfaction with NHS contracts
is a widespread issue, these ndings suggest a direct
link between contractual rigidity and workforce distri-
bution. In the North East, where NHS dental contracts
are often seen as less nancially attractive due to socio-
economic factors, practices struggle to retain sta. For
example, some participants reported their practices
could no longer justify hiring Foundation Dentists due
to contract constraints, despite recognising that failing
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Stelling et al. BMC Health Services Research (2025) 25:672
to do so would have long-term negative implications for
workforce sustainability. ese nancial pressures con-
tribute to uneven workforce distribution, as practices in
deprived or rural areas struggle to compete with private
sector opportunities.
A shift towards exible commissioning models [14]
that recognise the diverse range of services provided by
dental practices, and support skill-mix, could signi-
cantly improve care as illustrated in Yorkshire and the
Humber, where exible commissioning led to an increase
in appointments and range of services oered [11].
Implications
Our ndings identify several important, practical recom-
mendations for policymakers and employers, as sum-
marised in Table1.
Limitations
With focus groups generally there is the risk that those
with strong opinions may be more likely to participate,
leading to potential self-selection bias. In this study,
where data collection was conducted at specic work-
force events, dental professionals with knowledge of and
interest in workforce issues, may have been overrep-
resented. eir views may not fully reect those of the
broader workforce. Additionally, the focus groups lacked
balance with only three DCPs, meaning that the inter-
ests and experiences of DCPs may be underrepresented,
although dentists and practice managers did present
DCP viewpoints.
e analysis did not attribute quotes to specic occu-
pations, making it dicult to link statements to pro-
fessional perspectives. However, the strength of this
study lies in the richness of our data, which presents
valuable insights into the experiences of dental profes-
sionals in the North East. e ndings are considered
transferable to other regions with diverse geographies
and demographics, given the participants'diverse cross-
professional backgrounds and observations consistent
with broader literature. Future research should focus on
exploring national applicability.
Conclusions
ese ndings underscore systemic barriers that jeop-
ardize workforce sustainability in NHS dentistry.
Strengthening career progression pathways, improving
collaboration, and addressing nancial constraints are
critical to retaining a skilled and motivated workforce.
Meaningful reform requires coordinated action from
policymakers, employers, and regulatory bodies to create
an environment where dental professionals can thrive.
Without urgent intervention, NHS dentistry risks contin-
ued workforce decline, further limiting access to essential
care for diverse communities.
Abbreviations
ADC Advancing Dental Care
CPD Continuing Professional Development
DCP Dental Care Professionals
FD Foundation Dentist
GDS General Dental Services
LTWP Long Term Workforce Plan
NHS National Health Service
PG Postgraduate
UDA Units of Dental Activity
UG Undergraduate
Supplementary Information
The online version contains supplementary material available at h t t p s : / / d o i . o r
g / 1 0 . 1 1 8 6 / s 1 2 9 1 3 - 0 2 5 - 1 2 8 0 3 - 9.
Supplementary Material 1.
Supplementary Material 2.
Supplementary Material 3.
Supplementary Material 4.
Supplementary Material 5.
Supplementary Material 6.
Acknowledgements
We are grateful to a number of people who have been instrumental to
the success of this project. In particular, the professional perspectives of
Table 1 Recommendations for policy and practice, based on this study’s ndings
Recommendation Detail Theme Mapping
Structured mentorship Consider introduction of accessible opportunities for mentorship, especially for early career profes-
sionals. Formal support, including support for career progression, may help overcome feelings of
demotivation amongst younger dental professionals
Collaboration, careers
Policy changes to NHS
employment benets
Review access to employment benets for dental sta to ensure parity across all NHS professionals
and improve retention in underserved areas
Contentment
Contract reforms Continue to lead review and reform of the NHS GDS contract to reect the diverse workload,
skills, and experience of dental professionals more accurately. Consider exible models of
commissioning
Cost, careers
Administrative
streamlining
Review and reduce administrative burdens in NHS dental care to improve eciency and service
delivery
Collaboration
Professional networking
opportunities
Take steps to create a strong, collaborative team culture not just within individual practices, but
regionally by establishing professional networks that all dental professionals are supported to en-
gage with. Create both professional and social opportunities for support and connection-building
Careers, collaboration
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Page 8 of 8
Stelling et al. BMC Health Services Research (2025) 25:672
Jennifer Owen, Ben Wild, and Pauline Fletcher, along with the administrative
support of Carole Slator and Stuart Youngman, have given us immensely
valuable intelligence on the subject issues, and helped us reach dental
colleagues across the North East. Their time, insights and energy have been
much appreciated. We are also very grateful to Mr Malcolm Smith, former
Postgraduate Dental Dean, for commissioning research in this important area,
where there is currently a dearth of evidence. And lastly, we wish to thank
all the project participants. We understand how pressured dental sta and
services are currently and are grateful for the additional time spent in sharing
information and experiences for this project.
Authors’ contributions
GV and BB conceptualised the project and obtained funding. GV, BB, HS
developed the project methodology. All authors collected data. GV, BB, HS and
MB analysed all data. HS, MB and GV led on qualitative analysis. MB drafted the
rst version of this manuscript, which was revised by all authors. All authors
read and approved the nal manuscript.
Funding
This project was funded by Health Education England (now, NHS-England).
Grant title: The Dental Workforce in the North East, 2023.
Data availability
The raw datasets generated and analysed during the current study are not
publicly available due to the fact that ethical approval and consent was not
obtained for data sharing publicly but are available from the corresponding
author on reasonable request.
Declarations
Ethics approval and consent to participate
The study was carried out in accordance with the British Educational Research
Association [BERA] [5] Ethical Guidelines for Educational Research, fourth
edition, London ( h t t p s : / / w w w . b e r a . a c . u k / r e s e a r c h e r s - r e s o u r c e s / p u b l i c a t i o n s / e
t h i c a l g u i d e l i n e s - f o r - e d u c a t i o n a l - r e s e a r c h - 2 0 1 8). This study also adhered to the
principles outlined in the Declaration of Helsinki for ethical research involving
human participants. Ethical review and approval were given by the ethical
committee of Faculty of Medical Sciences, Newcastle University, (reference
2313–3). Informed written consent was obtained from all the participants in
the study.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Received: 20 December 2024 / Accepted: 24 April 2025
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