Orthodontic Training in the UK

Prepared by M Dixon

Chairman of Training Grades Group of British Orthodontic Society

Primary Draft 26^th August 2008

The TGG acknowledges the assistance of its local representatives within the UK Orthodontic programs in gathering all the data submitted.

Specific recognition of the contributions made to this report

• H Popat and M Nazir (Orthodontic course costs and format)
• S Henwood and T Ubaya-Naranage (Distribution of training posts)
• J Shah and R Benson (Outcome of training)
• E Thickett (Study leave entitlement)

The TGG are grateful to Iain Hathorne and the Representative Body of the BOS for their support and guidance in the preparation of this report.

• 250 orthodontic trainees in post Spring 2008
  • 129 NTN Specialist Registrars in post
  • 48 FTTA Registrars (consultant level) in post
  • 73 Non-NTN (over-seas) trainees in post
• 16 orthodontic training programs in UK
  • High concentration in South East
  • Associated with well established training programs
  • High retention of trainees in proximity of training programs
  • Salary scale £28K to £45K
  • Research costs incurred by trainees range from £3K to £24K over three years (not subject to tax relief)
• Between 2004 and 2015 around 440 orthodontists will retire
  • a minimum of 40 per year required to keep current provision
  • 35 to 40 new specialists accrediting per year
  • 86% remaining in UK
  • potential shortfall of between 60 and 110 by 2015
• Currently contracting compounds issues of local discrepancy
  • Favours area of historic high provision
  • Needs assessments have been inconsistent and have lacked transparency

1.1.The Training Grades Group (TGG) of the British Orthodontic Society (BOS) is a core group of the BOS and represents those dentists in SAC accredited orthodontic training programs. It currently has around 260 members.

1.2.Part of the group’s role is to monitor and report upon those issues pertinent to training.

1.3.In spring 2008 TGG undertook a review of Orthodontic training within the 16 UK Orthodontic training centres.A questionnaire based survey was completed with 100% response from TGG representatives in each program.

1.4.As part of this particular attention was paid to

• Geographical location of courses
• Fluctuations in numbers of trainees
• Cost of courses
• Career choice on completion of training

2.1.Orthodontics is a sub-specialty of dentistry concerned with growth of the face, development of the bite (occlusion) and prevention or correction of occlusal problems

Orthodontic training occurs at various levels.

There is a spectrum of orthodontic training within the UK dental workforce, from undergraduate level through to NHS hospital accredited consultant.

3.1.Undergraduate training

3.2.General Dental Practitioners (GDP)

3.3.Dentists with a Special Interest

- within the salaried service (Community Service)

• Continue training in a Fixed Term Training Appointment (FTTA)

- To accredit as a NHS Hospital Consultant

- To accredit as a University based Lecturer / Senior Lecturer

In the UK twice as many new orthodontists choose careers in specialist practice compared to continuing in the hospital service.The training pathway to become a hospital consultant in the UK is unique in that a trainee undertakes a further 2 years training as an FTTA to attain consultant level.Other countries have only a single 3 year pathway after which the graduate makes their career choice.

5.1.In spring 2008 there were 250 orthodontic trainees, 129 Specialist Registrars (SpR) holding National Training Numbers (NTN), 73 SpRs without NTNs (Non-NTN) (primarily self-funded overseas dentists – not eligible for specialist list entry) and 48 Fixed Term Training Appointment “Senior” Registrars (FTTA).This is comparable to 2007 with the exception of an increase from 47 to 73 for Non-NTN trainees⁶.

5.2.177 of the current trainees will be eligible for the GDC Specialist List (the remainder are overseas dentists with Non-NTN posts).This equates to between 35 and 40 new specialists (both primary and secondary care) per year becoming eligible for the GDC Specialist list.This figure falls short of the estimated numbers required to keep pace with projected workforce retirements.

5.3.A high concentration of posts are within London at the long established training centres, although over time we have seen expansions in NTN training numbers at most other centres (Table 1 and Figure 1).

5.4.Increasing the numbers of trainees in regions such as the South West and West Midlands has resulted in an increased retention of specialists locally.But this is still less than the retention of orthodontic specialists in the South East.

5.5.There is a dichotomy between maintaining our historically strong academic units in the South East whilst trying to expand provision in other regions.

6.1.Orthodontic training course fees range from £1,000 - £9,690 per year and from £3,000 - £24,000 for the entire duration of the training programmes (Table 2).

6.2.Orthodontic trainees have a choice of higher University degrees as part of their three year training programme.Course fees are highly variable and there has been a notable, but expected increase in fees over the last decade (Figure 2).

7.1.Between 2005 and 2007 150 orthodontic SpRs and FTTAs completed training.

7.2.86.8% of NTN-SpR’s continue to work in the UK after training, 10.6% went to other EU locations and 2.6% went to non-EU locations.

7.3.63.6% of non-NTN SpR’s went to work in non-EU locations, with 26.4% remaining in the UK.

7.4.NTN-SpR’s usually go into specialist practice or FTTA positions, but trends for these fluctuated during the survey period.SpR’s joining specialist practice dipped to 43% in 2006 from 63% in 2005, and rose back to 58% in 2007.In the same period FTTA appointments rose from 29% in 2005 to 44% in 2006, falling back to 36% in 2007. This coincided with the introduction of the new contract for NHS primary dental care.

There are currently 16 training programmes providing specialist orthodontic training in the UK.

There are 250 trainees registered on these programmes of which 129 are in NTN posts leading to registration on the GDC Specialist list for Orthodontics and a further 48 are in FTTA posts leading to accreditation as NHS consultants.These FTTAs are already on the GDC Specialist list.

Annually 35-40 specialist registrars become eligible for the GDC’s specialist list whilst a minimum of 40 senior colleagues are retiring annually.

There is a large geographical variation in the number of training programmes and the number of trainees with the largest numbers being concentrated in the South East.

Retention of specialists is highest in the location of the training programmes again particularly in the South East.

14% of trainees are not remaining in the UK.

UK has one of the lowest ratios of orthodontists per head of population in Europe and the number of specialists being registered in the UK each year is not sufficient to keep pace with retirements of senior colleagues, without beginning to address the disparity with our European colleagues.