Q&A with Joel Mannix and Jason Wong MBE, Chief Dental Officer at NHS England

This is a transcript of the interview, which ties in with our Business Outlook 2025 report. 

Joel: Hello everyone. My name is Joel Mannix, I’m the Head of Dental at Christie & Co. Today we have the privilege of being joined by Jason Wong, Chief Dental Officer at NHS England. Jason has made a significant contribution to dentistry and oral health, earning an MBE for his outstanding services. He leads the dental profession in England, working tirelessly to improve oral health outcomes.

Since our Business Outlook 2024, when you sat down with Paul Graham, you've moved from an interim position to Chief Dental Officer. Congratulations, firstly. How has everything been since then?

Jason: I think pretty busy is the way I would describe it. We have been busy trying to work on the next set of reforms for dentistry. It's now acknowledged that certainly, NHS dentistry requires reform. Meanwhile, you know, making sure that patient care is at the centre of everything that we do. There are a lot of things happening both on the world stage as well. The World Health Organisation, which we're feeding into in terms of what oral health has a part to play in terms of non-communicable diseases and, also, I think, in England, it is a case about making sure that we have the workforce to deliver the care that a patient needs and that is ongoing and has been since I took over the post about nine months ago.

Joel: How has the sector fared over the past year? What are you seeing as the key developments and changes?

Jason: There's been continued recovery. The target that was set was to try and get back at least to pre-pandemic levels, I don't think we're quite there as we stand with NHS dentistry at the moment. So, there's a significant amount of work that's ongoing to see how that can be achieved.

Last year, around this time of year, the previous administration launched a dental recovery plan. Within it, there were some short-term boosts to the sector as well as some, long-term workings that are aimed at improving oral health and the recruitment and retention of teams. So, we've been working through that and then, of course, with the change in the administration, we've been working with the priorities of the new Government and the manifesto pledges that the new Government has made as well.

Joel: Do you expect recruitment and funding challenges to remain in the NHS dental sector long-term?

Jason: I’m hoping it doesn’t. We are still at the stage now where two separate narratives are going on about recruitment, in particular. There is one which was picked up by a lot of people that suggests that we have enough dentists in the country, but that they don't want to do NHS treatment and therefore there's no need for more on top of what we have currently. But, if you look at the figures and compare us with other comparators in Europe, and certainly the number of dentists were capita, we're one of the lowest within Europe. So, I think that's something to bear in mind.

There was also a workforce survey carried out by the General Council in December 2023 as well as December 2024. The figures in December 2023 indicated that, out of the 25,000 dentists who responded to their survey, only 15 were looking for work. With 0.07% of the workforce looking for work, I think we can conclude we've got full employment.

The second issue is recruitment is not all just about dentists. It's about the whole dental team that is necessary, and we are really keen on trying to explore how far we can take the skill mix and how teams can work together better. That's not just because of the availability of workforce, although it's a positive, I think that it is good for a dentist to work in a multidisciplinary way so that they can concentrate on certain things that are perhaps on the more complex, leaving other parts of it for parts of the team. In dentistry as a whole, not just NHS dentistry, we've not been good at this. If you look at other sectors, and I always say compared with eye health, you walk into the place, and someone does certain checks with your eyes who is not a qualified optician. They also go through different parts of the diagnostic phase, and then the one part that the optician is licensed to do they do the eye test and then you come back. Here in dentistry, we seem to still believe that the dentist needs to be sat patient-side for the entire time. It almost seems to be something we really don't want to move away from. And, currently, we are pretty sure that dentists carry out about 95% of the work, and I think it would be of real benefit if we can increase that.

Alongside the fact we’ve got low dentist numbers, we do have one of the most professionalised dental workforces in the whole world. We have dental nurses who are registered. They're all regulated, and they've continued professional training. So, I think it's a real opportunity which both the NHS and the private sector probably need to think about how that is utilised as we progress.

Joel: Is there a roadmap for increasing the number of not just dentists, but sort of all staff, especially in the NHS dentistry world?

Jason: So, the NHS, the year previous, had published its NHS long-term workforce plan, and on there was a commitment to a 40% increase in homegrown undergraduate dentists as well as a 40% increase in dental therapists. So that, to a certain extent, was addressing that aspect. I also think that the biggest registered group, dental nurses, could be utilised to provide a lot more than they do right now. Rather than just chair side, actually having the ability to give preventative advice, apply fluoride varnish, and take radiographs. So, there's quite a bit that that really big workforce could be utilised to do. Also, we shouldn't forget that the smallest registered group, the clinical dental technicians, again, are a workforce that can be patient-facing, that can have direct access and the ability to carry out removable prostheses, so dentures of one sort or another, for the population and are really valuable, because, especially with the ageing population that we've got, as in it's something that I think that we can really utilise. So, I think there's a lot of opportunity, and the roadmap probably is that as well as increasing numbers.

One of the more controversial parts of the recovery plan was the idea of having provisional registrations and the use of international, dentists. We've always relied on the international workforce, and there have been geopolitical issues like Brexit as well as, generally how the UK is attractive for other nations’ professionals to come here, so that, whilst the quality is capped, but made less onerous in terms of the bottleneck that's caused by an overseas exam. So those are things that my office is working with the Government on to try to increase.

I think that's probably the roadmap. I think what we need to then consider is how we fulfil the vacancies, and the most recent survey carried out by NHS England of all its contracts suggested that there were almost 3,000 full-time vacancies within the system and it put it down to 2,700 being NHS vacancies, but actually 300 private vacancies. The biggest issue workforce for us is the urban-rural breakdown. So, you were asking about recovery, London is currently carrying out more units of dental activity than it's ever done. So, in effect, it has recovered. If you go more to the countryside, to Cornwall, Devon, Norfolk, Suffolk, Lincolnshire, and Cumbria, the recovery has not been as marked in those particular areas. There are multiple reasons why that is. Some of it is global, you know, if rurality is a barrier to young professionals wanting to move into those areas. But some of it is specific to dentistry - if you're a young graduate or recent graduate and you want to develop, these areas don't have big conurbations where you've got specialist units. So, you take on the risk of both not having the opportunities to develop yourself, as well as not having the specialist services to refer to, and therefore you've got this sort of concentration of the city conurbations to be where the recovery is most.

Joel: Just following on from that, what sort of words of hope can you offer those who are struggling in this sector?

Jason: I hope that the reforms that are being worked on right now, there is a commitment to quite a big set of reforms for the NHS contract that's coming along. I think there has been a recovery – we’re not back to where we'd like to be, but the trajectory has been improving. So, hopefully, that does give people hope. It is quite high in the priorities and agenda, so, whereas if you go back a few years and certainly pre-pandemic, that was probably the main challenge - was it a big enough priority for everyone? I don't think that’s in question anymore. So, that must give us hope.

Joel: Technology is obviously on a rapid increase. How do you see digital dentistry and technology changing the patient experience in dentistry?

Jason: I think it's a real plus in terms of the patient experience. You know, in particular, we've got digital dentistry, and of course, we've got the manufacturing of restorations that can be done quickly. We've got impression-taking that could be done without the traditional, impression material, which patients don't particularly like, and you can see why they would prefer a camera doing that bit of work. So, from that perspective, I think that's positive. There's the other part which is the connection with the practice as well. I see practices using AI and I see the ability of people to contact a practice outside of working hours in a multitude of ways now that they weren't previously able to, even including automatic booking of appointments without needing to speak to someone and find a time.

So, all that, I think, is going to improve the patient experience. Hopefully, it will speed things up and make things more effective and efficient. From the dentist's perspective, we're doing some work in trying to make the whole recordkeeping process not as onerous as it is right now. I think it's gone out of balance, and there's a lot of technology out there at the moment that is making that recordkeeping much easier. Either traditional methods of transcribing or using AI to improve those, and I think that that is to be welcomed.

The big area is diagnostics. We still rely heavily, although with magnification, on eyes and hands and again, something that we've been quite slow to pick up on as a sector is implementing the technology in and around that, so having things that can read the radiographs that we have and the pictures that we have to give us more feedback.

Joel: What changes have you seen in the NHS in the past few years, and do you see the NHS being able to keep up with tech in the same way that the private sector is sort of accelerating?

Jason: Yeah, the NHS has always had a very slow path to picking up technology. We had a conference about a week and a half ago, and one of the speakers said it took, on average, 17 years of innovation research to get to the front line of the NHS. There will be issues with it, although the NHS is placing quite a bit of its technological advancement on the NHS app, and if there's some way of linking the NHS app and the NHS information system with a practice software information system, I think that could be a big move, and certainly the ability to deliver advice and information, giving more power in the hands of - or the phones of - patients is a good thing. That goes further than just the NHS.

In terms of technological advancement, there are some of these technological advancements that make the provision of restorations cheaper to produce. So, it is an area that certainly the NHS would be keen to look at. So, all in all, we've been looking at this area and have been discussing with the regulators, and overall, although there are a few caveats, we think it's a really positive move and has real benefits to bring to the whole profession.

Joel: In 2024, 82% of our practice sales went to independent owners. How do you see this impacting dentistry and the NHS?

Jason: That was quite a surprising figure, and it was something that I chatted to Paul about last year in terms of where they were going, because the previous set of figures showed the practice ownership dropping very significantly. The one set of definite figures that I saw were between 2007 and 2017, and on the performance list the number of provider performance – which is how the NHS distinguishes between someone that has a stake in the practice - had dropped from essentially around 40% to below 10%, and the trajectory was going down much further.

The fact that there was enthusiasm for people within the profession to take it on. I think it is different. I think that there was a time, if you go back, that idea of someone just setting up essentially and not worrying about the running of the place and just having it, I think those days are over, and I think the running of a practice is now, you need a professional outfit in which to do that, and I think it's a welcome stat in terms of having that. There is also I think the increase probably in multi-practice owners as well, and quite a few of those are not just corporate bodies, but actually, dentists who've gone on to do that.

Joel: Yeah, we're certainly seeing that the next wave of empire builders, I guess, coming through, small groups, if you like. They're really taking their place in the market at the moment. From our perspective, it's great to see.

Looking at the year ahead, Jason, what are your expectations for UK dentistry in 2025?

Jason: From the perspective of the NHS, I think a lot hinges on the set of reforms and how the NHS brings that on both in terms of, I suppose, 2025/26, having some kind of reform that's going to help the market that can be put into place quickly, and then 2026 onwards or the end of 2025/26, you would hope that we will have a good picture of how the entirety, and perhaps reforms that we've not seen in dentistry probably for almost 20 years, to come about how NHS dentistry will be reconfigured. In terms of private dentistry, there's a lot going on about the current cost of living and how that might impact that, especially the elective part of the market.

But it is an area that seems to have been thriving, and the majority of private practices probably operate just healthcare out with the remuneration system that's within the NHS. Some rely quite a bit on cosmetics and I'm not into predicting how the cosmetic market will go, but overall, whilst I think there's no question that there is a definite need for reform, we're not blinded by fake optimism. But, if we can see both those happening, dentistry itself, as a sector, I think will do quite well.

One of the things I keep saying, and sometimes people disagree with this, is the overall issue is not that dentistry has failed, it’s access specifically to NHS dentistry that we've struggled with. The other issue is, if you look at the figures, yes, they're down from what they were, but it wasn't the wholesale complete change that everyone was talking about. I’m certain that, coming from an area that's a rural locality, I was aware of the problems pre-pandemic. The issue is that what we had was a recovery, but the recovery had almost become the new normal and we need to do something, first of all, to bring it back to the pre-pandemic levels. But we can't stop there. We have to extend that in which to sustain the NHS on a sustainable footing.

Joel: What are your goals as Chief Dental Officer?

Jason: Whilst the reform process is not directly under my responsibility, we put quite a lot of time and advice into helping the reform process. So, I think, seeing through some sort of reform programme, both short and medium and long-term, would be good.

In my own areas, I want to see some change in terms of the culture of the profession, and I think that, at the moment, it sort of sits in a culture of fear about almost about what will come next, and I'm doing all I can to try and change from a legislation perspective, which is talking to the regulators, as well as the clinical governance perspective to try and improve that sphere.

We're also looking at the well-being side of things. I think that mental health and wellbeing is an issue in society, but there's been a particular issue in dentistry that we're trying to do. So, improvement in that sphere is part of our aims and goals. I will be looking towards the bit about a COP6 this year, and one of the issues will be whether we retain amalgam use as part of the UK market, and that is something that I think will come along.

We also feed into the WHO non-communicable diseases strategy that's going to be presented to the UN. So, how the UK sits within global achievements, and we've been also helping in terms of the recruitment and retention and the workforce strategy. Some of that will be decisions made by the Government that we then feed into to try and help. So, if it becomes a confirmed policy of the new administration, it does provisional registration, my role will be to support that in every way that we can and, indeed, in other parts of the system as well, both to give advice but also to try and help with the implementation for England.

Joel: Thank you so much for your time today, Jason.

To watch the full video interview, click here.