Training for a Gap? Postgraduate Education, Referral Demand and Level 2 Oral Surgery in England

ABSTRACT Background Referrals to oral surgery services in England have risen sharply over the past two decades, a trend confirmed by large‐scale referral audits and accelerated by the disruption of the SARS‐CoV‐2 pandemic. NHS England has responded by expanding Level 2 or Intermediate Minor Oral Surgery (IMOS), provision, delivered largely by general dental practitioners with enhanced skills rather than by an expanded specialist or consultant workforce. Method This article examines whether postgraduate education is adequately preparing clinicians for this role. Training routes into Level 2 practice now span university‐validated MSc and PGDip programmes, Royal College diploma examinations, professional‐body frameworks, including those developed by the College of General Dentistry and private dental training academies, but accreditation onto the Level 2 performers list remains portfolio‐based rather than qualification‐based and is applied with considerable regional variation by Managed Clinical Networks (MCNs). This creates a recognition gap in which the same qualification may be weighted very differently by different MCNs, and a curricular gap in which courses build clinical competence but give limited attention to the commissioning and governance environment graduates are entering. At the same time, the number of salaried, specialist‐ or consultant‐led NHS posts has not grown in line with either referral demand or the output of full oral surgery specialty training, leaving many newly qualified specialists working as self‐employed Level 2 performers rather than leading services. Overlaying both issues is a structurally asymmetric relationship between Level 2 providers and MCNs, which act simultaneously as accreditor, governance body and, in some areas, referral gatekeeper and competitor. Conclusion The article argues that postgraduate curricula, a national framework for recognising Level 2‐relevant qualifications, specialty training commissioning and MCN governance need to be more deliberately aligned if the oral surgery workforce in England is to meet demand sustainably.