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Fixing the Crisis in NHS Dentistry

The crisis in NHS dentistry has become so significant that all parts of the political spectrum agree that urgent change is needed. A recent investigation by the Health & Social Care Select Committee – a cross-party group with Labour, Conservative and SNP members – found that the UK is facing acute access issues and deteriorating oral health.

BBC research published in August last year found that 90% of practices across the country were not taking on new patients, while one in ten Britons are attempting DIY dentistry1. There is no hiding from the fact that this is a shocking state of affairs.

London is the epicentre of the crisis. Fewer than one in four adults in some parts of the city have seen a dentist in the last two years2. In fact, nine of the ten worst places in the UK for dental access were in London, indicating a severe problem in our city.

In Tower Hamlets, only 22% of adults had seen a dentist in the last two-years, while just 27% of children in Westminster had visited the dentist in the past year.

As the cost of living crisis worsens, more adults are avoiding the dentist because of affordability – with almost one in four staying away because of cost fears. This will exacerbate health inequalities and prevent those most in need from accessing treatment.

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Moreover, British Dental Association (BDA) figures show that the number of dentists providing NHS services has declined to the lowest number in a decade. If this wasn’t concerning enough, the BDA has also outlined that these figures hide the extent of the problem, with more than half of NHS dentists reducing the amount of NHS work they do, opting instead to provide better renumerated private services3.

Dental health is a barometer both of general wellbeing and of the health inequalities. It is a pillar of the healthcare system, well-placed to pick up the early oral signs of systemic disease ranging from anaemias to cancers. Good access to dental care will lead to improved wellbeing and lowering of the disease burden alleviating pressure on the health system down the road.

Dentists need to be better integrated into the healthcare system, working in tandem with other parts of primary care, like GP practices. The new Integrated Care Systems, new partnership models which oversee local commissioning, may offer a way forward but the full impact of these new systems is yet to be seen.

The Oral Health Foundation has shown that the number of mouth cancer cases and deaths are on the rise, having increased by 34% and 46% respectively in the last ten years. Improving access to dentistry is one of the Foundation’s key recommendations to help reverse this trend4.

The current dental contract and a lack of funding are the main causes of the crisis. The Leader of the Opposition recently set out his plans to tackle these.

The 2006 contract is based around the number of “Units of Dental Activity” (UDAs) that must be delivered by a dentist each year and that form the basis for remuneration by the NHS. While well intentioned, this disincentivises dentists from seeing new patients, including those who have higher levels of disease and therefore require more time to treat, due to the lack of appropriate remuneration.

On top of this, the contract has resulted in large underspends from an already overstretched NHS dental budget. Under the contract, where fewer than 96% of contracted UDAs are delivered, the NHS initiates a clawback of funds. Similarly, practices cannot provide more than 110% of agreed UDAs even where there is demand and capacity to do so.

A shortage of dentists means that, across 2022/23, roughly £400m will be returned to the NHS from practices unable to provide their contracted UDAs. These funds are likely to be reallocated across the NHS and lost to dentistry budgets.

The BDA has called for reform of the contract, preferring a capitation-based model where dentists are paid for the patients seen, rather than by UDAs. This proposal should be seriously considered by the Government.

The case for reform is clear. NHS dentistry is in worrying place with an under-funded service, shrinking pool of dentists and a staggering amount of unmet need. Ministers must urgently work with the BDA to reform the contract; look at how to support the sector with more funding; and Integrated Care Systems must work to integrate dentistry more fully into local healthcare systems.

  1. Full extent of NHS dentistry shortage revealed by far-reaching BBC research, BBC, 08 August 2022, available online https://www.bbc.co.uk/news/health-62253893 ↩︎
  2. More than half of the children in London haven’t seen a dentist in a year, Evening Standard, 25 August 2023, available online https://www.standard.co.uk/news/health/london-dentists-children-nhs-crisis-b1102947.html ↩︎
  3. Half of dentists have cut back NHS work, with more to follow as crisis mounts, British Dental Association, 06 March 2023, available online https://bda.org/news-centre/press-releases/Pages/Half-of-dentists-have-cut-back-NHS-work-with-more-to-follow-as-crisis-mounts.aspx#:~:text=The%20proportion%20of%20dentists%20now,change%20career%2C%20seek%20early%20retirement. ↩︎
  4. Mouth Cancer Rates Hit Record High, Oral Health Foundation, 01 November 2022, available online https://www.dentalhealth.org/news/mouth-cancer-rates-hit-record-high#:~:text=Figures%20collected%20by%20the%20Oral,%25)%20within%20the%20last%20generation. ↩︎