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General Election 2024

This General Election has been called while there is a greater focus on NHS dentistry than there has been for many years. Within this context the three main parties have made general statements about healthcare generally and dental services specifically.

The Liberal Democrats stated: “[We will] Guarantee access to an NHS dentist for everyone needing urgent and emergency care by: Bringing dentists back to the NHS from the private sector by fixing the broken NHS dental contract and using flexible commissioning to meet patient needs. Introducing an emergency scheme to guarantee access to free NHS dental check-ups for those already eligible: children, new mothers, those who are pregnant and those on low incomes. Guaranteeing appointments for all those who need a dental check before commencing surgery, chemotherapy or transplant.”

The Labour party stated: “Getting an NHS dentist is increasingly a lottery and the consequences are dire. The most common reason children aged five to nine are admitted to hospital is to have rotting teeth removed. Labour will tackle the immediate crisis with a rescue plan to provide 700,000 more urgent dental appointments and recruit new dentists to areas that need them most. To rebuild dentistry for the long term, Labour will reform the dental contract, with a shift to focusing on prevention and the retention of NHS dentists. We will also introduce a supervised tooth-brushing scheme for 3- to 5-year-olds, targeting the areas of highest need.”

And the Conservative party pledged: “Our Dental Recovery Plan will unlock 2.5 million more NHS dental appointments, through a patient premium to encourage dentists to take on new NHS patients. We will make further reforms to the dental contract to ensure its future sustainability and we will ensure newly qualified dentists have to work in the NHS for a number of years or pay back their training costs. We will promote good oral health through our ‘Smile for Life’ programme. Rural and coastal communities will be better served through ‘golden hellos’ to encourage dentists to work in these areas, and through new dental vans. We will further improve access to NHS services across England by training more staff in rural and coastal areas. For the first time the NHS Constitution will reflect the bespoke healthcare needs of rural and coastal communities and the need for the NHS to tailor services accordingly.”

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These pledges are all well and good but there is no commitment to what a reformed contract looks like or a recognition of the significant increase in funding they require to implement. The Conservative party plan appears to be based on their plan published in February 2024  Faster, simpler and fairer: our plan to recover and reform NHS dentistry, which was not well received by the dental profession. The Labour party’s statement is a simple statement but one that has no substance to it with no account of where 700,000 appointments will come from, or why that number and not another. There is no account of how the Liberal Democrats or Labour would actually entice dentists back to the NHS from the private market.

To bring dentists back from the private market to the NHS would require a significant increase in investment into the NHS. The growing private dental market exists because successive governments have determined not to invest sufficiently into the NHS dental service. Headline making gimmicks to recruit dentists into areas without NHS dentists are not going to wash with the profession. Dentists need practices to work in. Instead, there must be substantial incentives for dentists to offer NHS services in communities without access to NHS care, that reflects the financial risks involved in providing a quality service to those communities. This includes the financial cost of recruitment of staff in those areas, and the need to address the unfairness and inequity that exists whereby team members do not receive NHS employment benefits, despite being committed to the NHS in their employment.

Further, no party has pledged to address one of the main factors preventing access to NHS dental services, the patient charge. There is no reason for patient charges in NHS dentistry as opposed to other areas, least of all when all parties are claiming a “new focus” on prevention. Unless this barrier is addressed as demanded by Healthwatch England it is hard to see how significant progress on improvement can be made. It is well documented how patient charges are one of the greatest barriers to access yet the rationale for them has not been reviewed since they were introduced. No party has pledged to look at this matter. 

The most fundamental omissions from all the manifestos, however, are the lack of mention of integration and lack of a full vision for what NHS dentistry really means. If NHS dentistry is to really thrive, if a reformed contract is to have real impact then real thought needs to be given to how it integrates with the rest of the health and social care sector. There is no commitment to improving pathways between primary care dentistry and other sectors, such as stroke rehabilitation or diabetes care.  All parties must commit further than they have done so to ensure that the LDC voice is heard by ICBs and that ICBs have the real support and flexibility to make the best of their existing dental resource and to commit to real investment in NHS dentistry to help the local clinicians play their part in reducing health inequalities and improving health outcomes.

The LDC Confederation will always welcome commitments to improve NHS dentistry and will work with all partners for a sustainable, valued and accessible NHS dental service. But to have a real meaningful impact we need a real vision for what NHS dentistry can provide and a recognition of the significant impact our service has on reducing health inequalities and improving health outcomes.