Back in December 2024 we asked if 2025 was going to be the year of NHS dentistry and looked forward to robust and meaningful conversations about dental contract reform, increased integration and the ability of dentistry to play it’s part in reducing health inequalities and improving health outcomes. Now that the NHS 10 Year Plan has been published are we any further forward in making sure NHS dentistry can be more effective?
The main announcements in the Plan about dentistry are:
- Continued focus on urgent dental care.
- Transforming NHS dentistry by 2035 so it provides high quality care at the right time, and nobody goes without because they cannot afford it.
- A new dental contract aligned with dentists’ values, transparent to patients and that puts prevention at the heart.
- A dental graduate tie-in for three years.
- Improve access to dental care children by making better use of therapists.
- Extending community water fluoridation in the north east and assessing further rollout in areas where oral health outcomes are worst
The Plan also sets out it’s three main shifts:
- hospital to community
- analogue to digital
- sickness to prevention
But it contains no real substance or confirmation about how this will actually be applied to dentistry. Instead dentistry, as we can see from the fact that all comments about it are sectioned off on pages 31 and 32, is once again treated in a silo, as a fringe service of the NHS.
So, what does all the above mean for dentistry? There are some curious misalignments of policy in the Plan. As noted above there is a continued focus on urgent dental care but the Plan also states: “Our first step is to stabilise NHS dentistry and make sure the budget we have is spent on those who need care most. Initially, we will prioritise urgent care.” This seems like a continued exercise of the tail wagging the dog. Prevention will never be at the heart of the system, nor will dentistry be able to reduce health inequalities and improve health outcomes if the focus is on urgent care over continuing care. Dentistry is prevention, so who needs it most? Everyone.
There are ambitious plans to make sure that in the future nobody goes without care because they can’t afford it, but no clarity on what this means. Is it a statement that they will abolish patient charges, expand exemption criteria or something else? If the former two options then the budget will have to increase, which in the current climate seems unlikely. Optimistically this is rather cryptic way of saying that dentistry will be more targeted to deliver care in line with local priorities to reduce health inequalities and improve health outcomes but a lot more detail is needed to make that a reality.
There is the intention to use therapists to increase access for children but if this is meant to be provided through GDS contracts then there is the question of NHS benefits for therapists as well attracting them over from the private work they are already providing. It is notable that the example they use of community engagement using therapists is run by the salaried services of the Community Dental Services in the Whittington, and not one from GDS primary care. The oblique intention of getting dentistry integrated in Neighbourhood Teams is to be welcomed and something the LDC has been urging and working with ICBs to achieve. Much more detail and fundamental reforms are required if this is to be a meaningful statement and not simply an extension of supervised toothbrushing and occasional outreach programmes.
Then there is the controversial plan to introduce a dental graduate tie-in. But what does this actually mean? The consultation on this was controversially run during the general election, a period of time when political activity is supposed to be suspended and consultations on government policy are not normally run. That notwithstanding, there is no detail about when or how this proposal is supposed to be implemented. It would be immoral to implement it on those students currently at University as they may have chosen a different course if they knew this was coming. There is also the wider issue of where these graduates are going to work. There is already a shortage or practices willing to engage with Dental Foundation Training, how will they be incentivised to take on a tied-in graduate and does this include Dental Foundation Training or does it start after that? How much time is this tie in? Full time? One day per week? How about NHS patient’s choice to have some private treatment? There are many unanswered questions on this which makes it very strange that it has been announced so robustly as part of the NHS 10 Year Plan.
In order to increase access it looks as though there will once again be an emphasis on pushing dentists to extend recall intervals to their maximum. The LDC Confederation has long warned of the danger of this approach, writing in evidence to the Health and Social Care Committee in 2023 about the problems with this approach. This is an approach based on finance and not on patient need. If dentists are to be compelled to extend recalls then they require additional protection when adhering to Government mandated activity, potentially provided through Crown Indemnity, and idea supported by those who responded to a recent poll we ran.
There is, however, one sliver of light in the Plan. That is the commitment to work with the profession to reform the contract in line with dentists’ values and making a system more transparent to patients. If this is to be case, however, DHSC may need to rethink some of the proposals they have committed to above, or at the least find a way to convince the Treasury to provide a significant increase in funding for NHS dentistry. Broadly speaking the tone is to be welcomed, but as ever it is the detail behind the statements that is important rather than the top level announcements. We will have to hope for an increase in engagement with the profession to ensure that the implementation of any and all changes is actually in line with the values of dentists.
It is disappointing that nowhere is there a mention of dental contract reform aligning with the rest of the NHS or a real commitment to support robust integration. This is at best alluded to in the sections which talk about Neighbourhood Care, but they do not state that all four pillars of primary care will work together. Instead “primary care” is once again taken as meaning solely General Medical Practice. There is no recognition of the isolation of dentistry from the rest of the NHS, it’s absence from the NHS App and digital infrastructure. Hopefully, however, while not explicitly mentioned, the overall direction of travel will include dentistry. While Integrated Care Boards are making cuts and restructuring they are unable to focus energy on improving ways of working so it will be some time before they are in a position to make the best of NHS dentistry unfortunately. This can, however, form the basis for ongoing discussions with DHSC about the general implementation of the NHS 10 Year Plan.
In addition, it seems strange that these announcements about NHS dentistry have been made before the final analysis of the recent DHSC dental finance survey has been finished, shared and discussed with dental stakeholders.
Is 2025 turning out to be the year of NHS dentistry? Sadly it does not look like it, though there has been more interest and more serious work done to understand it than in previous years. According to the Plan NHS dentistry should be transformed by 2035, so perhaps in 10 years’ time we’ll finally be able to say now is the year of NHS dentistry?
