Sara Hurley CBE, former Chief Dental Officer for England
After years of pushing for change from within the system, I’ve learned this: real breakthroughs don’t make headlines — they build quietly, through policy nudges and moments of alignment — and, if we’re ready, moments we can run with.
With the NHS 10-Year Plan now published — and with dentistry no longer confined to the margins — this feels like one of those moments.
We’ve earned the right to be cautious — but if caution hardens into inertia, we risk holding the next generation back — and missing the moment ourselves.
A Shift We’ve Called For — If We’re Ready to Act
The Plan sets out three core transitions that dental professionals will instantly recognise:
- From sickness to prevention
- From hospital to community
- From analogue to digital
And this time, NHS dentistry isn’t left behind.
Among its key commitments:
- A new contract focused on prevention, professional values and transparency
- Expanded use of dental therapists to improve access for children
- A pledge that no one will go without care because they can’t afford it
- Further rollout of community water fluoridation
- And, for some, a controversial graduate tie-in — more on that shortly
It’s not flawless. But it’s the clearest signal in over a decade that the system is serious about reform. The question is no longer if change is coming — it’s whether we’re willing to lead it.
We don’t need to reimagine dentistry as prevention-led or community-embedded — it already is. Across the country, dental teams are delivering exactly the kind of care NHS England now says it wants to see: person-centred, prevention-focused, and accessible.
“If the NHS is serious about prevention, it already has one of its most underused assets – the dental profession.”
We care for the patients others don’t reach. We spot what others miss. And we navigate risk and resilience every single day.
If the NHS is serious about prevention, it already has one of its most overlooked and underused assets: the dental profession.
We don’t need to romanticise what prevention could look like — we’re already living it. What we need now isn’t another vision. We need national policy to catch up with the care many of us already provide.
With the right support — flexible commissioning, digital integration, community partnerships — practices could:
- Flag early risk
- Refer into wider services
- Reduce pressure on GPs and A&E
- Embed oral health in population health
This isn’t about doing more — it’s about resourcing what we already do, and being recognised as part of the solution, not an afterthought.
These reforms live or die at the point of delivery. That’s why local leadership — including from LDCs — matters more than ever.
Across London, we’re already seeing examples of the profession stepping forward:
- Partnering with ICBs to design outcome-based, prevention-first dental models
- Supporting recall protocols grounded in patient risk, not fiscal targets
- Advocating for proper digital access, including Summary Care Records and NHS App integration
- Collaborating with schools, local authorities, and the voluntary sector to reach the least-served
Shared responsibility is essential, but shared responsibility means stepping forward — not stepping back.
Contract Reform: From Rhetoric to Reality
Among the Plan’s quieter but most significant promises is this: a new contract shaped around dentists’ values.
That matters. Because for too long, we’ve operated within a system that penalises continuity, undervalues complexity, and fragments teams.
In my 2023 evidence to the Health and Social Care Committee, I made the case for a contract that:
- Rewards prevention and long-term outcomes
- Enables the full dental team to work at the top of their scope
- Reflects local need and patient complexity
- Supports sustainability — not burnout
Now is the time to push for that vision. Not by standing back, but by leaning in — shaping the contract so it enables us to care differently, not just deliver more of the same.
The contract won’t fix everything overnight. But it is the foundation for everything that follows. Without a contract that aligns ambition with reality, we’re simply setting clinicians up to fail.
Graduate Tie-In: Challenge, Yes — But Also Opportunity
Let’s be honest: the proposed graduate tie-in has caused concern. But when you cut through the noise, the intent becomes clearer.
It won’t apply retrospectively. It’s expected to begin after Foundation Training. And it won’t preclude portfolio careers or private work.
“This isn’t a trap — it’s a test of our willingness to shape the future, not just criticise the present.”
The aim? To reduce early attrition, link public investment in education with public service, and provide a more stable, supported start to an NHS career.
But this only works if the NHS is worth staying in. That means:
- A contract that makes clinical sense
- A workforce model that supports sustainability
- A culture that values early-career contribution — not exploits it
It’s not about compulsion. It’s about mutual commitment. And this is where LDCs come in — not just to critique, but to co-design. To make it work in practice, not just on paper.
For those worried about the principle, let’s be clear: this isn’t a trap — it’s a test of our willingness to shape the future, not just criticise the present. And whether we’re willing to do the work to make NHS dentistry worth joining — and worth staying in.
We owe young dentists more than a system they’re expected to endure. We owe them a profession that’s actively working to improve the offer — and that includes standing up for reform when the opportunity arises.
A Final Word: The Glass Is Half Full — And It’s Ours to Fill
Is the 10-Year Plan everything we wanted? No. Is it a meaningful step forward? Absolutely.
It puts NHS dentistry back on the map — but keeping it there doesn’t mean waiting quietly for more pages. It means showing up, speaking up, and stepping up. Two pages aren’t a footnote if we treat them as a foundation.
“The glass is half full. Let’s stop waiting to be poured into — and start filling it. Together.”
We must continue to spotlight NHS dentistry’s role — confidently, constantly, and constructively. Not to dwell on what’s missing, but to build on what’s already moving. Not to lament the gaps, but to lead with solutions.
Yes, the here and now is tough. But that’s exactly why shaping what comes next matters. If we don’t, others will. And if we don’t claim the narrative, we risk becoming a footnote again.
We’ve heard plenty from the dental grandees of a bygone era — leaders forged in a different time, with different priorities. And from the veteran chairborne commandos — never short of strategic commentary, but often far removed from the realities of today’s frontline practice.
Their voices reflect hard-won experience, and many made lasting contributions. But too often, they default to a rhetoric of budgets, targets, and constraints — when what we need now is a clear-eyed focus on people, prevention, and possibility.
Wanting a better deal for young dentists and DCPs isn’t naïve — it’s necessary. The 10-Year Plan marks the first serious attempt to link training investment with a prevention-led, team-based system built to last. It’s not perfect, but it’s something we should be shaping — not resisting.
Of course, finance matters. But so does professional leadership.
Reform will fail if every challenge is met with cynicism or reduced to a spreadsheet.
The next generation deserves more than inherited scepticism. They deserve a system worth staying in — and a profession ready to help shape it.
This is our moment to move from the margins to the mainstream. The glass is half full. Let’s stop waiting to be poured into — and start filling it. Together.
Former Chief Dental Officer (England)
