What is NHS Dentistry?
When Local Dental Committees (LDCs) talk about NHS dentistry, they are referring to primary care dental services provided by an independent provider, delivering care under a contract held with the NHS. These are generally high street dental practices providing NHS General Dental Services (GDS) to patients. Not all dental practices enter into a contract to deliver NHS care; some operate on a purely private basis. General Dental Services are distinct from the Community Dental Services (CDS), which are a more integrated part of the NHS, often delivered by NHS Trusts or other large provider entities, with salaried dentists, who are directly employed. The CDS provision exists to care for patients whose needs cannot be met in a high street dental practice.
Accessing an NHS Dentist
The easiest way to find a dental practice with an NHS dental contract is to use the NHS find a dentist website.
There is no centralised list of practices which shows appointment availability.
There is no system of registration for NHS dentistry (like there is for GP services). No one needs to be registered with a practice to receive care and should be able to access care in any dental practice with an NHS contract that has capacity to see and care for them. Dental practices arrange their own appointments and so may or may not be able to offer an appointment to a patient within the timeframe they might expect. Whilst a patient is undergoing any NHS course of treatment, they are considered to be an NHS patient of the practice (such courses of treatment may be delivered over one or several visits to the practice). Once that course of treatment is complete, the relationship between the patient and the practice is at an end, though some dental treatments are covered by an NHS guarantee. Patients who routinely attend a dental practice and make (and keep) regular appointments are considered regular attenders.
Urgent Dental Care
Access to urgent dental care varies by region with different Integrated Care Boards operating different systems. In London, if the patient is a regular attender, they should be able to contact their practice for an urgent appointment. If the patient does not have a regular dental practice they can call NHS 111 or use 111.NHS.UK and go through the dental triage system which will assess the urgency of the issue and if the issue is deemed urgent, arrange an appointment at an Urgent Dental Care Centre. These are general dental practices which have been commissioned by the NHS to provide urgent dental care.
Orthodontic Care
Orthodontic care (including the fitting of braces) is usually delivered by specialist dentists called orthodontists. A referral from a general dental practitioner is needed to access NHS orthodontic care. There is a clinical threshold for determining patient eligibility for NHS orthodontic care; this is called the Index of Orthodontic Treatment Need (IOTN). The IOTN sets out the severity of an issue on a scale and a patient must meet the criteria for referral/treatment.
Who can access NHS Dentistry?
Anyone can access NHS dentistry, provided there is sufficient capacity available within local practices. Some people may find that their needs are better met by the CDS and, if this is the case, the dentist can arrange a referral.
The NHS charges most people to access NHS dental services. These charges are set by the government and collected by the dental practice. Not everyone needs to pay to access NHS dental care, but an ability to pay does not affect the likelihood of getting an appointment. When a patient attends a dental practice the practice will make it clear if the patient is attending an NHS or a private dental appointment.
Private fees are set by the practice and will be explained clearly before treatment starts.
More detail about dental charges and exemptions is available here and on the NHS website.
Why is it so difficult to get an NHS Dental appointment?
As noted above dental practices are independent businesses some of which hold a contract with the NHS to deliver dental services. The services that will be provided under the NHS dental contract are set out in the General Dental Services (GDS) contract.
The NHS contracts with dentists through a system using Units of Dental Activity (UDA). Every type of treatment provided by the dentist falls under a band of treatment as set out by the GDS contract, details of which are available in our information sheet.
Each band of treatment provided uses up some of the UDAs available for the practice to deliver as NHS dental care appointments for patients. Since the NHS commissions a limited number of UDAs, this limits the amount of treatment that the NHS offers to patients.
The number of UDAs allocated to a practice is variable, some have a lot, others not so many. So some practices offering NHS care will have fewer NHS appointments available than others.
Since NHS dental appointments are limited, it is important for patients who are unable to keep an appointment to let the practice know as soon as possible so there is the chance for the appointment to be offered to someone else.
As the dental practice is an independent business that holds a contract with the NHS for a certain amount of activity, any additional capacity will normally be used to deliver dental care privately. This is why some practices will have no appointments for NHS patients but will have appointments for private patients.
Referrals
Not all treatments can be provided by a general dental practitioner. If the dentist is unable to provide a complex course of treatment or one which would require the patient to be sedated they will refer the patient to another practitioner which holds a contract with the NHS to provide these advanced services. These may be other general dental practitioners with particular expertise in the area or to the CDS.
More Information
More information about NHS dentistry is available on the NHS website: https://www.nhs.uk/nhs-services/dentists/
