Ministers urged to ‘level up’ NHS dentistry

The British Dental Association (BDA) has backed calls from Healthwatch England for urgent and fundamental reform of NHS dentistry to be delivered by next year, as new figures point to the depth of access problems, and the risk of widening oral health inequality.

New polling from the patient champion shows 41 per cent of adults are struggling to access care, with nearly half (49 per cent) saying that patient charge levels are unfair given the mounting cost of living. Data show the shortage of appointments is hitting those on low incomes the hardest, with the most affluent patients six times more likely to be able to pay for private care than their least affluent counterparts. 

Around 3,000 dentists have left the NHS since the onset of the pandemic, an exodus fuelled by the discredited contract NHS dentists work to. Healthwatch has stressed a new system must be in place before formal responsibility for dental services passes to the 42 new Integrated Care Systems in April 2023, following the passage of the Health and Care Act.

The current NHS contract funds care for little over half the population and sets perverse incentives to dentists, rewarding them the same for doing one filling as ten. Whilst the BDA is now in negotiations to reform the service, it remains concerned about the extent of the government’s ambitions. Ministers have declined to set a date for when the dysfunctional system will end, and offered no assurances that adequate funding will be put in place to underpin the rebuild of the service.  

The BDA has long warned that charges discourage low-income patients, and have morphed from a ‘contribution’ towards the cost of care to a substitute for meaningful state investment. Direct government contributions fell by a quarter in real terms from 2010-20, with inflation-busting patient charges hikes plugging the gap in a flatlining NHS budget. Lower patient numbers during the pandemic saw Treasury contributions reach historically high levels to maintain operations in the service, and the BDA believes that pressure to 'balance the books' is now driving decision-making across government.  

The union has stressed the government must apply the principles of the ‘levelling up’ agenda to dentistry. NHS dentistry would require an additional £880m per year simply to restore levels of resources to 2010 levels. Uptake on a recent government pledge of £50m to provide 350,000 appointments by April 1 is understood to have been limited, with the majority of practices struggling to hit existing contractual commitments as they worked through the Omicron wave. The BDA says this underscores the need for meaningful reform, wedded to a long-term approach to investment.  

Shawn Charlwood, chair of the BDA’s General Dental Practice Committee, said, "Shameful inequalities are set to widen, but ministers don't seem willing to apply their own slogans to NHS dentistry. 

"For over a decade this service has been running on empty, our patients paying more just so the treasury can pay less. 

"Choices made by government mean dentists are now walking away from the NHS, while millions go without the care they need. 
 
"A problem made in Whitehall needs to be fixed in Whitehall, with real reform and fair funding."