Nearly half of dentists severing ties with NHS as government fails to move forward on reform

24 May 2022
5 min read
Published:

The British Dental Association warns an unprecedented collapse in NHS commitment among dentists in England could spell the end for the service without radical and urgent action from government.

As the professional body for dentists prepares to give evidence to the Health and Social Care Committee inquiry into recruitment and retention across healthcare, a new survey of 2,204 high street dentists [1] in England reveals: 

  • Nearly half (45 per cent) report they have reduced their NHS commitment since the onset of the pandemic, by an average of over a quarter. 
     
  • 75 per cent say they are now likely to reduce – or further reduce – their NHS commitment in the next 12 months, the highest level in any BDA surveys since the first lockdown. 45 per cent say they are likely to go fully private. Nearly half (47 per cent) indicate they are likely to change career or seek early retirement. 
     
  • Two thirds (65 per cent) say their practices have unfilled vacancies for dentists. 82 per cent of those reporting vacancies cite working under the current discredited NHS contract as a key barrier to filling posts, over half (59 per cent) cite issues relating to remuneration levels, and 30 per cent cite difficulties attracting candidates to remote, rural or deprived communities. 29 per cent say posts have been unfilled for more than a year.  
     
  • Nearly nine in 10 (87 per cent) state they have experienced symptoms of stress, burnout or other mental health problems in the last 12 months, with 86 per cent reporting colleagues in their practice have received physical or verbal abuse from patients. 75 per cent say they are unable to spend sufficient time with patients, and only 25 per cent say they are able to offer the kind of care they want to provide. 

Since the start of the pandemic around 3,000 dentists are understood to have moved away from NHS work entirely. However, BDA survey data suggests that this underestimates the real drop in NHS capacity, as the proportion of dentists who report having reduced their NHS commitment is 10 times higher than those who report having quit altogether.  Most dentists provide a mixture of NHS and private care - in varying proportions. The BDA has established that most of the dentists reporting a move into exclusively private dentistry have come from a background of providing predominantly NHS care.  

The BDA stresses this new data gives the clearest indication yet of the scale of the crisis facing NHS dentistry.  The government makes no official estimates on the number of ‘Whole Time Equivalent’ NHS dentists in England, with a practitioner providing a single NHS treatment in a year carrying the same weight in workforce data as one providing NHS-only care.

The discredited NHS dental contract, imposed in 2006, puts government targets ahead of patient need, effectively setting a limit on the numbers of NHS treatments a dentist can do in a year. Dubbed ‘unfit for purpose’ by the Health Select Committee fourteen years ago, the system 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 government has promised reform, there is no timeline for when this system will end, nor is there any indication the treasury is willing to commit funds to underpin the rebuild of the service. After a decade of cuts NHS dentistry would require an additional £880m per year simply to restore resources to 2010 levels.  

Shawn Charlwood, chair of the BDA’s General Dental Practice Committee, said, “Overstretched and underfunded, thousands of dentists have already left the NHS, but many more have begun severing their ties.  

“This is how NHS dentistry will die, a lingering decline that unchecked will leave millions of patients with no options.

“This government has ensured many dentists cannot see a future in this service. Without urgent reform and adequate funding there is little hope we can halt this exodus.”   

British Dental Association online survey of 2,204 general dental practitioners (ie: high street dentists) practicing in England. Fieldwork 9-17 May 2022. Unless otherwise stated data for each question is from all respondents.

Approximately what proportion of your income was NHS based prior to March 2020? 

100% (exclusively NHS)

9%

204

90-99% (NHS)

32%

711

80-89% (NHS)

14%

318

70-79% (NHS)

9%

207

60-69% (NHS)

6%

123

50-59% (NHS)

5%

120

40-49% (NHS)

3%

56

30-39% (NHS)

3%

67

20-29% (NHS)

3%

69

10-19% (NHS)

4%

94

1-9% (NHS)

4%

91

0% (exclusively private)

7%

144

 

Approximately what proportion of your income is NHS based now?

100% (exclusively NHS)

5%

114

90-99% (NHS)

25%

544

80-89% (NHS)

11%

239

70-79% (NHS)

10%

216

60-69% (NHS)

7%

156

50-59% (NHS)

6%

137

40-49% (NHS)

4%

98

30-39% (NHS)

4%

88

20-29% (NHS)

4%

80

10-19% (NHS)

5%

109

1-9% (NHS)

8%

183

0% (exclusively private)

11%

240

 
Analysis of individual responses indicates 45 per cent (1,000) of dentists surveyed report a decline in the share of earnings from NHS dentistry from the onset of the pandemic, with 4.5 per cent (100) reporting a move to exclusively private care. The average drop among those reporting a decline in the NHS share of their total earnings is estimated at 27 per cent.

Of those dentists moving into exclusively private work, the majority (62 per cent) have come from a background where more than half their earnings were based on NHS activity prior to covid.  
 

Please describe the levels of vacancies (if any) in your practice for each of the following roles   

 

No vacancies

1 vacancy

2 vacancies

3 vacancies

4 vacancies

5+ vacancies

Don't know

Net respondents with vacancies

Associate dentists

33%

32%

19%

9%

2%

2%

2%

65%

Therapists or hygienists

55%

31%

8%

1%

0%

0%

4%

41%

Dental Nurses

27%

28%

26%

10%

4%

2%

2%

70%

Non-clinical staff

59%

26%

7%

2%

0%

0%

6%

35%


Thinking of the current vacancies at your practice for Associate Dentists how long have there been vacancies for? (Data from 1,429 respondents currently citing vacancies in their practice)

Vacancy has only just become available (last 1 month)

7%

Vacancy for 2-3 months

16%

Vacancy for 4-6 months

19%

Vacancy for 7-9 months

10%

Vacancy for 10-12 months

15%

Vacancy for 1-2 years

19%

Vacancy for 2-3 years

7%

Vacancy for more than 3 years

4%

Don't know

3%

Net more than a year

29%


What would you believe are the main barriers to filling vacancies for dentists in your practice? Select as many that apply. (Data from 1,429 respondents currently citing vacancies in their practice)

Reluctance to work under current NHS contract

82%

Low Unit of Dental Activity (UDA) value

59%

The location (ie: a rural, remote or deprived area)

30%

Difficulties recruiting dentists from overseas

22%


Please indicate your level of agreement/disagreement with the following statements

 

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Net agree

Net disagree

I feel I am able to provide the kind of patient care I want to provide

10%

16%

10%

34%

30%

26%

64%

I am fairly remunerated for my work

6%

11%

8%

30%

45%

17%

75%

My career allows for a good work-life balance

4%

15%

13%

30%

38%

19%

68%

I feel I am able to spend enough time to fulfil patient need

5%

12%

8%

31%

44%

17%

75%

I would recommend a career in dentistry to my children

2%

8%

16%

23%

51%

10%

74%

I have felt symptoms of anxiety, stress, or depression because of my job in the past year

60%

27%

6%

3%

4%

87%

7%

A member of staff (clinical/ non-clinical) in my practice has experienced physical or verbal abuse from a patient in the last year

57%

29%

5%

4%

4%

86%

9%


What changes in your working life do you anticipate in the next 12 months?                             

 

Extremely unlikely

Unlikely

Neither likely nor unlikely

Likely

Extremely likely

Don’t know/not applicable

Net likely

Net Unlikely

I will increase my personal NHS commitment

80%

11%

2%

1%

2%

4%

3%

91%

I will reduce my personal  NHS commitment

3%

4%

8%

17%

59%

10%

75%

7%

I will go fully private

9%

17%

16%

22%

23%

13%

45%

26%

I will change career/seek early retirement

15%

18%

14%

23%

24%

7%

47%

33%

I will relocate to practice abroad

47%

20%

11%

7%

4%

11%

11%

67%

My practice will cease operations

39%

30%

14%

6%

2%

9%

8%

69%