The report ‘Faster, Simpler and Fairer: Our Plan to Recover and Reform NHS Dentistry’ aims to reshape the landscape of oral healthcare across the nation.
Nigel Carter, chief executive of the Oral Health Foundation, said, “The new NHS dental recovery plan, while showing glimmers of hope with confirmed prevention policies like water fluoridation and expanded roles for the dental team, ultimately falls short of expectations.
“The heavy focus on childhood initiatives in underserved areas rather than addressing broader oral health disparities appears inconsistent and inadequate. It's akin to applying an Elastoplast on a gaping wound.
“The recovery plan lacks the comprehensive, immediate solutions required to rescue NHS dentistry. The government's vague response to a new dental contract is frustrating and deflating. This lacks any kind of detail or vision for the future of NHS dentistry, amounting to mere words. The absence of a commitment to scrap the unfair UDA payment system leaves patients and dentists in limbo. It feels like a postponement tactic, kicking the can down the road and passing the issue to the next administration without tangible progress.”
A new programme to promote good oral health
The plan has announced the launch of ‘Smile for Life’ to promote preventive measures for pregnant mothers’ oral health and guide parents on protecting baby gums and teeth.
As part of a £300m three-year initiative, Family Hubs and Start for Life will establish hubs in 75 upper-tier local authorities, simplifying access to services and promoting the best start in life for every family, including oral health support.
Nigel commented, "While the idea of joining Smile for Life with Family Hubs is positive in principle, it echoes the trajectory of SureStart, which faced funding cuts and closures by the government. Sustained oral health education, advice, support oral health and investment for these initiatives can be hugely beneficial to local communities.”
Deploying dental teams to schools
To address dental care accessibility issues, especially for children, dental teams will visit under-served state primary schools, offering fluoride varnish treatments and advice. This initiative will aim to bridge the gap in dental care access, particularly for children whose dental activity recovery remains below pre-pandemic levels.
Nigel said, “While revisiting the concept of school dental nurses may feel like a déjà vu, there's potential positivity if they expand beyond epidemiology to include practical interventions like fluoride varnishes. However, true impact requires engaging parents and aligning with comprehensive education and community initiatives, such as Smile for Life, for a holistic approach to oral health.”
Improve prevention of tooth decay through the first national programme of water fluoridation
Switching to fluoridated water in the most deprived 20 per cent of areas could prevent 56 per cent of tooth extractions due to decay in children and young people. New legislation simplifies starting water fluoridation schemes, and the recovery plan aims to expand fluoridation with initial plans targeting 1.6m people in the North East.
Nigel said, “We welcome the emphasis on water fluoridation programmes for oral health improvement. However, the lack of a firm commitment is concerning. Urgency is paramount, and extended consultations may impede progress for years. While initial plans for the North East are positive, a nationwide expansion is essential for comprehensive oral health benefits.”
Deploy dental vans in under-served areas whilst longer-term solutions are established
To improve NHS dental access in underserved areas, dental vans will offer appointments in rural and coastal communities beginning later in 2024. The initiative aims to provide dental care, including examinations and fillings, to patients in need. Building on success in Cornwall, this approach will quickly address the urgent treatment needs of those who have struggled to access NHS care.
Nigel said, “While mobile dental vans offer valuable access to care, concerns arise over funding, budgets, and staffing details. Without clarity on NHS salaries or contracts for non-NHS dentists, the initiative will not create additional appointments. There's also a risk of burdening community dentistry by diverting staff from practices to operate these vans, impacting overall service.”
Offer golden hello payments to attract dentists into new areas
To address NHS dentistry shortages in challenging areas, a new golden hello scheme will offer £20,000 per dentist, up to 240 dentists. The phased payments over three years require a three-year commitment to NHS work in selected locations. The scheme's effectiveness will be assessed for potential future extensions.
“The golden hello payments of £20,000 over three years fall short as a true incentive, merely reshuffling existing dentists,” Nigel said. “This initiative, with a mere 240 dentists, has minimal impact and doesn't address the larger systemic issues in creating additional dental professionals or appointments for improved access to NHS care.”
Make it easier for patients to access NHS treatment by introducing a new patient premium
To enhance NHS dental care accessibility, a Patient Premium scheme will provide additional payments to dental practices for each new patient needing treatment. Launching in March 2024 and concluding in March 2025, the scheme aims to support individuals without NHS dental care for two years, offering payments of £15 or £50 based on required treatment.
Nigel remarked, “While the new Patient Premium is suitable for check-ups and healthy mouths, it falls short for high-needs patients requiring complex restorative work. Many of these payments will struggle to cover the costs for patients needing multiple treatments, leaving dentists at a loss. Implementation challenges also arise, with uncertainty on tracking accurate patient gaps. The intentions are good, but until we have more details, this leaves too many unanswered questions.”
Uplift to the UDA
To enhance the sustainability of NHS dental work, the UDA rate will be increased from £23 to £28. This uplift, benefiting nearly 1,000 contracts, aims to better support dental teams and improve the viability of treating NHS patients. Additionally, guidance for ICBs has been developed to aid local commissioning in addressing UDA rates for improved patient care.
Nigel said, “While the UDA payment increase is a positive step, it falls short for high-needs patients. Dentists are still contending with a broken contract and an outdated UDA system that's completely outdated. There's a critical need for modernisation to better support dentists and meet the diverse needs of their patients.”
Reform the contract to make NHS work more attractive
Acknowledging concerns from dental professionals, the NHS plans further changes to dental care funding and contract models to better support high-quality, personalised, and prevention-focused care.
The upcoming recommendations aim to reform the dental contract, reflecting diverse patient needs and ensuring fair remuneration. Additionally, efforts to support professional development and skill mix within NHS dentistry will be explored, with consultation options expected later in 2024 and changes phased in from 2025.
Nigel commented, “The government's vague response to a new dental contract is frustrating and mortifying. This lacks any kind of detail or vision for the future of NHS dentistry, amounting to mere words. The absence of a commitment to scrap the unfair UDA payment system leaves patients and dentists in limbo. It feels like a postponement tactic, kicking the can down the road and passing the issue to the next administration without tangible progress.”
Enable practices to deliver more NHS care
Before 2022, NHS dental practices were capped at 104 per cent of contracted activity, hindering patient treatment expansion. In 2024/25, NHS England will collaborate with ICBs to explore ways to help contractors provide extra capacity, potentially allowing up to 110 per cent of their contractual requirements.
Nigel said, “The government's plan to increase dentist capacity seems unrealistic, asking for rushed work that may compromise standards and risk long-term burnout. Contradicting the 2006 dental contract's promise of work-life balance, this plan exposes the underlying issue of an insufficient number of NHS dentists. It's an admission that the current workforce is unsupported and tied to a contract that is not fit for purpose.”
Free up funding for practices that can deliver more by addressing persistent contract underperformance
The plan claims that in 2021-22, £150m was handed back by dental practices in unprovided care. A recent initiative is meant to empower commissioners to permanently amend consistently underperforming dental contracts, releasing unused activity units for others to deliver. Ongoing review will determine if additional measures are necessary.
Nigel said, “The government's plan to address persistent contract underperformance lacks feasibility, as there's a shortage of NHS dentists to cover the clawback. This approach fails to incentivise dentists to stay in the NHS, highlighting the broader issue of workforce retention and questioning the effectiveness of the proposed funding reallocation for increased dental service delivery.”
Ringfencing NHS dentistry budgets for dental care
With an annual investment exceeding £3bn in NHS dental services, the government are safeguarding this funding in 2024/25. Guidance will be provided to ICBs, ensuring compliance through monthly returns and enhancing oversight of the ringfenced dental allocations budget for delivering access to NHS dental care.
Nigel said, “The longstanding underfunding of NHS dentistry is infuriating, with government claims of increased investment proven false against inflation rates. The £3bn allocated remains insufficient. The larger issue persists – a broken system requiring more than just financial injections for effective reform.
"The commitment to make ICBs ringfence NHS dentistry budgets is positive, following reports of some ICBs retracting previous promises. Government backing for this commitment is welcome but again raises concerns about the shortage of dentists to cover the increased workload, posing a potential challenge to effective implementation.”
Give local commissioners the tools they need
Since April 2023, ICBs have overseen dental service commissioning, enabling local accountability. Monthly data on local NHS dental activity, including UDAs, is now published. Upcoming workforce data will support ICBs, and consideration is given to publishing Community Dental Services data, fostering collaboration with other community datasets. The NHS aims to support ICBs in commissioning new dentistry capacity for underserved areas, aligning funding with actual needs rather than historical commitments.
“Gathering more dental data is positive”, Nigel said, “but its impact depends on a well-structured plan for implementation. The collaboration between NHS, ICBs, and dental practices is commendable. Shifting funding based on current needs, not historical commitments, is a sensible approach. However, it's imperative that all ICBs incorporate oral health into their health strategies, a currently overlooked aspect amongst many of them.”
Reduce bureaucracy in NHS dentistry
In NHS dentistry, there's potential for increased efficiency and digital improvements. A new Stakeholder Reference Group for dentistry and oral health will collaborate to identify and implement changes simplifying the system for dental professionals and patients, reducing bureaucratic burdens, and enhancing overall patient experience.
Nigel admitted, “I'm staggered that identifying efficiency and digital improvements in NHS dentistry isn't already standard practice. The lack of details, vision for change, or timelines in this aspect is concerning, raising questions about the readiness and commitment to embrace much-needed advancements in the dental healthcare system.”
Expand dental undergraduate training places by 40 per cent
The NHS aims to address dental workforce shortages by increasing undergraduate dentist training places in England. Initial expansion by 24 per cent to 1,000 places by 2028/29 and further growth by 40 per cent to over 1,100 places by 2031/32 will improve access to NHS care. Distribution will target areas with the greatest need, and potential new dental schools may be explored.
“While expanding dental undergraduate training by 40 per cent is a well-intentioned move, it falls short of addressing the immediate shortage of NHS dentists,” Nigel noted. “We also do not know whether this number will be enough to meet the population’s needs in another six to seven years – when these dentists are fully trained and able to go into practice. It may leave us in the same predicament we are in today.”
Consult on mandating NHS service for dentistry graduates
Addressing workforce challenges, the NHS recognised the need for more dentists to prioritise NHS work over private practice. While there are 35,232 registered dentists, only 24,151 delivered some NHS care in 2022-2023. Concerned about graduates choosing private practice, the NHS plans to consult on a 'tie-in' for graduate dentists, ensuring they spend time delivering NHS care post-graduation. Further measures may be explored based on consultation outcomes.
Nigel said, “While dental profession retention is crucial, we now have yet another consultation in the works, which raises concerns about delaying what should be immediate action. It also does nothing to bring back the 10,000 dentists who have left the NHS.”
Increase the number of dental care professionals
To enhance dental care in England, the NHS plans to expand dental therapy and dental hygiene undergraduate training places by 28 per cent by 2028/29 and further by 40 per cent to over 500 places by 2031/32. This expansion aims to increase the availability of routine care for NHS patients. The NHS will also encourage more dental nurses and clinical dental technicians to pursue relevant education and training programs.
Nigel said, “Expanding the number of dental care professionals is a positive move, leveraging the full scope of the dental team and freeing up the dentist’s time to do complex treatment.
“While 500 training places for dental therapists is a start, this number will have minimal impact, and once trained, they need a reason to stay in the NHS.
“Encouraging dental nurses to train is commendable, but many are on minimum wage and face financial barriers to being able to invest in education. Dental nurses must receive more financial support for their education, whether that’s help in becoming a dental nurse or upskilling once qualified.”
Enable patients to access care from a variety of dental professionals.
A shift towards enabling Dental Care Professionals (DCPs) to work to their full scope is emphasised to enhance NHS dental care access. Guidance has been published, clarifying that dental therapists and hygienists can open and close NHS courses of treatment, with administrative barriers removed. A national return to dental therapy program is also being developed to refresh dental therapists' skills.
Nigel said, “Enabling patients to access care from a range of dental professionals is a positive step. It maximises the expertise of the entire dental team, optimising patient care and allowing dentists to concentrate on more complex procedures. This strategic utilisation of skills will contribute to a more efficient and comprehensive NHS dental system – a proven model already heavily used in private dentistry.”
Promote therapist-led models of care
Current regulations limit dental therapists from administering medicines without written directions from dentists, despite their expertise. A recent consultation explored enabling dental therapists to deliver medications with fewer administrative barriers. Removing these restrictions would optimise the team skill mix, enhancing patient access to dental care.
Nigel said, “Supporting dental therapist-led models of care is a forward-thinking approach to oral healthcare. This model allows for a more efficient and collaborative use of the dental team's skills, ensuring that patients receive timely and effective treatment. It represents a positive step towards addressing the evolving needs of dental care delivery.”
Make it easier for overseas dental professionals to work in the NHS
Overseas-qualified dentists contribute significantly to NHS dental care. While 30 per cent of GDC-registered dentists are trained overseas, bureaucratic hurdles delay their entry to practice in the UK. Recent legislation allows the GDC to enhance international registration processes, with ongoing efforts to facilitate quicker and smoother inclusion of overseas qualified professionals meeting UK standards.
Nigel said, “Streamlining entry for international dental professionals into the NHS is crucial. Balancing efficiency and thorough credential evaluation is vital. Let's expedite the process without compromising standards, ensuring swift integration of skilled overseas talent to enhance the quality and accessibility of dental care for all.”
Increase exam capacity for overseas qualified dentists
To practice in the UK, overseas dentists undergo the GDC's Overseas Registration Exam (ORE) or the RCS' Licence in Dental Surgery (LDS) exam. Limited exam capacity and increased demand due to pandemic disruptions pose challenges. The GDC expanded ORE capacity by 1300 places in 2023-2024, and efforts continue to explore further expansion, reduce processing times, and address the registration backlog. Collaboration with the RCS aims to expand the LDS, enhance candidate preparation, improve pass rates, and maximise GDC registration eligibility.
Nigel said, “Increasing examination capacity for overseas dentists is essential. The current backlog must be addressed. A balanced approach ensures thorough assessments without unnecessary delays, allowing qualified professionals from around the world to promptly contribute to the NHS and deliver dental care to communities in need.”
Introduce provisional registration to streamline the registration of overseas dentists
Legislation will be introduced to establish a provisional registration status, offering a quicker route for overseas qualified dentists with non-automatically recognised qualifications to join and practice in the UK. Individuals with provisional registration can work under supervision, demonstrating the required standard for full registration. Collaboration with the GDC and stakeholders will ensure the effective utilisation of this new pathway.
Nigel commented, “Approaching provisional registration cautiously is crucial; streamlining for overseas dentists must not compromise UK standards. Thorough evaluation of qualifications is paramount to ensure patient safety. Balancing efficiency with robust scrutiny is essential in navigating these proposals, preventing potential risks, and upholding the integrity of dental care in the UK.”
Explore automatic recognition of international qualifications from outside the EEA
To be on the dentists register, qualifications must be recognised through various pathways, including UK qualifications, EEA/Swiss qualifications under EU exit arrangements, or passing the ORE/LDS exams. Recent legislative changes grant the GDC more flexibility to recognise additional qualifications for UK dentist registration. Efforts will be made to encourage the GDC to fully utilise these new legal flexibilities.
Nigel shared, “Caution is warranted in exploring automatic recognition of international qualifications outside the EEA. While faster processes are needed, maintaining stringent regulations is crucial for quality assurance. Striking the right balance ensures efficiency without compromising the integrity of our standards, safeguarding the excellence of dental care for all.”
Continue to improve the Dental Performers List
Improvements to the Dental Performers List (DPL) aim to swiftly accept experienced dentists for NHS work. Changes include eliminating fees and a goal to process applications within three weeks. A review will explore further streamlining, considering the use of private-sector dentists as a 'provider of last resort' during short-term NHS supply pressure.
Nigel said, “We welcome the acknowledgement of barriers in Dental Performers List enrolment and the commitment to their removal. A three-week target for processing applications is reasonable, fostering efficiency without compromising diligence. This step forward ensures swift integration of qualified professionals, enhancing access to quality dental care for our communities.”