How to get better access to NHS dentistry

Currently 32% of the 6447 NHS dental practices in England and the Isle of Wight have enough funding and capacity to accept new NHS patients. This is due to the way NHS dentistry is funded.

Let’s make a change. If we all work together we can improve local access to NHS dentistry.

The problem with access and NHS dentistry

It is time for government to think urgently about the dysfunctional dental contract and the chronic underfunding in NHS dentistry.
Shawn Charlwood
Chair, General Dental Practice Committee

Underfunding of NHS dentistry

There is currently only enough government funding for 25% of the population.

The government is well aware that the current NHS dental service does not meet demand. This because NHS dentistry is limited by design so that the government can limit spending. It limits the number of contracts available for NHS dentists. It then limits the number of courses of treatment for which NHS dentists can receive funding.

This means NHS dentists are not able to respond to public demand by seeing more patients, hiring more dentists or opening new NHS dental practices where they are needed.

It’s a system that works for the Treasury when it comes to keeping costs down, but it means practices can’t open where there’s demand, successful ones cannot expand, it caps access and propagates inequalities of health.
In real terms net government spend on general dental practice in England was cut by over a quarter between 2010 and 2020, and we estimate £880 million of additional funding per annum would be required simply to restore financial resources to 2010 levels.
Shawn Charlwood
Chair, General Dental Practice Committee

The current limits set on NHS dentistry result in a two tier system. Those who can afford to pay for private dentistry can access a dentist more easily. While people on low and middle incomes often struggle to access routine and emergency dental care. It would seem that equal and easy access to quality NHS dentistry is simply not a priority for the government.

Dysfunctional NHS dental contract

The NHS has already lost around 3000 dentists, and around three-quarters of NHS dentists say they are now likely to reduce (or further reduce) their NHS commitment in the next 12 months.

Morale among NHS dentists is at an all-time low.
Nearly 9 in 10 dentists have experienced symptoms of stress, burnout or depression in the last 12 months, with the majority having received physical or verbal abuse from patients who don’t understand why they can’t be seen on the NHS.
The NHS dental contract has created a working environment which most dentists say is no longer tenable.
Dentists are not leaving [the NHS] for money, they are leaving because they can’t provide the level of care they want for their patients. The quality of care they believe every patient deserves.
Dentists can’t see a light at the end of the tunnel and are voting with their feet.
The solution is not as simple as training more dentists or recruiting more from overseas.
It’s not a shortage of dentists causing these problems. It a shortage of people willing to work in a failed NHS system.
Shawn Charlwood
Chair, General Dental Practice Committee

Political party policies on NHS dentistry

Labour

Labour made the following pledges:

Provide an extra 700,000 urgent dental appointments and reform the NHS dental contract
Offer incentives for new dentists to work in areas with the greatest need, so that those who need an appointment will be able to get one.
Introduce supervised toothbrushing in schools for 3-5 year olds, targeted at the areas with highest childhood tooth decay
Shift the focus to prevention, so that in the long term, everyone who needs NHS dentistry can access it

And after entering into government, so far have taken the following actions:

A short term urgent dental care incentive scheme is being rolled out to offer funding for existing NHS dentists to help deliver the promised 700,000 additional urgent dental appointments, but no long term investment to increase capacity.
The dental recruitment incentive scheme scheme has helped recruit 93 new NHS dentists.
A supervised brushing program is being funded but only slowly rolling out in schools.
A consultation has outlined future plans to redistribute existing funding to help cover the cost to dentists of caring for new patients and patients with more complex care needs, and to help fund more prevention in children. However no extra funding has been announced to improve access for patients without an NHS dentist.
Labour plan to forcibly conscript newly qualified dentists to work in the NHS, even if working conditions are disagreeable.

It’s good that funding will be made available to cover the extra cost of treating new patients and patients with complex care needs, but this funding is just reallocation of existing funding and so will leave less funding available for routine care. Increased funding is needed to open more NHS dental practices, invest in building more surgeries in existing practices and hiring more staff to increase capacity and see more patients. Without increasing contract sizes or offering more contacts, new patients and patients with complex care needs will just be using up more funding leaving less available for routine care, in a game of musical dental chairs.

It seems such a shame that rather than concentrating on making NHS dentistry an attractive career, the government is putting resources into forcing newly qualified dentists to work in an unfit and failing NHS.

Supervised brushing programs and more preventative care for children is welcome, but water fluoridation is a glaring omission from Labours pledges and actions that could make a massive life long difference to the dental health of our children.

The Green Party

The Green Party promises:

Guaranteed access to an NHS dentist for everybody.
A new NHS dentists’ contract so that dentists are properly rewarded for taking on NHS patients.
Additional investment in NHS dentistry, reaching £3bn a year by 2030, used to transform the availability of appointments and eliminate dental deserts.
Funding for community hubs and primary care to roll-out free dental nursing for children and those on low incomes.

The Green Party has not outlined how they would change dental contracts.

Liberal Democrats

The Liberal Democrats promise to fix NHS dentistry by:

Reforming and increasing funding for the NHS dental services contract, to ensure it:
- Encourages and incentivises dentists to take on NHS patients,
- Meets patient need and demand rather than arbitrary targets,
- Puts an end to ‘dental deserts’.
Increasing the number of dentist training places in the UK and continued recognition of EU trained dentists’ qualifications.
Writing into law proper workforce planning for health and social care, including projections for dentists and dental staff.
Launching an emergency scheme to ensure children, pregnant women and young mothers have access to their free check ups on time.
Supervised tooth brushing training for children in early years settings, such as nurseries.
Removing VAT on children’s toothbrushes and children’s toothpaste.

Reform Party

The reform party have bizarrely (but perhaps not unpredictably) blamed the NHS dental crisis on migrants, and offered absolutely no pledges, promises or policies on how they would improve NHS dentistry.

Conservatives

The Conservative party finally broke its silence on any plans for NHS dentistry in February 2024 when they announced:

£200 million extra funding to be allocated to NHS dentistry, but no detail on where or how this will be spent.
Ring-fencing the £400 million underspend on NHS dentistry to be re-spent on dentistry the next financial year, but no detail on where or how this will be spent.
An increase in minimum funding to help the most underfunded dental practices.
£20,000 golden hello for up to 240 dentists to set up dental practices in ‘dental deserts’.
Reallocation of existing funding to help cover the complex treatment needs of new patients (but no extra pay for dentists).
Slightly increased flexibility for dentists to use the next financial year’s budget early, rather than pausing work when funding runs out.
A new education programme to offer parents advice on caring for babies’ milk teeth.
Dental vans will be commissioned to deliver dental treatment to some people in remote areas.
The return of dentists visiting state schools to apply fluoride varnish to children’s teeth.
A water fluoridation programme will be (very slowly) pursued (in some areas), subject to public consultation.
Plans to forcibly conscript newly qualified dentists to work in the NHS even if working conditions are disagreeable.
Plans to enable and encourage legal immigration of overseas dentists to prop up failing NHS dentistry.

Water fluoridation is the single biggest change that will have a massive positive impact on NHS dentistry and the nation’s dental health, but the planned rollout is very slow and will only be for very limited locations, and even after its rolled out it will take years to see the results – since the main benefits will be helping young children to grow stronger teeth, more resistant to decay throughout their lives.

While extra funding is both needed and welcome, £200 million was just a 6.6% rise to the £3 billion NHS dental budget – a drop in the ocean – when £1 billion (a 33% rise) is needed just to restore 2010 funding levels.

This ‘recovery plan’ is not worthy of the title. It won’t halt the exodus from the workforce or offer hope to millions struggling to access care. Nothing here meets government’s stated ambitions, or makes this service fit for the future.
Ministers wanted to stop dentistry becoming an election issue. By rearranging the deckchairs they’ve achieved the exact opposite. The crisis will remain a burning issue in communities across this country until we get real change.
Shawn Charlwood, Chair of the BDA’s General Dental Practice Committee

You have the power to change how NHS dentistry works

Your MP represents your views in parliament. If you have struggled to access an NHS dentist and you are unhappy about it, then write to your MP and tell them so they can make a change.

Writing to your MP is easier than than you think – just as easy as filling out a form. All you need to know is your postcode.

We have some suggestions for what you could say:

Tell them about the problems you have experienced trying to access an NHS dentist
Tell them you will be voting for a party that promises to improve access to good quality and affordable NHS dentistry
Ask them to publish some detail about their party’s policy on NHS dentistry
Ask them why dentists cannot open new dental practices or see more patients where you live
Ask them why we don’t currently have all of our water supply fluoridated, when water fluoridation is a proven effective, cheap and safe way to reduce dental decay for everyone
Ask them why if cigarette packets have to warn about cancer and gum disease, that sugary food and drink do not have to warn about tooth decay
Ask them why its cheaper to buy unhealthy and sugary edible food-like substances than it is to buy nutritious fruit and vegetables
Tell them what you want from NHS dentistry

WriteToThem – Write to your MP using WriteToThem.com.

You might also be interested in some of our popular dental guides and FAQ: