Go to content

Dentists: Progress now possible to save NHS services

The British Dental Association says initial talks with the new government have opened the door to reform of the discredited contract NHS dentists in England work to.

The professional body has stressed that the Government's new policy - to regard the NHS as 'broken' - could hold the key to breaking the impasse on fundamental reform of the service. It has greeted the acceptance from the new Secretary of State Wes Streeting MP on the damage caused by the current system.

The contract – imposed on the profession in 2006 – has fuelled workforce and access crises plaguing NHS dentistry. With an exodus already in motion, the professional body says reform won’t wait – a decent contract won’t work if there is no workforce left by the time it’s finally introduced.

The contract was dubbed 'not fit for purpose’ by the Health and Social Care Committee in its damning report published in July 2023, which urged a fundamental break with the target-based system, and a shift to a prevention-focused, patient centred model of care. The BDA described their recommendations as an ‘instruction manual to save NHS dentistry’.

The last government just offered tweaks to this framework. This resulted in the BDA damning their NHS Dentistry Recovery Plan as ‘unworthy of the title’. Former Ministers stated their ambition was to ensure “everyone who needs one [is] able to access an NHS dentist”, but only 1% of dentists believed the plan could achieve this laudable objective. The plan had no new funding attached.

The Nuffield Trust have stressed that successive governments’ approach of “muddling through” when it comes to dental policy is no longer viable. Both the Labour and Conservative Parties committed to reforming this system back in 2010.

The current contract effectively sets a cap on the number of patients a dentist can see on the NHS. If dentists cannot hit their target they face financial penalties, if they try and do more, they won’t get paid. Underspends – typically the result of unfilled vacancies – have left hundreds of millions of the dental budget unspent, and usually lost to cover deficits in other parts of the health service. The payments dentists receive also bare little to no relation to the work required, with procedures that take minutes rewarded at the same rate as treatments that can take hours – with the same rate for delivering 3 or 20 fillings. This means that the system effectively punishes dentists for taking on new patients with high needs. An entire course of treatment for a patient with very high needs is often not enough to cover costs.

Years of chronic underfunding have left some practices delivering some NHS treatments at a financial loss. The dental budget has been flat in cash terms since 2010, with a static budget of around £3bn failing to keep pace with soaring costs and population growth. This has resulted in real-term cuts with no parallel anywhere in the NHS – in real terms the dental budget was cut by over a third since 2010; a real cut of £1bn.

The BDA has called on the new government to set out both a short-term rescue package and longer term reform of the service, which will understandably take more time. The professional body has said a cost-neutral rescue plan - that puts huge underspends to work - could ensure hundreds of struggling NHS practices remain sustainable. This would be an interim measure, while negotiations are concluded on fundamental reform of the NHS contract.

The professional body has said it is ready to work constructively to with the new government on delivery of its commitment of 700,000 new urgent and emergency dental appointments.

Shawn Charlwood, Chair of the British Dental Association's General Dental Practice Committee said:

“The first step to save NHS dentistry is admitting we have a problem. Wes Streeting has done so today.

“There is finally recognition that failed contracts and underfunding have fuelled the current crisis.

"We take absolutely nothing for granted, and will hold this government to account as we did the last.

“But there's now a chance to move forward, to rescue and reform a service millions depend on.”