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Dentists: Tweaking broken system will not end NHS access crisis

The British Dental Association has warned minor tweaks to the widely discredited NHS dental contract - now set to roll out from today - will do little to arrest the exodus of dentists from the service or address the crisis in patient access.

The professional body has disputed claims that this represents a 'new contract' when the package amounts to tinkering at the margins of the failed target-based model and comes with no additional funding.

The contract still only funds care for little over half the population and maintains perverse incentives to dentists. The unsuitability of this system during the pandemic has accelerated the drift of dentists away from the NHS into a full-on exodus. The number of dentists delivering NHS care in England has fallen to levels not seen since 2017/18, and BDA surveys suggest that for every dentist leaving, 10 have reduced their NHS commitment by significant amounts.

The marginal changes include:

  • A 'find a dentist' website offering no appointments. Practices will now be legally compelled to update nhs.uk regularly with details on the availability of appointments. Given BBC research in August indicated 9 in 10 practices were unable to take on new adult NHS patients, the BDA stresses all this change will do is underline the paucity of patient access across England.
  • A higher reward for treating three or more teeth. Dentists will now receive five Units of Dental Activity (UDAs) for treating three or more teeth, an increase on the former level of three UDAs, which applied to care delivered to any number of teeth. However, with patients now requiring as many as 20 fillings, perversity will remain baked into the system, with less complex work still being rewarded at the same rate as treatments that can take hours.
  • A new payment rate for complex treatment. Root canal treatment on molar teeth will now be rewarded with seven UDAs, as opposed to three, as a result of BDA lobbying. However, the BDA warns the move is unlikely to be a game changer, given the nature of the challenging and time-consuming treatments – which can take up to three hours on a single tooth.
    In July, Parliament's Health and Social Care Committee dubbed the dental contract as "not fit for purpose", stating that "urgent reform is needed to boost recruitment and retention in NHS dental services." This mirrors the conclusion of a major government-commissioned enquiry 13 years ago.

The BDA has also warned that a return to austerity now risks fatally undermining NHS dental services. The recent Autumn Statement failed to set aside funds to fully insulate the NHS from skyrocketing inflation. The BDA estimates that simply to maintain the spending power in recent budgets for NHS dentistry would now require an additional outlay of nearly £0.5b a year. This follows a decade of cuts, in which funds failed to keep pace with inflation and population growth. It would take an extra £1.5b a year just to restore resources in NHS dentistry in England to 2010 levels.

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

"Minsters have done little more than rearrange the deckchairs. These minor tweaks will not end the access crisis or give demoralised dentists any reason to stay in the NHS.

"It's one thing to offer a shiny new website showing patients they can't get an appointment. It's quite another to put in place reform and funding so millions can get the care they need."