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Fixing NHS dentistry impossible without real reform

The British Dental Association (BDA) has responded to the latest report from the Association of Dental Groups (ADG) stressing that any action from government that falls short of fundamentally reforming the broken contract currently driving dentists out of the NHS is doomed to failure.

New figures show over 2000 dentists left the NHS in England in the last year as of January 2022, down from 23,733 in 2020-21, leaving the service with the lowest headcount it has seen in over a decade.

The ADG has emphasised the need for additional dentists, including training of additional dental students and import of dentists from overseas. The BDA has said meaningful reform must take priority. There are over 42,000 dentists currently on the General Dental Council's official register, up 5% of 2018 levels, but not enough are willing to work under the current NHS system. The union has stressed it is imperative to develop a service that encourages UK graduates to view the NHS as a place to build a career.

Over 40 million NHS appointments - the equivalent of a whole year's worth of care in pre-COVID times - have been lost since lockdown. While negotiations are ongoing on reform of NHS dentistry, real questions remain as to the government’s ambition. Ministers have to date declined to set a date to break the widely discredited system of targets that form the basis of the current NHS dental contract or guarantee adequate funding will be put in place to underpin the rebuild of the service.

The current contract funds care for little over half the population and sets perverse incentives to dentists, rewarding them the same for doing one filling as ten. Dentists face financial penalties for failing to hit their allotted targets, but if they have capacity and do more they will not get paid.

The service has faced unprecedented cuts over the last decade, and would require an additional £880m per year simply to restore levels of resources to 2010 levels. Uptake on a recent government pledge of £50m to provide 350,000 appointments by 1 April is understood to be limited, with the majority of practices struggling to hit existing contractual commitments as they worked through the Omicron wave.

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

“Dentists are simply not seeing a future in the NHS, with a broken contract pushing out talent every day it remains in force.

“Millions are going without the care they need, and quick fixes are no substitute for real reform and fair funding. If Ministers try to move forward without fixing a rotten system they will just be painting over the cracks.

“Contract reform isn’t an optional extra. It’s the necessary starting point to save NHS dentistry.”