The British Dental Association has mourned the scenes at today’s Public Accounts Committee inquiry into dentistry, stressing that the hand of the Treasury appeared to be guiding each of the witnesses from the Department of Health and Social Care and NHS England.
The professional body said all the parties giving evidence appeared to lack the autonomy to deliver on the government’s manifesto pledges to rebuild NHS dentistry, including the promise to reform the discredited contract fuelling current access crisis.
While officials spoke of commissioning ‘additional activity’, they sidestepped any talk of new investment, indicating this would be using ‘underspend’ rather than new investment. The BDA understand the Treasury has refused to countenance new investment on this basis, despite savage cuts to the service.
Ali Sparke, Director for Pharmacy, Optometry, Dentistry, at NHS England acknowledged that “there just isn’t enough dentistry commissioned full stop… we know there is only enough funding for 50 per cent of the population.”
The BDA has stressed that these underspends exist because practices are currently so poorly remunerated - a simple new NHS patient exam loses a typical practice £7.69 - a denture £42.60. The BDA stress that the Treasury’s unwillingness to help NHS dentistry stand on its own two feet is accelerating the exodus to the private sector. Officials fudged answers to calls from the Committee for an official assessment of the real costs of providing care.
During evidence NHS England CEO Amanda Pritchard acknowledged the past Government’s Recovery Plan was ‘not successful’ and the modelling behind it was fundamentally flawed. Consistent concerns over the numbers from both the BDA and Health and Social Care Committee were dismissed by the last administration.
In March 2024 former Minister Andrea Leadsom admitted the modelling “had a quite high likelihood of not being reliable.” Secretary of State Victoria Atkins was exposed for misleading the House with inaccurate claims that the Government’s so-called ‘Recovery Plan’ for NHS dentistry was funded by £200m in ‘new’ money. The BDA say the new Government risks repeating past approaches based on recycling already inadequate budgets, and that it would need real confidence and full collaboration in any future modelling on pay.
Shiv Pabary, Chair of the British Dental Association’s General Dental Practice Committee said:
“The people that could give NHS dentistry a future didn’t give evidence today, but their Treasury talking points were there for all to hear.
“Until the accountants step aside, health ministers and their most senior officials will not have the headroom to save this service.”
Data published by the BDA ahead of the evidence session and aired by the Committee stressed that the coming Spending Review will either save or sink NHS dentistry. Practices are losing at least £332m a year delivering loss making treatment, a figure set to rise as high as £425m taking into account Treasury hikes in National Insurance and the National Minimum Wage. With practices being kept afloat by private care, this is only accelerating the drift from the NHS.
The BDA stress the Treasury must ensure the coming Spending Review gives Ministers and senior officials the ability to meaningfully negotiate a new model of care.
Shiv Pabary added:
“Government says it’s ‘going for growth’, but Treasury policy is doing the exact opposite for dental care.
“The coming spending review will either sink or save NHS dentistry.
“Rachel Reeves doesn’t want to see her signature on the death warrant of a service millions depend on.”
Notes to editors:
Based on BDA modelling for a typical practice:
- A simple new NHS patient exam loses a typical practice £7.69 - a denture £42.60.
- Dental surgery involving bone removal – if carried out in the practice, loses £40.60 per treatment.
- A molar root canal and crown, even charged on band 3, still loses the practice more than £21 per treatment.
Adult Examinations
- We have modelled losses on examinations as an example, and we now estimate that there is a 21% loss on an exam for a new patient.
- Looking at a variation of exams (new/ recall & include radiograph/do not) we estimate that on average, practices are losing £14,712.
- This figure amounts to a total loss for the NHS dental budget of over £90million just on adult exams.
This puts pressure on the private pricing
- 24.17% increase in private fees between 2021 and 2024
- 9.6% increase in private fees between 2023 and 2024
- Largest increase in fees between 23 and 24 are for composite fillings
The impact of NICs and NMW
- Using average practice staff pay we have calculated that the overall cost of the rise in NICs and NMW amount to over £10,000 for a small to medium sized practice, or £61million pounds in total added to the taxpayer bill for providing NHS dental care.
- As this is not accounted for by the current budget, it amounts to another cost for practices to burden, meaning the increases will have to come entirely from private income.
- The previous cross-subsidy figure for private to NHS care was estimated at £332 million. This figure was calculated using our 2023 timings study and data available on treatment volumes for 2022-23.
- If we take into account dental inflation for 2023 - 2024 and our estimated total cost of the NIC/ NMW increase, this pushes the cross subsidy to more than £425million.