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Fixing NHS dentistry in England is not rocket science

We have told MPs it is not rocket science: Improve the terms and conditions and put in place sustainable funding, and we will have NHS dentists again.

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

We have been pushing for years, and the Health and Social Care Committee's inquiry into NHS dentistry has just begun taking oral evidence.

Thank you to every member who has continued to support us on this journey, sharing your frustrations, your concerns and your voices. We have worked to ensure they will be heard by government and the opposition.

NHS dentistry feels like it's in its final act. When I spoke to the Committee last spring, I knew many colleagues couldn't see a light at the end of the tunnel. The tweaks we have seen since have only added to that sense of frustration.

Since last year pledges have come thick and fast, but all we have seen are tweaks at the margins, showing us the limits of what's possible without real ambition and new investment.

We have heard statements made in parliament that this service has received more funding and has both more dentists and a new contract. This was our opportunity to set the record straight and to make the case for urgent and much-needed change.

Here's what you need to know.

UDAs must be scrapped

The recent marginal changes are nothing like reform. These will not stop the exodus of dentists and their teams from the NHS.

Access has fallen off a cliff."

Access has fallen off a cliff. Last summer BBC research in August showed that nine in ten practices were not accepting adult patients and eight in ten NHS practices were not taking on children as patients. There has been no clear recovery since. We continue to warn government about this, but nothing has been done.

Without new money – and none of the marginal tweaks have had a penny of new investment attached – nothing will change. It is much like rearranging the deck chairs on the Titanic, while the service slowly slips into the sea.

Without scrapping the Units of Dental Activity (UDA) system and implementing a prevention-based, capitation type system, the service will not be able to meet the demands of the population.

A recruitment and retention crisis

We continue to highlight the state of the workforce. Practices are struggling to recruit and retain staff, and every unfilled vacancy translates into thousands of patients unable to access care.

The Government has no idea how many NHS dentists England has. Officials count heads, not commitment, meaning that a full timer carries the same weight in these statistics as a dentist doing one NHS check-up a year.

Bringing overseas dentists in to work in a fundamentally flawed system will not wash."

Our surveys show over half of dentists have reduced their NHS commitment since lockdown. 75% are ready to go further. Successive governments have failed to grasp that we can't have NHS dentistry without NHS dentists. These numbers matter.

Recent changes to the contract may help some practices deliver NHS activity, but they fall far short of what is necessary to make the NHS an attractive working environment for dentists.

Some have suggested that we just need to recruit more dentists, but bringing overseas dentists in to work in a fundamentally flawed system will not wash. Dentists could be brought in, but once they experience the flaws of the UDA system, they will either go private or just leave.

We have got to get the fundamentals right, not only for people from overseas to come into the system, but to ensure our new, and existing, graduates have a service that is attractive to work in. Alongside this, retention is also a key and concerning issue.

Exodus from NHS dentistry

Dentists do not see the NHS as a place to build a career. We all know the reason. The Committee knew it fifteen years ago. A failed NHS contract is driving out talent every day it remains in force.

It is not just about money. Many new graduates are telling us that are just not happy about working in the NHS system as it is. It's not the way they want to deliver dentistry with no focus on prevention and a lack of time.

Dentists do not see the NHS as a place to build a career."

The discredited NHS contract has taken its toll on the workforce. The pressures of working to these targets during COVID has accelerated a long-term drift away from the NHS into a full-on exodus.

Government really needs to focus on what is driving the exodus and show some urgency, demonstrating how things are going to change.

A standstill budget is simply not sustainable

The Government wants to expand access and improve workforce retention on a standstill budget. It is not possible. I said that we are very worried about a continual erosion of the dental budget which stands at 38% in the last decade of real terms spend for dentistry.

At present the service is neither universal in scale nor comprehensive in scope. If there is no movement on funding, the only routes forward amount to rationing of care. Dentistry is the only part of the NHS that went into the pandemic with lower cash contributions from government than it saw a decade ago.

The UK spends less as a share of our NHS budget on dentistry than any other European nation. And even within the four devolved nations, England is an outlier, spending less per head of any of the four nations. England's dentists are legitimately concerned about the level of funding, the degree of urgency in terms of contract reform, and how are we going to recruit and retain dentists.

Recognise and reward commitment

The contract is key but there are tried and tested policies that can help to make the service a more attractive workplace for dentists that the Government can implement in the short-medium term.

I offered several solutions to help ensure dentists feel valued, such as reintroducing NHS commitment payments. A system like this was in place in England pre-2006 and continues to operate in Scotland. This would introduce a sliding scale of commitment payments for higher NHS dental activity to incentivise full-time NHS work.

I suggested a reinstatement of late career retention support payments. This would create a system to retain experienced NHS dentists at later stages in their careers and could be linked to a non-clinical role in mentoring early career dentists.

Comprehensive Occupational Health services including flu vaccinations for dentists and dental teams could also be a valuable incentive. This is in line with the rest of the NHS workforce and could provide a return on investment in the shape of a healthier and more supported workforce. While specific vaccination programmes would be inexpensive, a temporary extension during COVID illustrated the symbolism of being part of the 'NHS family'.

Bringing NHS dentistry back

I asked the committee if it was really surprised that NHS dentists are leaving this system.

Fundamentally for health professionals NHS dentistry is not a happy place to live.

It really is not rocket science to improve the terms and conditions, and increase the commitment to NHS dentistry through proper and sustainable funding. Then you will have NHS dentists again.

These messages have been heard, and in a few months the inquiry will generate recommendations to government that I'm confident will speak to the priorities of this profession and our patients.

We will continue to press for urgent change including fundamental reform of the NHS dental contract, by implementing a prevention-based capitation-focused contract, underpinned by sustainable funding.