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NHS dentistry: Have we reached the point of no return?

​We've worked with the BBC to lift the lid on the crisis facing NHS dentistry. The results are eye-watering and shine a light on the shocking state of access to NHS care for patients across the UK.

Shawn Charlwood
Shawn Charlwood Chair, General Dental Practice Committee
Shawn Charlwood speaks to the BBC about NHS dentistry access
Shawn Charlwood speaks to the BBC on NHS dentistry crisis

Unfortunately, as dentists, we have known this crisis has been brewing for many years. And despite our tireless campaigning and repeated calls on governments to step up, we've not seen the change we need.

Many colleagues joined with me to speak on your behalf in the national and local media. They said that dentists are voting with their feet, and thousands have now left the service since lockdown.

NHS dentistry is at a tipping point. If we're not there already, we're reaching the point of no return.

We are currently surveying dentists on these issues, so please take the chance to have your say. The BBC documentary Disappearing Dentists is now available to view online. It shows why we need action from governments now:

Hanging by a thread

Nothing we've heard from any UK government in recent months gives us any confidence that NHS dentistry has a future – and we are not exaggerating when we say to politicians that this service is hanging by a thread.

Now we're seeing the results - a staggering 9 out of 10 dental practices UK-wide are unable to offer NHS appointments to new adult patients – while 8 in 10 are not accepting new child patients.

A map of the UK showing the proportion of dental practices not taking new patients, based on data obtained by the BBC


UK-wide, 25% of practices said they had an open waiting list, and over 1000 said the wait time was a year or longer or were unable to say how long it would be. However, the crisis runs deeper, for as we know many practices have effectively given up the pretence of maintaining these lists given the huge pressures they are under.

This is a crisis being felt in every corner of the UK. BBC researchers did not reach any practices accepting new adult NHS patients in over a third of all local authorities.

The Scottish Government has tried claiming things are fine north of the border, given the number of practices not taking on new NHS patients is a mere 82%. However, this looks like a laughable attempt to deflect from the sheer scale of the crisis.

We've been clear, the backlogs are not just caused by Covid, but by systems that are unfit for purpose and funding that has simply not kept pace with demand or rising costs.

We need real reform

It's a simple fact Ministers in all nations need to understand, that we can't have NHS dentistry without NHS dentists.

Colleagues are quitting or radically scaling down their commitment, exhausted and fed-up with a system they cannot make work anymore. Morale has hit rock-bottom.

We need to see ambition and commitment: real reform, backed up by sustainable investment.

They need to act now to stem the tide and ensure NHS dentistry is rebuilt from the ground up.

NHS England's recent modest, marginal changes to the discredited NHS contract, go nowhere near addressing the systemic problems the service faces. It's time to do more than rearrange the deck chairs.

In Northern Ireland, health service dentists have seen incomes fall by 40% in real terms since 2008/2009 and, added to rising costs, many practices are facing the prospect of delivering care at a financial loss. It is time for change.

The scaling down of financial support for NHS dentists in Scotland has also left many practices at risk of delivering NHS care at a loss. We have called for an interim funding package to help work through the backlog, as well as a new, sustainable, long-term model for NHS dentistry.

And while contract reform is moving forward in Wales, recently announced policies go nowhere near addressing the scale of the crisis. Moving the goalposts on recall intervals will go no way to fighting the tide of the backlog, as the Welsh Government suggests. We have stressed that sustained investment is needed to actually fix this broken system.

We need to see ambition and commitment: real reform, backed up by sustainable investment.

Dentistry is not an optional extra

Many dentists are at the end of their tether, but patients are also giving up hope of ever getting an NHS dental appointment.

Many have been writing to their MPs, incredulous that they cannot see a dentist. We have been horrified by reports of people pulling out their teeth in desperation, resorting to methods which belong in the Victorian era.

And this matters. Dentistry is not an optional extra.

As our new Chief Scientific Advisor, Prof Justin Durham has stressed dental pain is like no other. Teeth are hard wired to the brain, and it's no surprise that it's the number one driver of overdoses from paracetamol.

Dental pain has always had a huge impact on people's lives – their physical and mental health, and their productivity. Now they now face a double whammy.

Patients in pain are unable to secure the care they need. Patients wanting to stay out of pain through routine check-ups are unable to secure an appointment.

We are yet to see the full impact the pandemic has had, but health inequality is already widening. Failure to act will hurt those in our most deprived communities.

What we need to see now

NHS dentistry is now on 'life support' according to Nigel Edwards, Chief Executive of the Nuffield Trust. "Action will need to be taken" he said, but "there doesn't seem to be any real appetite for real structural and investment decisions required to fix NHS dentistry."

NHS dentistry is now on 'life support'.

This situation is the result of choices made by successive governments and opposition parties across the UK are now calling on their respective governments to wake up.

Years of under-investment in NHS dentistry has led us to this point. In England alone it would take £880m more a year simply to restore funding to levels we saw a decade ago.

No dentist should have to provide NHS care at a loss.

We are dealing with a preventable disease, and prevention must be at the heart of any new contracts.

We need an end to arbitrary targets and accessible care for all those who need it.

Urgent change is needed now and only this will help to tip the scales and end the growing oral health inequalities we are seeing across the UK.

It is time to fix NHS dentistry before it is too late. The clock is ticking.