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The end of NHS dentistry as we know it?

Thanks to our members we've been able to present the facts to MPs on what's really driving the crisis in NHS dentistry.

Shawn Charlwood
Shawn Charlwood Chair, General Dental Practice Committee

I was honoured to be given the opportunity to express the frustration that thousands of dentists are feeling across the country in Parliament. I warned of the growing exodus, and that inaction from government will mean the death of NHS dentistry.

BDA General Dental Practice Committee Chair, Shawn Charlwood, speaks to MPs at the Health and Social Care inquiry into recruitment and retention across healthcare

We were asked to address the Health and Social Care inquiry into Workforce: recruitment, training and retention in health and social care, armed with evidence from thousands of members which truly showed the strength of feeling across this profession. Here's what you need to know:

Patients and the profession are suffering

I'd like to thank everyone who responded to our survey. What you told us, your evidence, your voices are what I expressed to the Committee.

I said I have not seen the state of NHS dentistry this bad in my 35 years of practising and told them colleagues are genuinely struggling.

I said one young dentist, saddled with £70,000 of student debt, told us he earned only £9 for a whole day's work due to the UDA system: "I don't hate my job" he said, "I hate not getting paid for all the work I'm doing."

Many of you spoke about the fears you have for your NHS patients getting access to treatment but said that you just can't keep working in a system that doesn't reward you for the work you do, and that clearly doesn't value your skills or experience.

I told the Committee that their report must not be ignored again – as it was in 2008 – when they said UDAs were 'unfit for purpose'. Inequalities in terms of dental health are widening and government must do something now.

The tip of the iceberg

Over 40 million NHS dental appointments have been lost since the beginning of the first lockdown – a year's worth of dentistry in pre-Covid times.

We've worked with the press to highlight these issues – including stories of those who are pulling out their own teeth in desperation, unable to get appointments. This Victorian dentistry has no place in a modern society.

But this is just the tip of the iceberg.

The crux of the issue is ensuring the NHS is an attractive place for dentists and their teams to work. Younger dentists have told us they are fed up with this broken system; morale has hit rock bottom, the pressures of working under Covid have been too great.

We've lost around 3,000 dentists from the NHS, but the problem goes deeper. For every dentist that's given up NHS work, there are ten who have reduced their commitment. Nearly half of dentists we polled have pared down their NHS work since lockdown, by an average of well over a quarter.

It speaks to the total lack of meaningful workforce planning. As I told the Committee, there is no data on whole time equivalent numbers for NHS dentists, and so Ministers and officials are flying blind.

Ministers can try and fill this leaky bucket, or they can get on and fix it.

The results are obvious, for the profession and for patients. Practices across the country are struggling. They can't retain the staff they have or fill their vacancies.

Even London – which never normally saw any problems with recruitment – has an average of 5 vacancies for every applicant, with dozens of vacancies unfilled for up to 12 months.

It's not a shortage of dentists causing these problems. It a shortage of people willing to work in a failed NHS system. The solution is not as simple as training more dentists or recruiting more from overseas.

Ministers can try and fill this leaky bucket, or they can get on and fix it.

Chewed up and spat out

As I told Mr Hunt and his colleagues, at the end of the day working chasing NHS targets, dentists feel like they've been chewed up and spat out.

Nearly 9 in 10 say they have experienced symptoms of stress, burnout or depression in the last 12 months, with the majority having received physical or verbal abuse from patients who don't understand why they can't be seen on the NHS.

I said it is time for government to think urgently about the dysfunctional dental contract and the chronic underfunding in NHS dentistry, or these trends are only going to get worse.

Dentists can't see a light at the end of the tunnel and are voting with their feet.

Our latest research also shows three-quarters of dentists say they are now likely to reduce – or further reduce – their NHS commitment in the next 12 months, with 45% saying they are likely to go fully private. They want to provide the level of care they believe their patients deserve.

Many colleagues have simply given up hope government is willing to deliver the change we need. These dentists can't see a light at the end of the tunnel and are voting with their feet.

As Committee member Rosie Cooper MP noted, it really feels like we're approaching the end of NHS dentistry as we know it.

Bin the UDA

I told the HSC that the issue is not a lack of dentists, but that the NHS dental contract has created a working environment which most dentists say is no longer tenable.

This problem is not new either – the Committee looked at the current contract back in 2008 and deemed it 'not fit for purpose'. And yet, successive governments have not sorted it out.

Hundreds of you told us government needs to 'bin the UDA'. One respondent said they could earn more as a lorry driver. It's made dentists feel undervalued and disrespected. No other area of healthcare has had its budget slashed as much as dentistry over the last decade.

Committee members struggled to get their head round the perversity of the UDA. It prompted the Chair to throw the question is this 'rationing' by the back door? It was a simple yes from me, and the patients who lose out most are the patients that need us most. The higher needs, irregular attenders, often from areas of high deprivation. It's a system that works for the Treasury when it comes to keeping costs down, but it means practices can't open where there's demand, successful ones cannot expand, it caps access and propagates inequalities of health.

Prevention should not be an afterthought. We have made it clear what we want: a commitment to a timeline when a new contract will be rolled out and an immediate and long-term increase of financial investment into NHS dentistry.

I told the Committee that dentists' take-home pay has fallen by 40 per cent in real terms in the decade from 2010/11. In real terms net government spend on general dental practice in England was cut by over a quarter between 2010 and 2020, and we estimate £880 million of additional funding per annum would be required simply to restore financial resources to 2010 levels.

Looking ahead

For his part, Mr Hunt has opened the door to revisiting a major inquiry into dentistry, which was cut short by the snap 2019 General Election. And we need to keep the pressure on.

Morale among NHS dentists is at an all-time low and I told the Committee that dentists are not leaving for money, they are leaving because they can't provide the level of care they want for their patients. The quality of care they believe every patient deserves.

Every dentist lost to the workforce and every vacancy that remains unfilled means thousands more patients losing access.

We know that we can do better for our patients. We just want government to make that commitment and do what's needed.

To fund the service properly. Provide a contract dentists would choose to work under. Only then will we be able to retain, recruit and provide the care our patients need.