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The perfect storm: the 4 million being failed by NHS dentistry

Blog Author Dave Cottam

Blog Date 20/11/2019

What is ‘unmet need’? It’s a question that all political parties need to answer when it comes to the perilous state of NHS dentistry in England.

We’ve exposed a scandal tucked away in the government’s own data. It’s the 1.4 million adults who tried, and failed, to access care in the last two years. 

But it doesn’t end there. It’s a further two million that didn’t try to attend because they believed they would be unable to secure an appointment. It’s the 130,000 reporting they are on waiting lists. And it’s over 700,000 citing cost as a barrier.

It’s a level of unmet need of over four million people. That’s close to one in 10 of the adult population.


It’s not just a few ‘hotspots’

Officials have begrudgingly acknowledged there are access ‘hotspots’. But it is clear from the data that problems are now blighting communities across every English region. 

Yes, the situation in parts of West Yorkshire, Lincolnshire, the South West and the North West remains dire. But we’re no longer talking just the ‘usual suspects’. It’s a problem we’re seeing in communities from Bradford to Brighton.

And, if we look at all unmet need, some of the worst affected areas are the capital and the Home Counties, including the overwhelming majority of the London boroughs. 



We know the reasons for a static NHS dental budget

Our patients face this perfect storm as a direct result of NHS budget cuts, dental contract failure and staffing problems that are becoming ever more acute. 

NHS dentistry is operating on a budget that has remained static since 2010. And it’s no surprise many are feeling the pinch as stealth cuts have seen state contributions tumble, and left patients putting in an ever-greater share of the budget through NHS charges.  

We’ve seen GPs receive a 17% increase in investment since 2010. Ophthalmic Services 14%. 


However, our corner of the NHS is operating on less than it is was a decade ago, with no attempt to keep pace with population growth or inflation.

And it’s the dental contract that funds care for little over half the population, and its activity driven targets that have caused a collapse in morale within the dentistry workforce.

Recruitment problems are now endemic. We’ve shown 75% of practices struggling to fill vacancies, and 59% of dentists stating their intentions to reduce or end NHS work. 

And it’s an act of self-harm that these problems are hurting practices most that have made the biggest commitment to the NHS. 


We need dental contract reform that works for all

We’ve set out the changes we need to see for dentistry.


Dentistry cannot remain the missing piece in our health service, and whoever forms the next government has to tackle underfunding, offer support for the workforce, and deliver meaningful reform. 

Yes, we want to see dental contract reform succeed.  

Yet when 20-45% of the practices testing new models of care have failed to hit their targets we have to ask whether the government’s stated objectives - maintaining access, ensuring the sustainability of practices and embedding prevention, all within the current cost envelope - can actually be met. 

So, we will not let up. We’ve spoken up for the profession. Parliament’s Health and Social Care Committee has already responded by launching an inquiry. And for the first time in a generation, dentistry has now become a hot topic in a general election. 

This is about delivering a fair deal for both practitioners and patients. 

We’re seeing families in Portsmouth facing ferry rides, and patients in parts of Cornwall round trips of up to 120 miles to access care. These stats show lower success rates in securing appointments among new patients, younger adults, and ethnic minorities.

The public is entitled to access care. And the system should not be stacked against them. 

But they face practices struggling to fill vacancies, NHS charges which are designed to discourage attendance, while our contracts cap patient numbers.

The one in 10 who are losing out are the patients who need us most. The next government owes it to them to ensure this service has a future.

Dave Cottam, Chair
General Dental Practice Committee

Can you help us? Speak to your candidates...

It's vital that prospective MPs know they have dentists living in their communities, who are ready to stand up for dentistry. We need you to speak to candidates in your local area and make sure they know the issues facing our profession: 


  • Please read our manifesto: from underfunding to access, ensure you know the bigger picture and can explain it to your candidates
  • Start the conversation: Candidates will be out on the streets, on your doorstep, and at hustings events. Please stand up for dentistry: introduce yourself, tell them about the issues in our manifesto, and ask them, if they are elected, will they speak up for dentists and the nation’s oral health in Parliament? This is your chance to make a difference
  • Share with colleagues, and on your social media channels: we will be making the case for dentistry strongly on our Twitter and Facebook. Please join in, repost and share, using the hashtag #MissingPiece.

Through our policy and campaigning work, we ensure that the concerns of all sections of the profession are raised and that dentists' voices are heard at a national level.

With each new member, our voice and our influence grows. Add your voice, join today.