England: Fixing NHS dentistry impossible without real reform
3 May 2022
We have responded to the latest report from the Association of Dental Groups (ADG), stressing that anything short of fundamentally reforming the broken contract is doomed to failure. New figures show over 2000 dentists left the NHS in England in the last year as of January 2022, down from 23,733 in 2020-21. This leaves the service with the lowest headcount it has seen in over a decade.
“Dentists are simply not seeing a future in the NHS” Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee, has said. “Millions are going without the care they need, and quick fixes are no substitute for real reform and fair funding. If Ministers try to move forward without fixing a rotten system they will just be painting over the cracks.”
The ADG has emphasised the need for additional dentists, including training of additional dental students and import of dentists from overseas. We have emphasised that meaningful reform must take priority. There are over 42,000 dentists currently on the General Dental Council's official register, up 5% of 2018 levels, but not enough are willing to work under the current NHS system. We have stressed it is imperative to develop a service that encourages UK graduates to view the NHS as a place to build a career.
Negotiations are ongoing on reform of NHS dentistry, but real questions remain as to the Government’s ambition. Ministers have to date declined to set a date to break the widely discredited system of targets that form the basis of the current NHS dental contract or guarantee adequate funding will be put in place to underpin the rebuild of the service.
Over 40 million NHS appointments - the equivalent of a whole year's worth of care in pre-COVID times - have been lost since lockdown. The current contract funds care for little over half the population and sets perverse incentives to dentists, rewarding them the same for doing one filling as ten. Dentists face financial penalties for failing to hit their allotted targets, but if they have capacity and do more, they will not get paid.
The service has faced unprecedented cuts over the last decade, and would require an additional £880m per year simply to restore levels of resources to 2010 levels. Uptake on a recent government pledge of £50m to provide 350,000 appointments by 1 April is understood to be limited, with the majority of practices struggling to hit existing contractual commitments as they worked through the Omicron wave.