A growing exodus of dentists from NHS work is worsening the access crisis for dental patients across England, according to the British Dental Association (BDA). The organization warns that the financial strain placed on dental surgeries by NHS fees, which fail to cover the costs of treatments, is forcing many practitioners to abandon public service work altogether.
Dentists are increasingly ceasing to take on NHS cases due to the unviable reimbursement rates. The BDA reports that NHS payments have not kept pace with rising costs, causing dental surgeries to operate at a loss for many procedures. This has led to a situation where NHS-funded work is being subsidized by private practice income, with an estimated annual loss of £332 million across the industry.
For instance, dentists lose £42.60 for each set of dentures fitted under the NHS, and £7.69 for every new patient exam. Other procedures, such as dental surgeries or root canal treatments, are also resulting in significant financial losses for practices.
The crisis was highlighted earlier this year when Health Secretary Wes Streeting acknowledged that NHS dentistry was “at death’s door,” pledging to take steps to address the problem. However, the BDA’s recent analysis points to continued struggles despite promises of reform.
Shiv Pabary, chair of the BDA’s general dental practice committee, described the current system as “operating like a charity,” sustained only by private work and dwindling goodwill from dentists. “A typical practice is losing over £40 on a set of NHS dentures. Without the income from private patients, many practices wouldn’t survive,” Pabary said, emphasizing that the situation is unsustainable.
Financial struggles have driven many dentists to abandon NHS contracts entirely, and the government’s attempts to rectify the situation with incentives, like the “Golden Hello” payment scheme, have largely failed to make a significant impact. Only 39 dentists have taken up this offer, far short of the 240 originally targeted.
Mark Dayan, a policy analyst from the Nuffield Trust, also warned that the financial sacrifices required for NHS care are discouraging dentists from treating health service patients. As a result, fewer dentists are taking on NHS work, and the amount of care being provided has significantly decreased. NHS England statistics show that while spending on dental care rose from £5.6 billion in 2005-06 to £10.2 billion in 2022-23, the proportion of NHS-funded work dropped from half to just one-third of the total.
The government’s current plans to address the crisis include providing an additional 700,000 urgent appointments and promising reforms to the NHS dental contract. However, the BDA has criticized the lack of progress, noting that since Labour’s victory in last year’s election, no significant steps have been taken to improve the situation.
Professor Sir Chris Whitty, England’s chief medical officer, recently stated that the government’s Dental Recovery Plan, which aimed to provide 1.5 million new treatments, has failed. He acknowledged that the expected increase in NHS patient appointments simply did not materialize, leading many to conclude that the plan was ineffective.
A Department of Health and Social Care spokesperson reiterated that the government inherited a “broken” NHS dental system and that rebuilding it will take time. The spokesperson highlighted new initiatives, such as supervised tooth-brushing programs for children and the provision of additional urgent appointments, but acknowledged that the system’s long-term sustainability will require more significant reforms to attract and retain dental professionals.
As the NHS dental crisis deepens, many fear that without immediate and effective action, the public health service may soon be unable to provide the essential dental care millions rely on.
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