English dentists ‘walking away’ from NHS work as fees fail to cover costs | Dentists

A growing “exodus” of dentists willing to provide care on the NHS threatens to exacerbate the crisis in patients’ access to treatment, the profession’s leaders have said.

Dentists are increasingly stopping doing NHS-funded work because their fees for many procedures do not even cover the costs involved, according to the British Dental Association (BDA).

The fact that NHS payments had not kept pace with rising costs was forcing dental surgeries in England to “operate like a charity” when carrying out work for the health service, it said.

The situation was so serious that dentists were in effect subsiding the NHS care they provided from their private work to the tune of about £332m a year, according to BDA analysis.

Dentists lost £42.60 every time they fitted dentures and £7.69 on each examination of a new patient’s dental health when the NHS was paying for the treatment, it said.

Similarly, a practice lost £40.60 when it carried out dental surgery involving the removal of bone and £21 on a molar root canal and crown treatment, its calculations showed.

The findings come weeks after Wes Streeting, the health secretary, warned MPs that “NHS dentistry is at death’s door” and promised to take steps to save it from extinction.

The BDA submitted a dossier of evidence to the Commons public accounts committee before it takes evidence on Thursday from the NHS England chief executive, Amanda Pritchard, and Prof Sir Chris Whitty, England’s chief medical officer, on the growing disappearance of NHS dental provision.

The inability to get NHS dental care, and the consequent emergence of “DIY dentistry” and “dental deserts” across swaths of England, has become a key public and political concern in recent years.

“Demoralised dentists are walking away from a system that is forcing practices to operate like a charity,” said Shiv Pabary, the chair of the BDA’s general dental practice committee.

“This service is running on empty, kept afloat by private work and goodwill which is now in very short supply.

“A typical practice is losing over £40 on a set of NHS dentures. Without the cash from private work covering those losses it wouldn’t be possible to pay the bills.

“Austerity has fuelled the growth of private income streams. The Treasury could halt the growing exodus from the NHS, but instead it’s turbo-charging it.”

He said that without a big increase in government funding for NHS dentistry in her spending review this autumn, Rachel Reeves, the chancellor, could have “her signature on the death warrant of a service millions depend on”.

The Nuffield Trust, which warned in a report in 2023 that NHS dentistry risked being “gone for good” without bold action, said dentists were being penalised financially for treating NHS patients.

“Dentists will not necessarily lose money on NHS work. But it is a real problem that they are often being asked to make a financial sacrifice to see a health service patient instead of a private one,” said Mark Dayan, a policy analyst and head of public affairs at the thinktank.

“We see from recent data that fewer dentists are carrying out less NHS work than before the pandemic, and even they are doing fewer hours.”

NHS England figures show that while the total amount of money spent on dental care in England rose from £5.6bn in 2005-06 to £10.2bn in 2022-23, the proportion of NHS work shrunk from half to barely a third, and the share of private care increased to almost two-thirds.

Dayan said the NHS was breaching its legal duty to provide dental care that was available to everyone and free at the point of use.

“Even before the pandemic, only half of adults were receiving a checkup every two years on the NHS, the minimum that is recommended: it is now considerably fewer. The NHS is supposed to be a universal service, but for dentistry the majority of the population are not getting the basics.”

Streeting has pledged to reform the NHS dental contract, provide an extra 700,000 NHS-funded appointments and publish a dental recovery plan. However, the BDA noted there had been “no progress towards delivery” since Labour won power last year.

A Department of Health and Social Care spokesperson said: “This government inherited a situation where NHS dentistry is broken after years of neglect. We are committed to rebuilding it, but it will take time.

“Our plan for change will see an extra 700,000 urgent dentistry appointments to help those who need it most – with new NHS planning guidance instructing trusts to start working up plans to deliver them as soon as possible.

“We will also reform the dental contract to encourage more dentists to offer NHS services to patients and introduce supervised tooth-brushing for three- tofive-year-olds in the most deprived communities.”