The British Dental Association has called on Government to heed the call of the Public Accounts Committee (PAC), and deliver fundamental reform of NHS dentistry, underpinned by sustainable funding.
The Committee have slammed repeated tweaks at the margins from the last government, and expressed concern over the lack of detail from the new administration on the shape and timings of comprehensive reform.
The PAC has called on the authorities to be clear what the actual cost of delivering NHS dentistry is, stating “without which any efforts at reform will fail to address fundamental issues around the affordability of NHS work.” Evidence put by the BDA to the Committee showed the typical practice loses over £42 delivering a set of NHS dentures.
News comes as analysis published by the Nuffield Trust and The King’s Fund shows satisfaction with NHS dentistry is at an all-time low. As recently as 2019 this was at 60%, but it has now fallen to a record low of 20%. Dissatisfaction levels (55%) are the highest for any specific NHS service asked about.
The Labour Party committed to reform the discredited contract fuelling the crisis in NHS dentistry. Lord Darzi’s Independent investigation of the NHS in England noted: “if dentistry is to continue as a core NHS service, urgent action is needed to develop a contract that balances activity and prevention, is attractive to dentists and rewards those dentists who practice in less served areas.” The Government has yet to offer a mandate for formal negotiations to begin.
Shiv Pabary, Chair of the British Dental Association’s General Dental Practice Committee, said: “MPs have arrived at an inescapable conclusion, that tweaks at the margins have not and will not save NHS dentistry. We’ve never budged from our view that government’s past and present have needed to go further and faster. We’re ready to roll up our sleeves and start on the fundamental reform required to give this service a future.”
‘Welfare reform has pushed millions away from NHS dentistry’
With up to half a million recipients of Tax Credit Certificates set to lose their access to free NHS dental care from April 6 the British Dental Association has interrogated official data, and found millions of patients have stopped accessing NHS dentistry since the transition to Universal Credit (UC) since transition began under the last government.
7.8m claims were made for free dental care by adults in England in 2015/16, falling to 5.4m in 2023/24. The BDA examined all the benefit groups transitioning to UC, and has found no corresponding growth in paying adult NHS patients, leaving a net loss of over 2.3m appointments in this group – which is characterised by lower incomes and higher needs. Over 500,000 free appointments were claimed by Tax Credit Certificate recipients last year, down from nearly 2.5m in 2015/16 as a result of the UC transition.
Factoring in COVID disruption, these vulnerable patients have been left as a much smaller share of overall appointments, 16% in 2023/24 compared to 20% in 2015/16. While the ongoing crisis in access to NHS dentistry has led to a drop in the number of paying adults seen too, the fall in the exempt group has been by far the most dramatic, fuelling health inequalities.
While the BDA has only assessed English data, this change will hit recipients across all four UK nations.
Fuelling this fall is huge confusion over entitlements for UC recipients. To be eligible for free NHS dental treatment when receiving UC, a household’s total take-home pay in the last assessment period must be £435 or less, or £935 or less if the UC includes a child element or the adult (or partner) have limited capability for work. Exemptions based on previous benefits like income support and tax credits did not include such complex conditions and have instead operated on a simple yes/no basis for access to free dental care.
The BDA has told the Department of Health and Social Care and the Department of Work and Pensions that a transition period must be introduced, that ensures these tax credit recipients do not end up exposed to the £100 fines routinely issued to confused patients for ‘misclaiming’ free care. The professional body says the transition must be used to roll out Real Time Exemption Checking to NHS dentists, a service that already exists in pharmacy that could help eliminate this confusion.
Dentist leaders have been pushing for sustainable funding and have said this drop illustrates the huge impact charges have on patients. On Tuesday charges in England increased by around 2.3%. The increase is unlikely to put a penny into the struggling service – in the past hikes in patient charges have simply allowed government to reduce its share of spend into a budget that has remained effectively static for a generation.
BDA Chair Eddie Crouch said: “The architects of welfare reform in the last government threw millions of our patients under a bus. A new government must change tack. The people who lost their entitlement to free dentistry haven’t suddenly started paying for NHS care. They’ve just stopped attending. Further changes are set to cast more patients adrift or expose them to the risk of fines because no one is spelling out what these changes mean.”
