The British Dental Association (BDA) has responded to the latest report from the Association of Dental Groups (ADG) stressing that any action from government that falls short of fundamentally reforming the broken contract currently driving dentists out of the NHS 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, leaving the service with the lowest headcount it has seen in over a decade.

The ADG has emphasised the need for additional dentists, including training of additional dental students and import of dentists from overseas. The BDA has said 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. The union has stressed it is imperative to develop a service that encourages UK graduates to view the NHS as a place to build a career. 

Over 40 million NHS appointments – the equivalent of a whole year’s worth of care in pre-COVID times – have been lost since lockdown. While negotiations are ongoing on reform of NHS dentistry, 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.   
  
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.

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee said:  
  
“Dentists are simply not seeing a future in the NHS, with a broken contract pushing out talent every day it remains in force.

“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.  
  
“Contract reform isn’t an optional extra. It’s the necessary starting point to save NHS dentistry.”  

The British Dental Association has warned Government must pick up the pace on the reform of NHS dentistry, following an investigation from the BBC which found that teachers have requested charities to step in to provide access to dental care for school children. 

The BBC learned that with no local practices able to provide NHS care, teachers at Trinity Academy Grammar in Calderdale had appealed to their local authority, who have arranged for the charity Dentaid to assess and treat their pupils. Many of these children have not seen a dentist since the onset of the pandemic, impacting on both their health and ability to learn. The BDA understands the charity has already provided treatment to as many as 80 children for conditions including decayed and cracked teeth and abscesses, as part of a visit set to last for two weeks.   

Over 40 million NHS appointments have been lost since lockdown in England alone – amounting to over a year’s worth of dentistry in normal times – including over 12.5 million for children. Given the ongoing disruption to dental services and public health programmes, experts warn these unprecedented backlogs mean oral health inequality will inevitably widen, resulting in patients requiring more extensive, time-consuming and costly interventions. Tooth decay has long been the number one reason for hospital admissions among young children.  

At present practices are still working significantly under capacity owing to ongoing pandemic restrictions.  However, access problems have been the norm for a generation. Since 2006 dentists have been forced to work to a widely discredited target-based NHS contract – where practices have to deliver a fixed amount of activity. This perverse system pays dentists the same amount for doing 1 filling as 10, and has fuelled recruitment and retention problems across the service.  

No long-term funding has been offered to underpin the recovery and reform of the service. Despite a recent pledge of £50m to provide up to 350,000 appointments by 1 April 2022, the service has faced unprecedented cuts over the last decade and would require an additional £880m per year simply to restore resources to 2010 levels. While negotiations are now ongoing on a reformed NHS contract, there are real questions over the extent of the Government’s ambitions, and whether any meaningful improvements in access can be achieved within the current financial envelope.    

From 1 April 2022 NHS dentists in England are now working to an imposed target of 95% of pre-COVID activity, effectively amounting to a return to ‘business as usual’ while dental teams continue to be subject to pandemic restrictions. Nearly 1000 dentists left the NHS in England last year, a trend now set to go into overdrive given current pressures.     

The BDA has called on the Government to recognise the urgency, set a date for breaking from the current failed system, and provide the necessary resources to underpin the rebuild and reform of the service.   

British Dental Association Chair Eddie Crouch said: “We salute these volunteers, but this isn’t the Victorian era. A wealthy 21^st century nation shouldn’t be relying on charities to provide basic healthcare to our children. Schools can see how crucial access to dentistry is, with children struggling to eat, sleep and study. Ministers really need to learn lessons from these teachers about the importance of oral health.  

“NHS dentistry is on its last legs. Overstretched, underfunded and facing an unprecedented backlog many dentists have reached the end of their tether. One-off visits to playgrounds risk becoming the new normal unless the government steps up.”  

The British Dental Association has appointed Professor Justin Durham to the role of Chief Scientific Advisor.  

Professor Durham is currently Head of the School of Dental Sciences at Newcastle University and holds a personal chair in Orofacial Pain. He has wide-ranging research experience from early-stage biosciences research through translational studies and into applied health research. On top of providing high level advice to underpin BDA policy and campaign work, he will now be a lead voice on matters relating to evidence-based practice and public health.

On taking up the appointment Professor Durham said, “I am delighted to take up this privileged position and hope to be able to use this as a springboard to help further develop oral health related research, its implementation and its presence in the consciousness of decision-makers, the public and our profession.”

He also emphasised the importance of ensuring the broadest possible representation for the BDA on scientific matters with the widest possible number of voices contributing to this. To this end the BDA’s Health and Science committee’s already impressive group of experts has been further expanded to include six new members to allow the committee to work across the broadest possible agenda.

“Our work on Health and Science underpins the changes we seek on behalf of our members and the millions they treat,” said Health and Science Committee Chair Mick Armstrong.

“Justin brings formidable knowledge and experience to the task ahead. We’re thrilled he’s joining us, alongside new voices reflecting the breadth and depth of expertise across dental academia, practice and public health.”

The new Health and Science team members:  

Professor Justin Durham, Chief Scientific Advisor  
Justin is a Professor of Orofacial Pain and Head of School at Newcastle University’s School of Dental Sciences and an Honorary Consultant Oral Surgeon at Newcastle-Upon-Tyne’s Hospitals’ NHS Foundation Trust in the UK.  His primary research interests are in orofacial pain both at the first and second translational research gaps. He has wide experience in a variety of methodologies involved in health services research and has received international awards both for clinical and pedagogical research. 

Dr Charlotte Currie
Charlotte is a Clinical Fellow/Doctoral Fellow at Newcastle University’s School of Dental Sciences.  Her primary research interests are in health services research for acute dental pain and associated urgent dental care pathways.  She has research experience and training in epidemiology, qualitative research, behaviour change and intervention development. 

Professor Paul Hatton
Paul is the Professor of Biomaterials Science and Director for Research at the School of Clinical Dentistry, University of Sheffield. His main research focus is on biomaterials and medical devices for unmet clinical needs in oral medicine and surgery, with wider expertise in the safety of healthcare technologies and regulatory affairs. He has led a number of major UK and European research projects, and his contributions to the field have been recognised with the award of a number of prizes as well as elected roles in societies. 

Dr Hanya Mahmood 
Hanya is an NIHR funded Doctoral Research Fellow and Honorary Registrar in Oral Surgery based at the School of Clinical Dentistry, University of Sheffield. Her current research focuses on the application of Artificial Intelligence/Machine Learning to explore novel digital biomarkers in oral precancers. She is a key member of the evolving NEOPATH research group and CR UK funded ANTICIPATE project. She is also lead trainee representative for the Association of British Academic Oral and Maxillofacial Surgeons. 

Dr Gerry McKenna
Gerry is a specialist in Restorative Dentistry and Prosthodontics working as a Consultant in the Belfast NHS Health and Social Care Trust. His clinical duties are based in the Centre for Dentistry, Queens University Belfast where he also provides clinical supervision and teaching for dental undergraduates. He is a Principal Investigator based within the Centre for Public Health and a member of the Nutrition and Metabolism and Health Services Research Groups. His research is centred around optimising treatment options for older patients which positively impact their dental and overall health. His current position combines research, clinical teaching and specialist patient care.

Dr Praveen Sharma  
Praveen is an Associate Professor and Honorary Consultant in Restorative Dentistry at the School of Dentistry in the University of Birmingham. His research expertise lie in the fields of big data, epidemiology, medical statistics and the interface between oral and systemic diseases. Praveen’s research has won him numerous accolades and he has been invited by national and international periodontal societies to present his research. Praveen’s specialty is Restorative Dentistry, encompassing periodontics, endodontics and prosthodontics. 

Professor Rob Witton
Rob is a Consultant in Dental Public Health, and Professor of Community Dentistry at University of Plymouth dental school. He has a particular interest in community–based dental education and oral health improvement. He plays a key role in the University’s award winning social enterprise clinical service provider (Peninsula Dental Social Enterprise CIC) and its partner community engagement team (CET). His interests include patient safety and clinical quality improvement, children’s oral health, dental education and developing dental services for at risk groups. As Chair of the BDA’s Dental Public Health Committee, he will serve as a cross-rep. 

The full committee membership is available to view here. 

The British Dental Association Scotland has warned that dental practices will continue to face grave uncertainty, as the Scottish Government moved to impose an interim funding model for the service without meaningful negotiation.

While the BDA has welcomed the introduction of a ‘multiplier’ to be applied to dental fees, dentists have significant concerns that the planned 3-month review will have serious implications for patient care and will leave practices unable to plan. The union remains steadfastly opposed to the return to the unworkable high volume/low margin model of care that operated pre-COVID, and has urged the Government to apply the multiplier until new contractual arrangements are in place.   

The BDA had argued that the Scottish Government needed to significantly increase the current inadequate fees for extractions and denture repairs. Increased lab fees mean that dentists often provide these treatments at a loss, and the treatments are particularly prevalent in more deprived areas so any reduction in provision may further widen oral health inequalities.  

The announcement follows a bruising debate in Holyrood last week, in which all opposition parties accused the Scottish Government of failing to heed the warnings from the BDA on the potential collapse of NHS dentistry in Scotland. A BDA survey from late last year reported that 80% of dentists expect their practices will reduce their NHS commitment should the Scottish Government withdraw emergency support and return to pre-COVID models of care. 

Dentist leaders have also warned that comments made yesterday by the Public Health Minister fly in the face of the facts, given the tight restrictions practices continue to work to. Maree Todd MSP incorrectly stated that “from April, the new system will support dentists to see more patients”: an impossibility without meaningful change to COVID operating procedures.    

Both the Scottish Government and the BDA recognise the urgent need for long-term contractual reform. The Government has committed to start discussions as soon as the interim funding model is in place. The BDA stress the negotiations must include all practice activity – including work on prevention that is currently unremunerated – and adopt an evidence-based approach to address the current low fees.  

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee, said:  “Bruised by the political pressure that’s been brought to bear in recent weeks Ministers have railroaded through a package that will leave practices totally unable to plan.

“The idea this package is the result of meaningful negotiation is laughable, and any idea that practices can see more patients from April flies in the face of the facts. Dentists are still working to tight restrictions, and there is no sense we are returning to anything resembling ‘business as usual’.  The Government needs to communicate this clearly to patients.

“Applying a multiplier is the right call but the Government should have taken this opportunity to address derisory fees. We have faced the absurd situation where dentists are providing NHS care at a loss. 

“What NHS dentists desperately needed was some certainty on what’s expected of them in the year ahead. The choice to put these new arrangements in place for just three months is an exercise in futility.” 

The British Dental Association has lamented the lack of urgency from government in rebuilding and reforming NHS dentistry, as new data shows a full years’ worth of appointments has now been lost since lockdown.  

Analysis of new Freedom of Information data indicates just short of 40 million fewer courses of treatment have been delivered in England since March of 2020, when compared to pre-COVID levels. In the 5 years prior to the pandemic average volumes delivered sat at 39.4 million. [1]

As MPs prepare for a major debate on the future of the service today (10 February 13:30-16:30) the union has stressed urgent reform is now vital, both to manage the unprecedented backlog, and to halt the exodus from the NHS.  

According to a new survey, over 40% of dentists indicate they are likely to change career or seek early retirement in the next 12 months given the current pressures on the service. Two thirds (66%) indicate they will reduce their NHS commitment, with more than a third (34%) stating they plan to go fully private in the next year, and less than half (48%) are confident their practice will continue to provide any NHS services from April 2022. [2]

Dentists now face financial penalties for failing to hit an imposed targets of 85% of pre-COVID activity during the Omicron wave, amid high levels of staff sickness and patient cancellations. Data indicates a significant majority of practices will be unable to hit this target.   

The number of dentists working in the NHS in England fell by almost a thousand last year.  To stop this flight dentist leaders stress Ministers must make NHS dentistry a place where people want to work. While reform has been pledged to the dysfunctional target-driven NHS, it is unclear if there is sufficient ambition and resources to secure meaningful change. The BDA have said reform is a matter of urgency, given any reform of the service will fail if there is no workforce left by the time it is finally introduced.  

NHS dentistry has been subject to cuts not seen anywhere else in the NHS. In real terms, net government spend on general dental practice in England has been cut by about a third in the last decade.  The government recently offered a time-limited £50 million ‘treatment blitz’ designed to cover 350,000 appointments, and must be used by 1 April 2022.

Due to chronic underfunding and failed dental contract the service has long faced chronic problems with burnout, recruitment and retention, particularly in rural and coastal areas. Those with the highest NHS commitment are now the most likely to want to leave.  A BDA member survey from late 2021 indicated 93% of owners of dental practices with a high NHS commitment found it difficult to recruit a dentist, with more than 4 in 10 vacancies unfilled for more than 6 months.  

Research recently published in the British Dental Journal underlines the expectation that inequalities will have increased due to the disproportionate impact of the pandemic on particular groups including children, older people (especially those in care homes), and the socioeconomically disadvantaged. 

British Dental Association Chair Eddie Crouch said: “A year’s worth of dentistry has been lost, and we are yet to detect any real urgency from government. Patients are bottling up problems and oral health inequality is set to skyrocket. Yet far from this crisis being a COVID blip, it now risks becoming a fact of life for families across England. Ministers have recognised the system is rotten, but there is still no timetable for change and no tangible commitment to row back on a decade of cuts.

“Dentists need to see a light at the end of the tunnel. Exhausted colleagues are making exit plans while desperate patients are facing yearlong waiting times. It will take more than warm words to halt the exodus from this service and restore access to millions”   

The British Dental Association has called on Ministers and the dental regulator to deliver rapid change to laws governing tests for overseas dentists, after COVID restrictions have left thousands of applicants waiting to pass registration exams to practise in the UK.  

The union has warned that a three-month consultation on necessary legal changes – launching today – will mean little chance of parliamentary time until the autumn at the earliest – leaving an incredibly narrow window until mutual recognition of qualifications for EU dentists ends in December.
 
Due to the pandemic, the Overseas Registration Exam (ORE) has not taken place since January 2020. In response to a parliamentary question Minister Maria Caulfield MP revealed that there are over 2,000 applicants currently waiting for an opportunity to sit these exams. Under existing arrangements most of these dentists will end up waiting years before being allowed a chance to practise in the UK, and due to outdated regulations many won’t be allowed to work in the NHS.

The General Dental Council (GDC) recently told 132 candidates who had already passed the first part of their ORE that they cannot currently be allocated a place to sit Part 2 as – due to no exams taking place for two years – they have exceeded the permitted waiting time of five years from the first attempt at Part 1.

In messages to these candidates on 3 December 2021 the GDC said there was nothing it could do given the legislation it works to. The consultation that has now been published addresses the imminent issues for these candidates – but the timescales involved mean further delays to meaningful change. The consultation had been expected since the middle of 2021 and it is not clear why it has taken so long to get off the ground. The BDA will consider all proposals and provide relevant feedback, but stressed government must act quickly on feedback.
 
The BDA has been overwhelmed by messages from candidates citing desperation, suicidal thoughts and immense anger at the current situation. It has heard from dentists that have postponed having children because of the delays, and have been forced to work in roles such as minicab drivers, security guards, busboys and supermarket shelf stackers to make ends meet. 
  
The union had pressed both the GDC and Health Secretary Sajid Javid to work at pace to resolve the situation and bring down the backlog awaiting examinations, and improve the processes which allow overseas dentists to work in the NHS.

Patients in England face profound access problems, with over 38 million NHS appointments lost since the first lockdown, and with nearly 1,000 dentists leaving NHS services in the last year. 

BDA Chair Eddie Crouch said:  “Every new colleague unable to sit this exam translates into thousands of patients that will be denied access to needed care.

“We warned of the risks since the outset of the pandemic yet Ministers and our regulator failed to grasp the nettle. Inaction has left highly skilled clinicians waiting tables and stacking shelves while millions struggle to get an NHS appointment.

“For the sake of our patients government must ensure that these dentists are supported, and those still waiting to sit the exams can look forward to a fairer system.”   

The BDA has condemned the gulf in support offered to over 100 pioneering practices in England, who after years of testing new ways of providing NHS care, are bring forced back to working to historic models of care from April.

These ‘prototype’ practices volunteered to form the test-bed for new ways of delivering dentistry, to replace the widely discredited target-based NHS dental contract. In October they were informed that regulations supporting new ways of working would not be renewed.

NHS England has now confirmed it will be offering a helpline and patient leaflets. While it is anticipated other NHS practices will have to hit 100% of pre-Covidactivity from 1 April 2022 to escape financial penalties, these practices will be given leeway of hitting 90%.

Under systems being tested dentists were allocated greater time to assess the oral health needs of patients and provide needed care. This reduced the volume of patients these practices could treat, and their patient base. Pledges were made to practices that there would be no detriment as a result of their participation in the programme.

Reverting to existing models of care has taken up to 4 years for practices that have left the programme in the past. Practices are anticipated to face severe staffing problems, aggravated by already acute recruitment problems across the service. Many practices are already facing real issues with their long sustainability, hitting an 85% activity target the BDA believe are wholly unrealistic during this phase of the pandemic.

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee, said: “The support offered to these pioneering practices is too little, too late. Colleagues who volunteered to find a new and better way of delivering NHS dentistry have been thrown under a bus. After committing years of effort their reward amounts to a helpline, a few leaflets, and the uncertainty of starting again, effectively from scratch.

“These NHS practices were given the time to care that all dentists require. Going back to chasing targets could take years, and there will inevitably be casualties. Patients will once again pay the price for the reckless decisions taken by government.”