BDA: Government needs to show same ambition across tobacco prevention agenda

Following plans for a phased ban on tobacco, the British Dental Association says Government must now show the same ambition across public health, given consistent failure to grasp the nettle on prevention in the face of deep and widening inequality.

The Prime Minister has proposed annual rises in the legal age for purchasing cigarettes. The move, echoing an approach already in force in New Zealand, has potential to ensure the next generation grows up smoke free.

Dental professionals are on the frontline in the battle against oral cancer – which claims more lives each year than car accidents – and gum disease. Smoking is one of the key drivers for both conditions.

Dental leaders stress ministers must now show they are serious about prevention across all areas of health. The ongoing access crisis in NHS dentistry is fuelling widening inequalities, with unmet need for NHS dentistry in 2023 estimated at 1 in 4 of England’s adult population. The first oral health survey of 5-year-olds published since lockdown showed no improvements in decay levels and a widening gap between rich and poor. The government pledged a recovery plan for NHS dentistry in April 2023 that remains unpublished. Its official response to the Health and Social Care Committee’s damning inquiry into NHS dentistry has been overdue since 14 September.

The professional body has lamented drift on bans on prime-time junk food advertising and on buy one get one free offers for products high in sugar.

Despite the Health and Care Act ‘simplifying’ the process for water fluoridation, there is no indication capital funding is being brought forward for rollout.

The public health grant – used by local authorities to fund vital preventive services – has been cut by a quarter since 2015 in real terms, undermining existing preventive schemes.

Mick Armstrong, Chair of the British Dental Association’s Health and Science Committee said: “Government seems willing to be bold and ambitious on tobacco but appears to be waving a white flag on the wider prevention agenda. Deep seated health inequalities in this country are widening with every passing day. We need real commitment to close that gap.”

NHS dentistry isn’t working: PM pressed to act on access crisis at conference

With government yet to honour pledges for a rescue plan for the ailing NHS dental service, the British Dental Association has taken the message directly to delegates at the Conservative Party Conference. 

As the host city joining the growing list of communities seeing patients queuing round the block to access care, the professional body has adapted the Party’s iconic ‘Labour isn’t working’ poster to underline the depth of the crisis now facing patients. 

Last month in Leigh, Greater Manchester, daily queues starting as early as 4am were reported outside the Avenue Dental Centre, which offers appointments to NHS patients on a first-come-first-serve basis. This follows reports in August from Faversham, Kent, where a practice received 27,000 calls for just 60 NHS slots, and in Kings Lynn which in May saw queues of more than 300 form from 4am. 

During last summer’s leadership bid Rishi Sunak pledged to “restore” NHS dentistry, with a vow to address the “unprecedented pressure” the service is under. Minor tweaks to the discredited contract fuelling the exodus of dentists from the NHS were announced in July 2022 under the Johnson administration and finally rolled out in October 2022 under the Truss administration. No part of the PM’s ‘5 point plan’ – which included a pledge to reform contracts to keep dentists in the NHS – has since been taken forward. 

Ahead of a bruising evidence session with the House of Commons Health and Social Care Committee in April 2023, the government pledged a Recovery Plan for the service. Widely expected before summer recess, it remained unpublished as parliament broke for conference season. In July the Committee concluded its inquiry, describing the state of the service as “unacceptable in the 21st century”, and set out recommendations to government for real, urgent reform, alongside a call for the recovery plan to be underpinned by necessary funding. The Government’s response to the inquiry has been overdue since 14 September 2023.

Analysis undertaken by the BDA of recent government data indicates unmet need for dentistry in 2023 stands at over 12 million people, up a million on 2022 figures, and now well over one in four of England’s adult population. Over six million adults tried and failed to get an appointment in the past two years, and 4.4 million simply did not try because they thought they could not secure one. Those put off by cost are now equivalent to over 1.1 million adults, those on waiting lists estimated at around 600,000.

British Dental Association Chair Eddie Crouch said: “While Ministers drag their heels on a rescue plan, patients are queuing from the crack of dawn and many dentists are giving up hope of change. Rishi Sunak ran for the top job with a promise to ‘restore’ NHS dentistry, and so far that promise is being broken. If this government fails to step up there may not be a service left to save.”

New workforce data must drive new approach to tackling crisis in NHS, says BDA

The British Dental Association has responded to changes to NHS England’s workforce data collection, stressing new numbers must underpin effective strategies for easing the crisis in NHS dentistry. 

Traditional approaches have counted heads, not commitment, giving a dentist doing one NHS check-up a year the same weight as an NHS full-timer.

In England NHS dentist numbers are over 500 down since lockdown, but BDA surveys indicate over half of dentists have reduced their NHS commitment since 2020, a movement going unseen in official figures. NHS England will now be seeking data bi-annually on headcount, NHS contracted hours, as well as vacant posts. More detail on the new approach is available here.

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee said:

“Clearly any new paperwork will create some administrative burdens for practices. And that is precisely why we need to see these figures put to work.

“This data needs to start driving effective decision-making across dentistry.

“Used appropriately it can show where the real ‘dental deserts’ actually are. It must support evidence-based workforce planning and illustrate the real pressures practices are under.”

Dentists effectively told to keep NHS afloat out of their own pockets, says BDA

The British Dental Association has said government has effectively told the profession it cannot afford NHS dentistry, as it prepares to impose an approach to pay that will leave a gaping hole in the service’s budget which practices across England will be expected to fill.

Despite having publicly accepted the independent pay review body’s recommendation of a pay increase of 6%, the Department of Health has refused to reflect the soaring operating costs of delivering NHS care. It is imposing a rock bottom uplift of 3.23% to cover expenses leaving a total uplift in NHS contract values of just 5.13%.

Based on survey data measuring the costs facing practices, the BDA estimate a total uplift of 8.3% would be required as a bare minimum, simply for the service to stand still with the promised 6% pay rise. The uplift leaves a gap of over £100m in the NHS budget that already struggling practices will have to plug out of their own pockets. The BDA say its warnings to Ministers that this will only accelerate the drive to the private sector – as practices endeavour to remain financially viable – have gone unheeded.

The professional body stress it will be effectively impossible for practices to pass on recommended pay increases to their teams, further escalating the chronic recruitment and retention problems in the sector, that are leaving millions unable to access care.

In its dialogue with government the BDA say officials categorically accepted that its figure of 3.23% is not based on hard evidence of the levels of costs facing practices, but simply reflects what the Government felt it could afford. In a break from its usual model of using CPI inflation to establish the costs of delivering NHS dentistry – which would have generated an uplift of 8.7% – the Department chose another measure – the GDP deflator – which appears a cynical measure designed purely to keep costs down.

Dentist leaders say this approach risks fatally undermining the forthcoming ‘recovery plan’ for NHS dentistry, expected for imminent publication. In July the Health and Social Care Committee described the state of the service as “unacceptable in the 21st century”, and set out recommendations to government for real, urgent reform, alongside a call for the coming recovery plan to be underpinned by necessary funding.

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee said: “If Government can’t afford NHS dentistry, dentists can’t be expected to prop it up out of their own pockets. This penny pinching will derail the promised ‘recovery plan’. It’s an insult that will force practices to increase private work simply to stay afloat.”

BDA: 4am queues for NHS care risk becoming the new normal

Dentists: 4am queues for NHS care risk becoming the new normal

The British Dental Association has urged government to step up as Leigh, Greater Manchester, joined the growing list of communities where struggling patients have queued from the break of dawn to secure access to NHS dentistry.

Daily queues starting as early as 4am have been reported outside the Avenue Dental Centre in Leigh town centre, which offers appointments to all NHS patients on a first-come-first-serve basis.

This follows reports from Faversham, Kent, last month, where a practice received 27,000 calls for just 60 NHS slots, and in Kings Lynn which in May saw queues of more than 300 also form from 4am.

Wannabe patient Leah Price, who requires regular dental treatment as a result of Chron’s Disease, photographed the scenes. Leah told local media: “the people working in the NHS are trying their hardest.

“But in this country, people should not be camping outside a dentist at 4am on camp chairs just to get on the NHS patient list, it’s wrong.

“Dental treatment is just as important at the end of the day as other health issues and I’m just in disbelief that this is where we are at.

“I wasn’t expecting to be added to waiting lists that are two years long and to be within a chance of being seen, I need to camp outside.

“I also have a child that I have to take to school, so waiting outside for hours isn’t an option for me, it’s a mess.”

A recent Health and Social Care Committee inquiry described the state of the service as ‘totally unacceptable in the 21st century’, setting out fundamental changes centred on reform of the dysfunctional NHS contract dentists work to. The BDA has urged the government to sign up to this reform plan, which it has characterised as an ‘instruction manual’ to save NHS dentistry. A recovery plan for the service – pledged by government in April – has yet to be published. Dentist leaders warned that without fundamental reform the exodus of dentists from the NHS will grow, and the service will not have a future.

Analysis undertaken by the BDA of recent government data indicates unmet need for dentistry in 2023 stands at over 12 million people, up a million on 2022 figures, and now well over one in four of England’s adult population. Over six million adults tried and failed to get an appointment in the past two years, and 4.4 million simply did not try because they thought they could not secure one. Those put off by cost are now equivalent to over 1.1 million adults, those on waiting lists estimated at around 600,000.

Figures are now nearly three times pre-pandemic totals. In 2019 unmet need sat at over 4 million people, or nearly one in ten adults.

BDA Chair Eddie Crouch said: “These scenes have no place in wealthy 21st century nation, but risk becoming the new normal for millions of patients.

“The Conservative Party will gather in Greater Manchester in little under a month. Ministers need to come armed with solutions to this crisis or NHS dentistry won’t have a future.”

NHS dentistry: No return to ‘business as usual’ for struggling service, says BDA

The British Dental Association has stressed latest official figures show there is no prospect of NHS dentistry bouncing back to pre-Covid levels without radical and urgent change.

NHS Dental Statistics 2022/23, published today, show the service is still struggling to return to pre-pandemic norms, with the 32.5 million courses of NHS treatment delivered sitting at just 82% of the 39.7 million provided in 2018/19. The professional body warns limited gains in the last year will not take the edge of an ever-growing backlog, as patients present with higher levels of need, the result of ongoing access problems.

Just 18.1 million adults in England were seen for NHS dental treatment in the 24 months up to June 2023, 17.5% lower than the 22 million seen in the 24 months up to June 2019. Just 6.4 million children were seen in the 12 months to June 2023, down 9% on figures for 2019.

Minor tweaks to the discredited NHS contract fuelling the crisis in NHS dentistry were rolled out during this financial year. The BDA say that the fact the number of dentists delivering NHS care has continued to fall – down 121 on last year – reflects to the wholesale inadequacy of these changes. 24,151 dentists are recorded as performing NHS work in 2022/23, over 500 down on numbers before lockdown.

The recent Health and Social Care Committee inquiry described the state of the service as ‘totally unacceptable in the 21st century’, setting out fundamental changes centred on reform of the dysfunctional contract. The BDA has urged the government to sign up to this reform plan, which it has characterised as an ‘instruction manual’ to save NHS dentistry. A recovery plan for the service – pledged by government in April – has yet to be published.

Dentist leaders have long warned that without fundamental reform the exodus of dentists from the service will grow, and the service will not have a future.

This month a dental practice in Faversham, Kent, received 27,000 calls and saw patients queuing overnight to compete for just 60 NHS places.

Eddie Crouch, Chair of the British Dental Association, said: “We’re seeing the limits on the recovery and this government’s ambition. Demoralised dentists are walking away from a broken system, while millions struggle to access the care they need. NHS dentistry can come back from the brink, but only if Ministers turn the page.”

NHS dentistry: Reform must not be a final destination for service in Scotland

The British Dental Association has said Scottish Government reforms to NHS dentistry announced today fall short of the root and branch change required to make the service fit for the 2020s.

Following tense negotiations, a reformed payment system will be rolled out from 1 November 2023. This includes changes to the fees provided for many treatments and will see the number of items on the ‘menu’ at dental practices slimmed down – purportedly meant to make it less burdensome – to 45 codes down from around 400. The BDA had stressed that surging costs had left practices delivering some NHS care at a financial loss, particularly for items like dentures that require laboratory work. These items have seen significant increases in fee levels.

However, the professional body has stressed reforms offer no fundamental changes to the current model of care. The service is still predicated on a low margin/high volume system, without the appropriate targeting of resources for those in highest need. The BDA had been seeking a clean break towards a new patient-centred and prevention-focused model and say the package as it stands will do little to tackle deep oral health inequality across Scotland.

Dentist leaders have warned ministers not to view the current package as a “final destination.” There is uncertainty over whether these changes will be sufficient to halt the exodus of dentists from NHS services and restore access to millions.

The Scottish Parliament COVID Recovery Committee recently concluded its inquiry into the recovery of NHS dentistry, including a recommendation that the Scottish Government provide costings for – and consults on – different service model options, including those that it does not prefer, in partnership with the sector so that the opportunity is not missed to consider a full range of options for the future of service delivery.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee, said: “We’ve secured some improvements, but the fundamentals of a broken system remain unchanged. The Scottish Government have stuck with a drill and fill model designed in the 20th century. They were unwilling to even start a conversation on making this service fit for the 21st

“Ministers cannot pretend this is a final destination for NHS dentistry in Scotland. We struggle to see how these changes alone will close the oral health gap, end the access crisis or halt the exodus from the NHS.”

BDA: Bad data underpinning bad policies as Ministers correct the record

The British Dental Association has said decent data must underpin the government’s response to the crisis in dentistry, following the use of wholly inaccurate numbers to underpin calls to ‘tie in’ young dentists to the NHS.

Following publication of the NHS Long Term Workforce Plan both the Prime Minister and Health Secretary claimed that ‘two thirds’ of dentists did not practice in the NHS after training, evidence which served as the basis for a new policy for dental graduates. The official record has now been updated to state just ‘one third’ of dentists do not do NHS work, a figure the professional body stresses remains erroneous.

Asked at a Downing Street briefing whether more dentists should work in the NHS rather than doing private work, and whether the government would do anything to achieve that goal the Prime Minister answered: “The simple answer is yes and yes. We are exploring the possibility of introducing what’s called a tie-in for dentistry. Around about two-thirds of dentists after they have finished their specialty training end up not doing work in the NHS.” The Health Secretary subsequently told MPs “two thirds of dentists do not go into NHS work after training”, stating that the ‘tie-in’ was “an important part of the long-term workforce plan.”

The Dental Schools Council has since stated that 97% of dental graduates currently continue to vocational training within the NHS. The BDA understand the government’s corrected figure makes no attempt to establish the destination of dentists after training, but is simply a crude measure of high street NHS dentists as a proportion of all those currently registered to practice. This approach ignores over 3000 NHS dentists working in hospitals and makes no consideration of those in dental public health, academia or the armed forces.

The BDA had slammed the ‘tie in’ plan for failing to tackle the root of problems driving NHS dentists of all ages out of the service.  Dentist leaders stress Ministers need to reform the discredited contract fuelling the exodus and make the service a place dentists would choose to build a career, not just “handcuff the next generation to a sinking ship.” The Commons Health and Social Care Committee stated in its recommendations to end the crisis in NHS dentistry, published just days after the claims, that any tie-ins should follow a full consultation with the workforce and rollout of “fundamental contract reform.”

Government workforce data does not capture the amount of NHS work dentists do, with headcount figures giving a dentist doing one NHS check-up a year the same weight as an NHS full timer. Over half (50.3%) of high street dentists responding to recent BDA surveys reported having reduced NHS commitments since the start of the pandemic. 74% stated their intention to reduce – or further reduce – their NHS work. This includes dentists at all stages in their careers, not merely newly qualified dentists.  

MPs have repeatedly sought to correct the record following consistent misrepresentations from government on the scale of the crisis in dentistry. Contrary to repeat claims made by the Prime Minister, official figures secured last month by the BDA under freedom of information indicate just 23,577 dentists performed NHS work in England in the 2022/23 financial year, over 1,100 down on numbers pre-pandemic, a level not seen since 2012.

BDA Chair Eddie Crouch said:  “Dodgy numbers make for a nice soundbite, but not for sound policy to tackle the crisis in NHS dentistry. A failed contract is forcing dentists out of the NHS every day it remains in force. Ministers need to start by fixing a broken system, not by handcuffing young dentists to it.”

No sign of recovery plan as unmet need for NHS dentistry hits record high

As parliament prepares to break for summer recess, the British Dental Association has expressed its dismay at government’s failure to honour pledges to implement a recovery plan for NHS dentistry, now facing the gravest access problems in its history.

Analysis undertaken by the BDA of government data published just last week indicates unmet need for dentistry in 2023 stood at over 12 million people, up a million on 2022 figures, and now well over one in four of England’s adult population.

The data indicates over six million adults tried and failed to get an appointment in the past two years, and 4.4 million simply did not try because they thought they could not secure one. Those put off by cost are now equivalent to over 1.1 million adults, those on waiting lists estimated at around 600,000. 

Figures are now nearly three times pre-pandemic totals. In 2019 unmet need sat at over 4 million people, or nearly one in ten adults.

In April the government pledged a recovery plan just minutes before a bruising interrogation from parliament’s Health and Social Care Committee. The Committee’s damning report has described the state of NHS dentistry as “unfit for the 21st century” and backed calls for fundamental reform to dentistry, and for any recovery plan to be underpinned by appropriate resources.

The BDA has said the plan offers an effective blueprint to save NHS dentistry. It has pressed government to sign up in full to the cross-party recommendations, with over 1,300 dentists putting in an open letter to Health Secretary yesterday.

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee, said: “It’s the end of term at Westminster but Ministers have failed to do their homework on NHS dentistry. Record numbers are now struggling to access care. This service is going under, and we need a rescue plan.”

Ministers have moral duty to act, as kids face yearlong waits for extractions, says BDA

Ministers must show they are willing to put prevention at the heart of NHS dentistry, as new figures from the Liberal Democrats show children in some parts of England are now waiting up to 18 months for dental procedures under general anaesthetic, principally tooth extractions

The BDA stress these yearlong waiting times are nothing new and reflect systemic failures in government policy, the ongoing impact of access problems and huge bottlenecks across all parts of NHS dental services.

BBC research last year found 8 in 10 practices were incapable of taking on new child patients on the NHS. High street dentists are now reporting children presenting with higher levels of need, a result of disruption to routine preventive care. Meanwhile the colleagues tasked with these paediatric extractions in the Community Dental Services, are struggling to secure needed priority, and need to be included in restoration and recovery planning alongside other surgical services.

Last week, a damning report from the Health and Social Care Committee said the discredited system of targets NHS dentistry works to must be abandoned and replaced with a model that is patient-centred and prevention-focused. The BDA has characterised the document as an ‘instruction manual to save NHS dentistry’ and today over 1,300 dentists have now co-signed an open letter to Steve Barclay MP, pressing the Health Secretary to commit to accept the Committee’s recommendations.

Some paediatric patients are awaiting full mouth clearances, the removal of all baby teeth, where delays can leave young patients struggling to eat, sleep, communicate or learn.

British Dental Association Chair Eddie Crouch said: “Children are waiting in agony thanks to the indifference successive governments have shown to dentistry. Yearlong backlogs pre-date COVID, because ‘prevention’ has been little more than a buzzword. It’s a perfect storm. Dentists are losing the battle to nip these problems in the bud, and struggle for theatre space when extractions are the only option. Ministers have been offered a blueprint for reform. They have a moral responsibility to use it.”