NHS

Official data shows over 60% of dentists in England thinking leaving the NHS

Government failure leaves morale among dentists at all-time low, says BDA

The British Dental Association has lamented Government’s failure to tackle the growing exodus from the NHS workforce, as new official data shows the numbers are set to mount.

Dentists’ Working Patterns, Motivation and Morale data shows morale is now at an all-time low – with only 16% of dentist practice owners and 18% of dentist associates in England saying morale is high, a record low result for both groups. 6 in 10 of all dentists say their morale is low or very low.

With the access crisis hitting millions across England, 64% of practice owners and 61% associate dentists in England are now thinking of leaving NHS dentistry.

The BDA has described the Government’s recent Recovery Plan as ‘unworthy of the title’ and has lambasted the non-stop spin from Ministers attempting to defend their unambitious and unfunded policies.

Dental Minister Andrea Leadsom MP told Parliament last week that “it isn’t the case dentists are disappearing from the NHS,” citing supposed ‘growth’ of 1,352 dentists, by comparing to 2010 figures. The reality is NHS dentist headcount has fallen to levels not seen since 2017, with today’s data showing a steady fall in the proportion of NHS work dentists do.

Last month the Secretary of State had to correct the official record after informing Parliament that the plan was funded by £200m of ‘new’ money. It is entirely funded by recycling underspends in the service’s existing £3bn budget, which has been cut by a third in real terms since 2010. The Government has tried claiming that 500 practices are now taking on new NHS patients as a result of this package. The reality is officials have just changed the definition of ‘access’ on NHS.uk.

A recent poll of dentists in England by the BDA showed just 3% think the plan will result in their practice seeing more NHS patients. 43% believe the plan will actually lead to their practice seeing fewer NHS patients. Only 1% of respondents believe the plan is capable of meeting the government’s stated objective to provide NHS dental care to ‘all who need it’.

The BDA has slammed Government for rejecting the Health and Social Care Committee’s key recommendation to break with the discredited NHS contract, which is fuelling this exodus. It stresses that any progress will hinge on real reform and sustainable funding.

BDA Chair Eddie Crouch said: “This Government hasn’t given dentists any reason to be cheerful. The PM promised to ‘restore’ this service, but all we’ve had is spin, and unfunded, unambitious plans. We can’t have NHS dentistry without NHS dentists. Without real reform Ministers won’t make it a place dentists want to work.”

NHS charge increase branded ‘a slap in the face for hard pressed families’

The British Dental Association has lamented the latest increase in NHS patient charges, stressing the hike will not put a penny in the cash-strapped service, and is merely covering for government cuts.

Charges in England will rise by 4% from 1 April 2024. This will mean the cost of a band 1 treatment like a check-up will increase from £25.80 to £26.80, a band 2 like a filling will increase from £70.70 to £73.50, and a band 3 like dentures will increase from £306.80 to £319.10.

Polling conducted by YouGov for the BDA last year found nearly a quarter (23%) of respondents in England delayed or went without NHS dental treatment for reasons of cost. 45% said the price shaped the choice of treatment they opt for. Entitlements to free care are limited, with many Universal Credit recipients not being eligible.

The BDA has long warned of the Government’s long-term strategy of using charges as a substitute for meaningful state investment. NHS dentistry’s budget has been effectively static at around £3bn for the best part of a decade, with patient charges forming an ever-greater share of the total pot until COVID. Direct Government spend on dentistry was lower as the country headed into the pandemic than it was in 2010. The collapse in patient numbers at lockdown required Ministers to increase their contributions to maintain the viability of the service. Last year’s 8.5% hike saw the return to a fatally flawed ‘business as usual’ model as far as funding is concerned.

The recent NHS dentistry Recovery Plan claimed to offer £200m in investment. The BDA now understands that none of this is ‘new’ money, but is based on recycling vast underspends, the result of practices struggling to hit their punitive contractual targets.

The Welsh Government has not adopted the same strategy as England. The BDA has demanded that Ministers explain to the English public why they are expected to pay over £100 more for treatments like dentures than their Welsh cousins. Over 170,000 people have joined a joint petition calling for fair funding and real reform of NHS dentistry in England in a month.

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee said: “This latest hike is another slap in the face for hard-pressed families across England. This won’t put a penny in to bring NHS dentistry back from the brink. The Government is asking the public to pay more for less of a service.

“Ministers need to explain why patients in England are expected to pay £100 more than their Welsh cousins for identical NHS treatment. The answer is very simple. Ministers are simply covering for cuts.”

NHS Dental Recovery Plan officially unveiled

Following early leaks to the press, NHS England and the Department of Health and Social Care have released the NHS Dental Recovery Plan.

Victoria Atkins, Secretary of State for Health and Social Care, explains that the plan has three components:

  1. In 2024, we will significantly expand access so that everyone who needs to see a dentist will be able to. This will begin with measures to ensure those who have been unable to access care in the past 2 years will be able to do so – by offering a significant incentive to dentists to deliver this valuable NHS care. We are introducing mobile dental vans to take dentists and surgeries to isolated under-served communities.
  2. We will launch ‘Smile for Life’ – a major new focus on prevention and good oral health in young children, to be delivered via nurseries and other settings providing Start for Life services, and promoted by Family Hubs. We will also introduce dental outreach to primary schools in under-served areas, and take forward a consultation on expanding fluoridation of water to the north-east of England – a highly effective public health measure.
  3. We will ramp up the level of dental provision in the medium and longer term by supporting and developing the whole dental workforce, increasing workforce capacity as we have committed to do in the NHS Long Term Workforce Plan, reducing bureaucracy and setting the trajectory for longer-term reforms of the NHS dental contract.

“The publication of this recovery plan is a significant step on the journey to improve and transform access to NHS dentistry and deliver care that meets the diverse oral health needs of people across England,” says Jason Wong, Chief Dental Officer, England (interim). “The NHS dental service is an essential cradle-to-grave prevention service. The government’s launch of Smile for Life and the focus on early years is welcome, particularly for England’s most deprived communities. The consultation on expanding water fluoridation in some parts of England is an opportunity to improve the oral health of communities for generations to come.

“Offering dental teams a new patient premium to treat patients who’ve not seen an NHS dentist in over 2 years will help more patients access NHS dental care. Changes such as uplifting the minimum unit of dental activity (UDA) value to £28 will make NHS dentistry provision more attractive and the service more sustainable. More importantly, it will make the NHS dental service fairer.

“Growing the workforce so that more patients can access NHS dental care is critical in helping us improve and expand services. We will support government and the General Dental Council (GDC) in the introduction of provisional registration and making it easier for international graduates to work in England while maintaining our high standards. I have always been a strong advocate of the use of skill mix and look forward to further developing this in the provision of NHS care, and we will support the implementation of the NHS Long Term Workforce Plan.”

Andrea Leadsom, Minister for Public Health, Start for Life and Primary Care, adds: “This recovery plan addresses the urgent need to boost access, and we aim to make sure everyone needing NHS dentistry will be able to access it. Not only that, but we are building capacity for the long term, supporting our excellent dental staff to work at the top of their training, and encouraging more hard-working dentists to those areas of England that are currently under-served.”

The Prime Minister, Rishi Sunak, said: “NHS dentistry was hit hard by the pandemic and while services are improving – with 23% more treatments delivered last year compared to the previous year – we know that for too many people, accessing a dentist isn’t as easy as it should be.

“That’s why we’re taking action today to boost the number of NHS dentists, help cut waiting lists and put NHS dentistry on a sustainable footing for the long-term. Backed by £200 million, this new recovery plan will deliver millions more NHS dental appointments and provide easier and faster access to care for people right across the country.”

Dental Care Professionals

The recovery plan also includes steps to improve access for patients immediately, suggesting changes so more dental therapists, hygienists, dental nurses and dentists can treat further NHS patients. 

As outlined: ‘Dental care in England could not function without the vital contribution of its dental care professionals, including dental therapists, hygienists and nurses. As set out in the NHS Long Term Workforce Plan, we will expand dental therapy and dental hygiene undergraduate training places by 28% by 2028 to 2029, and expand training places by 40% from current levels to over 500 places by 2031 to 2032.

‘Dental therapists’ scope of practice means that they can deliver much of the routine care that dentists provide so more therapists means more care for NHS patients. In addition to dental therapists and hygienists, we will also encourage greater numbers of dental nurses and clinical dental technicians into relevant education and training programmes.’

Read the NHS England announcement here.

Click here to view the full policy paper.

For further reactions from across British Dentistry, you can find our rolling coverage here.

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.”

First cohort of Oral Health Practitioner Apprentices complete their courses

The first cohort of Oral Health Practitioner Apprentices received their awards in May, making them the first recipients of the Royal Society of Public Health Diploma for Oral Health Practitioners. 

This Oral Health Practitioner apprenticeship, alongside a Dental Practice Manager apprenticeship and an Orthodontic Therapist apprenticeship, is designed to support recruitment and retention within the dental nurse workforce as well as help to free up time and resources. The Oral Health Practitioner apprentices, of which there are seven in total, are now fully qualified to work as oral health practitioners delivering care and treatment to patients alongside dentists in practice.

This new and innovative programme is the only formal qualification of its kind, with a strong emphasis on not only oral health education and promotion, but also the links between systemic disease and oral health, connecting this apprenticeship to the NHS Long Term Workforce Plan which has a strong emphasis on investing in prevention.

The dental nurses came from dental practices and salaried dental service in the Thames Valley and Wessex region. 

The apprenticeship was delivered by a team from the Workforce Training and Education Directorate of NHS England.

The curriculum focus is on the following knowledge areas:

  • An understanding of common medical conditions and how they can impact on oral health and wellbeing
  • Head and neck anatomy, physiology, the prevention of dental caries and periodontal disease
  • Diet, nutrition, hydration, and their links with systemic and oral health
  • An understanding of differing patient group needs across the life course and the management of patients with learning disabilities, dementia and mental health conditions. 
  • The theories that underpin models of learning in individuals and groups to change behaviour.
  • Theories and concepts of motivational interviewing
  • Supporting behaviour change with individuals ( e.g. in a dental surgery) and with groups (e.g. health and social care professionals, ante natal groups etc)

They also acquired the following skills,

  • Performing intra oral skills in taking plaque scores, impression taking, intra oral scanning, application of topical fluoride, intra and extra oral photography
  • Carrying out brief clinical preventive advice interventions and targeted group interventions
  • Provide both oral and general systemic health advice such as smoking cessation
  • Able to provide behaviour change advice and support to individuals and groups across the life course with different cognitive abilities.
  • Provide motivational interviews.
  • Undertake standard NHS health checks for diabetes and blood pressure

Michael Wheeler, Dental Workforce Advisor at NHS England and Course Director, said: “This apprenticeship is one of three that is designed to support recruitment and retention within the dental nurse workforce, the others being the dental practice manager and orthodontic therapist.

“For dental practice owners and salaried dental services, it provides a better trained workforce to embrace flexible commissioning at a local level especially in delivering oral health education and promotion. 

“The oral health practitioner apprenticeship will allow individuals to further progress to become dental hygienists and dental therapists, for which an apprenticeship route is currently being explored by NHS England and the Institute of Apprenticeships and Technical Education.

“This apprenticeship is designed to support widening participation into dental hygienist and dental therapist training and contribute to the ambition to increase training places by up to 40% by 2031 / 32 which is set out in the NHS Long Term Plan.”

BDA: Workforce plan attempting to handcuff dentists to sinking ship

The British Dental Association has expressed deep concern that the new NHS Long Term Workforce Plan is setting out aspirations to tie dental graduates to a failed NHS system, with no tangible plans to reform the discredited contract fuelling the exodus from the service.

In proposals set out just for dentists the plan states “one approach we will consider with government is to introduce incentives or other measures, such as a tie-in period, that encourage dentists to spend a minimum proportion of their time delivering NHS care in the years following graduation.”

The plan set out aspirations to expand dentistry training places by 40% so that there are over 1,100 places by 2031/32. The BDA has described this move as an attempt to “fill a leaky bucket.” 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.

British Dental Association Chair Eddie Crouch said: “Ministers need to make the NHS a place young dentists would choose to work. Not handcuff the next generation to a sinking ship. Seeing the detail, nothing changes our view that government is trying in vain to fill a leaky bucket. It’s an exercise in futility training more dentists who don’t want to work in the NHS.”

The professional body says it is also striking that dentistry appears to be the exception to the rule on reducing dependence on overseas labour.

The dental regulator, the General Dental Council, has recently gone on the record stating bringing in more dentists will not solve problems fuelled by broken contracts.

“Improving the throughput of those from overseas who want to be registered in this country is the right thing to be doing,” said GDC chair, Lord Toby Harris at the Annual Conference of Local Dental Committees earlier this month. “But it is not some magic bullet that will solve the problems in NHS dentistry.

“If the contractual terms by which NHS services are provided are unattractive to many dentists currently on the register, then there is no reason why those same terms will be any more attractive to new registrants – whether they are from overseas or who qualify here.”

The Government has consistently championed the import of overseas dentists. There are currently around 1,500 candidates waiting to sit Part 1 of the Overseas Registration Examination (ORE). While the BDA supports urgent action to deal with this huge backlog, it does not represent a solution to the access crisis.

Jason Wong named interim CDO England

Jason Wong, who has served as Deputy CDO England since June 2020, has been named as Interim Chief Dental Officer England as Sara Hurley prepares to depart from the role of CDO England at the end of June.

Sir Stephen Powis, NHS National Medical Director, confirmed the news, stating: “Representing the entire dental profession across England, the role of the Chief Dental Officer is a joint appointment between Department of Health and Social Care and NHS England, with their base in NHS England.

“I am pleased to inform you that Jason Wong will take over from Sara on an interim basis while we recruit for a permanent replacement.”

Recruitment for a permanent CDO England will begin soon.

BDA Scotland: Covid impact on scale unseen in any other part of NHS

The British Dental Association has warned MSPs the pandemic has had an unparalleled impact on NHS dentistry, that leaves the service facing an existential threat. 

As the professional body prepares to give evidence to the Covid-19 Recovery Committee inquiry into NHS dentistry today (22 June 2023), it has published new analysis showing the scale of the backlogs.

Initially closed to routine care, and then facing exacting Infection and prevention control guidelines that reduced patient throughput, lost capacity on the high street exceeds general medical practice and secondary care, resulting in backlogs that will take many years to clear:

  • Dentistry has lost over half (52%) of its capacity since lockdown, when comparing examinations delivered since March 2020 with typical levels pre-Covid.
  • For GPs, that figure is just over 30% (when looking at lost face-to-face appointments). It is just over 6% for hospital outpatients and in terms of volume, inpatient care appears to have already recovered lost ground.
  • By any measure captured in official data, whether it is examinations or Statement of Dental Remuneration (SDR) activity claims, Scotland has lost more than a year’s worth of NHS dentistry.
  • Ongoing access problems are fuelling backlogs, with patients presenting with higher levels of clinical need. In recent BDA surveys over two thirds (67%) of dentists cite higher needs patients requiring more clinical time as a key issue on return to ‘full’ capacity. The only comparable problems are those concerning recruitment and retention of dentists (61%).

Dentist leaders say it will be impossible to restore pre-pandemic activity without radical change. The low margin/high volume model the service works to was incompatible with working through the pandemic and cannot form the basis for a meaningful or sustainable recovery.

This leaves the service at a crossroads: with a contract that is unfit for purpose, underfunded, overstretched and facing the challenge of deep and widening oral health inequalities. BDA Scotland fear that an exodus of dentists from the NHS is already in motion. This shift is going unseen in official data, that counts heads not the amount of NHS work dentists do. These workforce statistics give an NHS full-timer the same weight as a dentist doing one NHS check-up a year.

Recent BDA surveys indicate only 1 in 5 (21%) of practices have returned to pre-Covid-19 capacity. The professional body say hard limits on restoring capacity, and the existential threats to NHS dental services require a proportionate response from the Scottish Government.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “Covid hit dentistry like no other part of the NHS in Scotland. We’re not asking for special treatment, just a proportionate response. One that recognises the scale of the backlogs and the existential threat to this service. NHS dentists are already walking away from a broken system. There can be no recovery without reform.”