The British Dental Association has urged government to drop any pretence that NHS dentistry is on the road to recovery and finally deliver a meaningful rescue package, as the exodus from the service reaches new heights.

Freedom of information requests undertaken by the BDA indicate just 23,577 dentists performed NHS work in the 2022/23 financial year, down 695 on the previous year, and over 1,100 down on numbers pre-pandemic. The crash brings the workforce to levels not seen since 2012/13. [1]

These official figures are at odds with repeat claims from the Prime Minister that recent reforms have boosted dentist numbers [2], arguments also made by ministers and officials in evidence to the current Health and Social Care Committee inquiry into the crisis in NHS dentistry. [3] The BDA understands several MPs have already sought corrections to the official record, and there are now at least 7 instances where they have a basis to proceed.

The PM has stated time and again that 500 additional dentists recorded as delivering NHS work in the 2021/22 financial year reflect the success of recent government reforms. The minor tweaks to the discredited contract fuelling the current crisis were rolled out in October 2022, so do not even correspond to the year the PM chose to cite. The BDA believes that any ‘bounce’ in 2021/22 likely reflects the unique circumstances from the first year of COVID in which practices were closed from lockdown to June.

The professional body stresses that recent commitments to develop a ‘recovery plan’ for dentistry were made by government based on false assumptions that the workforce had ‘turned a corner’. It says there can be no more tinkering at the margins, and real commitment is now required to form the basis of a rescue package, simply to stabilise the service ahead of longer-term negotiations on wholesale reform.

The BDA believes that the clearest way forward is to utilise record-breaking ‘underspends’ in the dental budget to bring a degree of sustainability to practices on the brink. The BDA estimated in February that funds returned by practices not hitting their contractual targets would likely exceed £400m this year, or over 10% of the total NHS budget. The BDA now believe this was a very conservative estimate. Practices face huge financial penalties often as a result of being unable to fill vacancies.

The BDA says a new higher minimum Unit of Dental Activity (UDA) value could bring all practices in line with areas with the strongest access levels, give them the chance to fill vacancies, support retention and operate more sustainably in the face of soaring costs. The BDA stress any costs could be kept within the anticipated levels of clawback for 2022/23. A minimum UDA level of £23 was rolled out in October, lower than the current patient charge level of £25.80, and below the level required for most practices to cover their costs or attract new dentists.

In August the PM pledged a Five-Point Plan for dentistry, including commitments to ring fence NHS dentistry funding. [4] The BDA’s approach builds on this, and echoes observations made by Broadland’s Jerome Mayhew MP, who in a recent debate urged members to “follow the money”, noting that the best areas for access “spend nearly £80 per mouth per year on dentistry; in the East of England, the figure is £39—a full 50% less.”

The BDA stresses the fall in workforce numbers significantly understates the full scale of lost capacity within NHS dentistry. The government counts heads not NHS commitment. A recent BDA survey of dentists in England revealed over half of dentists (50.3%) had reduced the proportion of NHS work they did since the start of the pandemic – by more than a quarter. 74% indicated they plan to reduce – or further reduce – the amount of NHS work they undertake in the year ahead. [5]

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee said: “Government needs to drop the spin, accept the facts, and provide a rescue package to keep this service afloat. “NHS dentistry is haemorrhaging talent, and further tweaks to a broken system will not stem the flow.

“The PM once called for this budget to be ring fenced. We face an access crisis, and with hundreds of millions set to be pulled away, funds must be put to work solving these problems. Ministers have a choice. They can help thousands of struggling practices fill vacancies and see patients, or just pass by on the other side.”

References:

[1] Number of dentists with NHS activity,

Data for 2011-12 to 2021-22 from NHS Dental Statistics. *Data for 2022/23 financial year from Freedom of Information request from NHS Business Services Authority. This is expected to form part of NHS Dental Statistics 2022/23 due this coming August. 

[2] Comments from the Prime Minister, Rt Hon Rishi Sunak MP

The British Dental Association had disputed wholly misleading claims on workforce numbers, funding and reform made since the start of the year. Even setting aside underspends of over £400m, the £3bn dental budget has remained almost unchanged for a decade, failing to keep pace with inflation and population growth, with patient charges forming an ever-greater share of total spend in the run up to COVID. The marginal changes to the NHS contract rolled out in November change none of the fundamental perversities of the target-based system. Dentists used to be paid the same whether they did 1 filling or 10. Now they are paid the same for 3 fillings or 10.

Wednesday 11 January 2023

Cat Smith (Lancaster and Fleetwood) (Lab)

There are no NHS dentists taking on patients in Lancaster and Fleetwood, and those constituents of mine who are lucky enough to have one are waiting months for an appointment. How long did the Prime Minister have to wait for his last NHS dentist appointment?

Prime Minister

As a result of the new reformed NHS dentistry contract, there are now more NHS dentists across the UK, with more funding, making sure that people can get the treatment they need.

Simon Lightwood (Wakefield) (Lab/Co-op)

Less than half of Wakefield’s children managed to see an NHS dentist last year. My constituent Mr Faqirzai’s six-year-old daughter has never seen an NHS dentist. She has 10 teeth that are black with decay and is often crying in pain. Her father feels helpless. He has called every dentist in Wakefield for a place but has not managed to secure one. More than 25% of five-year-olds in Wakefield already have visible tooth decay, so when will the Prime Minister stop dithering and take action to address our national dental emergency? (902917)

The Prime Minister

I am very sorry to hear about the case raised by the hon. Gentleman, and I am happy to look into that specific one more closely. As I said in answer to an earlier question, we have recently reformed the NHS dentistry contract, and the hundreds of millions of pounds more funding and more dentists should make a difference around the country, but I will write to him on that specific case.

Wednesday 8 March 2023

Mr Richard Bacon (South Norfolk) (Con)

The adjustments to the dental contract last November were a welcome step, but there is more work to do. Will the Prime Minister therefore keep this area under the closest review to ensure that constituents such as mine in South Norfolk and those of other hon. Members get the best possible dental care?

The Prime Minister

My hon. Friend raises an excellent point. I can tell him that we are continuing to invest in NHS dentistry, with £3 billion a year, and we have also enabled practices to do 10% more activity on top of their contracts and removed the barriers so that hygienists and other therapists can continue to work to their full skillset. The number of NHS dentists has increased by about 500 over the last year and we will continue to work with the sector to see what more we can do.

Wednesday 15 March 2023

Judith Cummins (Bradford South) (Lab)

Every child in the UK is entitled to free NHS dental treatment, but with 80% of practices not accepting children as new patients, is the Prime Minister proud of his record on our children’s dental health?

The Prime Minister

We are investing £3 billion in NHS dentistry. Because of the reforms to the contract, there will be about 10% more activity this year above contracted levels. There are 500 more dentists in the NHS today and, I think, almost a 45% increase in the amount of dental care being provided to children.

Wednesday 19 April 2023

Ed Davey (Kingston and Surbiton) (LD)

Tooth decay is the No. 1 reason that children over the age of four end up in hospital. Regular dental check-ups could prevent it, but too many parents cannot get one for their child. In the East Riding of Yorkshire, there are now almost 3,000 people per NHS dentist. In places such as Herefordshire and Norfolk, fewer than two in five children have been seen by a dentist in the past year. This is a scandal, so will the Prime Minister take up the Liberal Democrat plan to end this crisis and make sure people can get an NHS dentist when they need one? The Prime Minister The NHS recently reformed dentistry contracts, which will improve access for patients. Dentistry receives about £3 billion a year, and there were around 500 more dentists delivering care in the NHS last year than in the previous year. I am pleased to say that almost 45% more children saw an NHS dentist last year compared with the year before.

Wednesday 3 May 2023

Mary Kelly Foy (City of Durham) (Lab)

 Unable to secure an NHS dental appointment, my constituent Ray was forced to go private. It was then discovered that he had a large, aggressive tumour in his face and jaw, and 16 hours of gruelling surgery was required to remove it. If he had not been able to afford it, Ray might not be with us now. This is yet another chapter in the horror story that is the decay of dentistry on this Government’s watch, so does the Prime Minister accept that NHS dentistry is in crisis, and will he meet me and the British Dental Association to ensure that no one loses their life because they could not get a dental appointment—yes or no?

The Prime Minister

I am sorry to hear what happened to the hon. Lady’s constituent. That is why the NHS has recently reformed dental contracts to improve access. We now invest more than £3 billion a year, and there are more than 500 more dentists working in the NHS this year than last year. Discussions are ongoing between the Department of Health and Social Care and the NHS around dentistry, and DHSC is planning to outline further reform measures in the near future.

Wednesday 10 May 2023

Clive Lewis (Norwich South) (Lab)

Two years ago, I raised the case of a Norwich Army veteran who was in such agony that he was forced to pull out 18 of his own teeth because he could not get access to a dentist. The grim fact is that despite repeated promises from the Prime Minister, Norwich and Norfolk remain dental deserts. Dentists excel at extracting rotten teeth, so does the Prime Minister agree that the only way my constituents will see results is when this rotten Government are extracted from office and replaced with a Labour one?

The Prime Minister

I am very sorry to hear about the hon. Gentleman’s constituent. The hon. Gentleman will know that there are record sums going into dentistry and indeed 500 more NHS dentists working today. Because of the contract reforms that we have put in place, 10% more activity can happen, and the Department of Health and Social Care is currently talking about reforming the dentistry contract with dental practices to increase activity further.

[3] Comments from Neil O’Brien, Parliamentary Under-Secretary of State for Primary Care and Public Health at Department of Health and Social Care

25 April 2023. This evidence was made after the end of the 2022/23 financial year in which collapse of workforce numbers took place. 

To Health and Social Care Committee inquiry into NHS dentistry

Neil O’Brien: There are about 6.5% more dentists doing NHS work than in 2010; about 2.3% more than last year. We know that the number of people seen is up by about one fifth on the year to March, compared with the year before. There are not a fifth more dentists than there were a year ago, but they are doing more NHS work. Because of the nature of NHS dentistry, dentists are constantly able to choose between doing NHS work and the kind of Instagram dentistry that the CDO just talked about. We need to make NHS work attractive in that context. That is about contracts, about how much people are paid, and about fair payment.

[4] 18 August 2022, Statement ‘Restoring NHS dentistry’.

“Rishi will strengthen the protections around the annual NHS dentistry budget (approximately £3bn per annum), to ensure it is maintained exclusively for frontline dental services. As part of this ring-fencing exercise, commissioners in rural areas will be required to demonstrate how they are securing provisions for communities who do not live close to a dentist, including exploring mobile clinics and delivering services at alternative sites.”

Rishi Sunak said: “NHS dentistry is under unprecedented pressure with people unable to get the treatment they need, leaving them in pain or forced to fork out thousands for private care.

“My five-point plan will be activated on day one to free up dentistry professionals to do their jobs, encourage NHS trained dentists to stay in the NHS, and focus on prevention as that is always better than the cure.

“As Prime Minister, I’ll be focused on getting the British people more bang for our buck from our NHS.”

[5] BDA survey of 1,921 General Dental Practitioners in England, fieldwork December-January 2023

The British Dental Association has urged the Health and Social Care Committee to set out a clear roadmap to reform for government, following evasive answers and poorly defined commitments to rescue the struggling service.

It has disputed data cited by Minister O’Brien on the supposed ‘recovery’ in NHS dentistry. The Minister repeatedly spoke of NHS activity rising by ‘a fifth’ in the last year. Dentist leaders stress this ‘growth’ is based on comparing 2021/22 figures with the depths activity fell to during the height of the pandemic.

Levels of activity are so low that in the last financial year over £400m of the service’s budget is expected to be clawed back. Contrary to claims from NHS England on contract, the BDA has seen official data suggesting just 75% of contracted UDA activity was delivered in the eleven months to the end of February. This compares with activity levels before that pandemic, which, the BDA understands, were normally well in excess of 95% of contracted levels.

The BDA said the government’s pledge to develop a recovery plan for dentistry just ahead of the evidence session as ‘reeking of desperation.’

British Dental Association Chair Eddie Crouch said: “Witnesses tried to defend the indefensible, attempting to put a gloss on the government’s record. It won’t wash. NHS dentistry needs urgent reform, it’s got tweaks. It requires sustainable funding, instead we’ve got a charge hike that’s hit the patients who need us most. An exodus of dentists is still in motion, and millions remain unable to secure the care they need. The Committee can draw a line under this and set an urgent ‘to do list’ for government.”

With NHS dental charges in England set to jump by an historic high of 8.5% today (Monday April 24), the British Dental Association has warned government that costs are now shaping the clinical choices made by millions of patients.

The professional body has urged Ministers to follow the lead of public opinion and break with its long-term strategy of using charge increases as cover for cuts in government spending on NHS dentistry.

A new survey by YouGov of adults in England shows:

• Nearly a quarter (23%) report delaying or going without NHS dental treatment for reasons of cost.
• 45% say the price shapes the choice of treatment patients opt for, more than those following the clinical recommendations of their dentist (36%)
• An overwhelming majority support a break from the government’s current model of ramping up charges while reducing government spending. 38% say dentistry should be fully funded by government through general taxation, effectively free at the point of delivery. 29% say funding from government should increase, while maintaining some patient charges. Similar levels of support are clear among all political allegiances [2], social classes, and regions.  A further 16% say charge levels should remain unchanged.
• There is strong support for extension of free NHS dentistry to groups not currently covered, with 82% saying exemptions should cover cancer patients, whose treatments can cause severe dental problems.

In light of this evidence the BDA has urged the government to reject plans broadcast by Whitehall sources for a further 4% increase in charges next year, and to fully appreciate the impact charges have on lower income, higher needs patients. While some adult patients are exempt from charges, many on modest incomes still have to pay, including many recipients of low-income benefits such as Universal Credit. Dentist leaders warn that any repeat of these choices from government will inevitably widen already significant oral health inequalities.

The BDA has rejected claims from Minister Neil O’Brien that the increase “will raise important revenue for pressurised NHS budgets” stressing funds raised will simply become a substitute for state investment. NHS dentistry’s effectively static budget has remained at around £3bn for the best part of a decade, with patient charges forming an ever-greater share of the total pot. Direct Government spend on dentistry was lower as the country headed into the pandemic than it was in 2010.

The BDA told the Health and Social Care Committee inquiry last month that saving NHS dentistry will require a sustainable funding settlement. Since 2010 Spending on dentistry has failed to keep pace with both inflation and population growth. The UK now spends the lowest share of its health budget on dentistry of any European nation, with England spending the lowest amount per head of population of any UK nation. 

The BDA stress no other UK nation has followed this model, with the latest hike following a decade of inflation busting rises. A band 1 treatment like a check-up will now cost £25.80 in England, but just £14.70 in Wales. A band 3 treatment like dentures will now cost £306.80 in England and just £203.00 in Wales.

BDA Chair Eddie Crouch said: “This hike won’t put a penny into NHS dentistry, it will just force millions to think twice about needed care. Sadly, widening health inequality is a price this government seems willing to pay to cover for cuts. This is not a partisan issue. The public recognise this is not the way to fund a core part of our health service.”

The British Dental Association has slammed moves to increase NHS dental charges during the cost-of-living crisis, accusing Ministers of prioritising lowering their own cash contributions to the service over tackling tangible barriers to access for those with both higher needs and lower incomes.

Charges in England will rise by 8.5% from 24 April 2023. This will mean the cost of a band 1 treatment like a check-up will increase from £23.80 to £25.80, a band 2 like a filling will increase from £65.20 to £70.70, and a band 3 like dentures will increase from £282.80 to £306.80, an increase of £24.

While a proportion of the adult population is exempt from NHS charges, the BDA stress that many on modest incomes will inevitably be forced to think twice about seeking care. Entitlements to free care are limited, with many Universal Credit recipients not being eligible. The government’s own data [1], indicates that around 1 million adults declined to see an NHS dentist for reasons of cost in 2022.

The BDA has underlined that the increase will not put a single penny of new investment into the cash strapped service, and appears to mark a return to a long term strategy in which charges are used 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 struck. 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. [2] The BDA believe this latest increase represents an attempt by the Treasury to return to a fatally flawed ‘business as usual’ model as far as funding is concerned.

The BDA has stressed in oral evidence to the current Health and Social Care Committee inquiry that NHS dentistry’s survival will hinge on a sustainable funding settlement. Since 2010 Spending on dentistry has failed to keep pace with both inflation and population growth. The UK now spends the lowest share of its health budget on dentistry of any European nation according to OECD data, with England spending the lowest amount per head of population of any UK nation.

The BDA is deeply concerned that this increase in charges – the largest since the current system for NHS dentistry was rolled out in 2006 – will have a disproportionate impact on higher needs patients, and fuel already widening oral health inequality. The professional body has requested the equality impact assessment that should have underpinned this latest increase.

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee said: “This is an utterly grotesque display of priorities from the Treasury. This hike won’t put a single penny into a struggling service. Our patients are being asked to pay more simply so ministers can pay less.

“The Government did not have to go down this path during a cost-of-living crisis. This is a cold, calculated political choice, that will hit millions on modest incomes. Ministers must know some face a choice between heating, eating and seeking NHS care. And they are carrying on regardless.”

[1] Analysis of the GP Surveys by Ipsos Mori, 2022.

* Base: all patients who have tried to get an NHS dental appointment more than 2 years ago, or have never tried, and answered the question

**Base: all patients who have tried to get an NHS dental appointment in the last 2 years and answered the question, excluding ‘can’t remember’ and failed to secure one.

[2] NHS General Dental Services budget (England) 

Source: Department of Health accounts 

The British Dental Association has said government’s approach to pay is driving talent out of the NHS, as below inflation awards leave NHS dentists in England facing a drop in real incomes with no parallel in the UK public sector.

With the Association set to hold talks with Health Secretary Steve Barclay tomorrow morning, the Department of Health and Social Care has finally confirmed a substantially delayed uplift in contract values for general dental practice in England at 4.75% for 2022/23, reflecting a 4.5% rise in pay with an additional uplift applied for practice expenses. With inflation at an historic high, this corresponds to real terms cuts to the funding available to deliver NHS dental services and to pay associate dentists and other staff. Dentists in England have already seen their real incomes collapse by nearly 40% since the financial crash.  

In conjunction with the BMA, the BDA has stressed that root and branch reform is now required to give pay review bodies real independence. The government has interfered in the Review Body for Doctors’ and Dentists’ Remuneration processes as a matter of course, imposing public sector pay freezes and pay caps, and by arbitrarily defining ‘NHS affordability’ each year.

The process has been dogged by interminable delay, with the government routinely providing late evidence. The pay uplift for 2022/23 is set to be implemented ten months late in February 2023, close to the end of the NHS financial year and backdated to April 2022. The political chaos and the resultant churn at the Department of Health and Social Care have been cited as excuses. 

Dentist leaders have stressed that this approach will only push talent out of the NHS.

Research undertaken by the BBC underlined the scale of the current access crisis, with nine in ten practices reporting as unable to take on new adult patients on the NHS. The Health and Social Care Committee is now holding a dedicated inquiry, having been warned by the BDA in May that NHS dentistry in England faced a ‘slow death’, in the face of endemic recruitment and retention problems.

BDA Chair Eddie Crouch said: “England’s dentists have just been handed an unprecedented pay cut at the eleventh hour. If Steve Barclay wants to win over NHS colleagues, he must turn the page. Current pay review processes offer textbook examples of what not to do. Every dedicated health professional requires fair and timely pay uplifts. When so many are reconsidering their future in the NHS, to do otherwise is an act of self-harm.”

Following Jeremy Hunt’s emergency statement on the public finances, the British Dental Association has warned any further cuts risk destroying any prospect of saving NHS dentistry in England.

In an open letter to the new Chancellor, the professional body has stressed that without meaningful investment a reform process looks doomed from the outset, and that any further ‘efficiency savings’ will critically undermine existing dental providers and further erode access to the public.

Formal negotiations are yet to begin on reforming the discredited NHS contract dentists in England work to that is fuelling the current access crisis. The system puts government targets ahead of patient care, and caps spending to cover barely half the population. Minor ‘tweaks’ to the contract announced before the summer recess, will do nothing to improve access, or halt the exodus of dentists from the NHS and had no additional funding attached.    

The BDA has long pressed for a decisive break from this failed contract, recently dubbed by Parliament’s Health and Social Care Committee as ‘not fit for purpose’, underpinned by sustainable investment. It warns that the government’s objectives to improve access and boost retention simply cannot be achieved within the historic financial constraints set by the Treasury. Dentist leaders warn another period of austerity will leave the service at risk of collapse. The BDA estimates it would take an extra £880m a year simply to restore resources back to 2010 levels.

In his former role as chair of the Health and Social Care Committee, Jeremy Hunt had been a leading advocate of reform in dentistry, and a fully funded workforce plan for the NHS.

BDA Chair Eddie Crouch said: “Without fair funding for NHS dentistry, there was little scope to do more than rearrange the deckchairs as the ship goes down. New cuts will only speed that process along.

“Since the financial crash, dentists have faced cuts with no parallel anywhere in the NHS. There is simply no more fat to trim, short of denying access to an even greater proportion of the population. 

“We never imagined we would need to defend the wholly inadequate resources currently offered to us. But it seems we must. However, the stark reality remains that sustainable investment is urgently required if we are going to bring this service back from the brink.

“In his former role, the Chancellor recognised the scale of this crisis. NHS dentistry is already on the critical list. Any further cuts will kill the patient.”