BDA on NHS dentistry: Little evidence Ministers are ready to honour pledges on reform

The British Dental Association has warned government needs to show real ambition to bring NHS dentistry back from the brink, given the absence of any new commitments in Therese Coffey’s ‘Plan for Patients’.  

While the new Health Secretary restated her ‘ABCD’ priorities – ambulances, backlogs, care, doctors and dentists – she offered no new proposals to halt the exodus of dentists from the NHS or expand access to care to patients.  

News comes as over 60 MPs from across Parliament – led by the Mother and Father of the House – have called on the PM to make good on her campaign pledges on NHS dentistry. During the recent leadership election Liz Truss stated that action on the access crisis would form a ‘top 3’ target in her first 90 days. 

The discredited NHS contract dentists in England work to is fuelling the access crisis. It puts government targets ahead of patient care, and caps spending to cover barely half the population. Coffey’s speech, the BDA say, offered nothing new, simply revisiting minor ‘tweaks’ to the contract announced before summer recess, which do nothing to improve access, or halt the exodus of dentists from the NHS, and had no additional funding attached.   

The BDA is pressing for a decisive break from this failed contract, underpinned by sustainable investment.  It would take an extra £880m a year simply to restore resources to 2010 levels. It warns that government objectives to improve access and boost retention simply cannot be achieved within the financial constraints set by the Treasury.  

Recent BBC research has revealed 9 in 10 practices are unable to take on new adult NHS patients.  In Liz Truss’s constituency base of Norfolk that stands at 100%, and the same applies in Suffolk, home to Therese Coffey, the new Deputy PM and Secretary of State for Health and Social Care. In Surrey, home to new Chancellor Kwasi Kwarteng, the figure stands at 93%.  

BDA Chair Eddie Crouch said: “Today we saw little evidence government is ready to honour its pledges on NHS dentistry. This isn’t a partisan issue. Underfunding and failed contracts can be fixed, but we need real leadership across Whitehall. Millions of patients need these promises to be kept.” 

NHS Dental Statistics for England, 2021-22, Annual Report released

NHS England has released its annual report of dental statistics. NHS Dental Statistics for England, 2021-22, Annual Report is available to read here

The report covers NHS dental activity in England for the 12-month period up until 31 March 2022. It includes clinical treatments and dental workforce, as well as information on the number of patients seen by an NHS dentist up to 30 June 2022. Details of patients seen and NHS dental activity is broken down to dental practice level.

NHS England notes that the data reported in some instances, such as activity, patient numbers, finances and treatments, will be lower than expected due to Covid-19 restrictions.

NHS Dental Statistics for England, 2021-22, Annual Report has produced the following key figures:

  • 16.4 million adults were seen by an NHS Dentist in the 24-months up to 30 June 2022
  • 5.6 million children were seen by an NHS dentist in the 12 months up to 30 June 2022
  • 26.4 million courses of treatment were delivered in 2021-22. An increase of 120% compared to the previous year
  • 24,272 dentists performed NHS activity during 2021-22, an increase of 539 on the previous year
  • 29.7% of adult clinical treatments included Scale and Polish in 2021-22
  • 53.8% of clinical treatments for children included Fluoride Varnish Treatment in 2021-22

Read more: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-dental-statistics/2021-22-annual-report

BDA: ‘New figures show service on its last legs’

The British Dental Association says the latest damning data on NHS dentistry in England underlines the need for radical and urgent change. 

Just a third of adults (34%) accessed NHS dental care in the 24 months to 31 March, with children seen in the last year at 44.8%. This compares to 49.6% for adults, and 58.7% for children in the last full year prior to the pandemic. 

In 2021-22 just 26.4 million courses of NHS dental treatment were delivered. This is just two-thirds (67%) of the average volumes delivered annually in the five years prior to the pandemic, 39.4 million. Since April 1, dentists have been compelled to hit 100% of pre-pandemic activity, but the BDA understands there have been no gains in terms of the volume of NHS dentistry delivered.

Over a year’s worth of NHS dental appointments have been lost since lockdown, creating a backlog that will take years to clear, with patients now presenting with higher levels of need, having stored up problems as a result of ongoing access problems.

Recent BBC research has underlined the scale of the crisis, with nine in ten practices reported as unable to take on new adult patients on the NHS. The Health and Social Care Committee was warned in May that NHS dentistry in England faced a ‘slow death’, with endemic recruitment and retention problems fuelled by the discredited target-based contract. The Committee dubbed the contract ‘not fit for purpose’ and has pledged a dedicated inquiry. 

While both contenders for the Conservative leadership have pledged urgent reform of NHS dentistry, there is no indication yet that the Treasury will be mandated to provide the funding needed to underpin the rebuild and reform of services. The current system funds care for only half the population. After a decade of savage cuts the BDA estimate would take an extra £880m a year simply to restore resources to 2010 levels.  

Recently announced ‘tweaks’ to the NHS contract have had no new funding attached, and the BDA argue changes will do nothing to meaningfully expand access or halt the exodus from the NHS.

BDA Chair Eddie Crouch said: “What we’re seeing isn’t a recovery, but a service on its last legs. The Government will be fooling itself and millions of patients if it attempts to put a gloss on these figures. NHS dentistry is lightyears away from where it needs to be. Unless Ministers step up and deliver much-needed reform and decent funding, this will remain the new normal.” 

NHS Dentists demand lifeline as ‘dental inflation’ soars

Dentists need real support from all four UK governments to withstand the impact of ‘dental inflation’, now standing at over 11% according to new analysis from the British Dental Association.   
  
BDA modelling of data from NHS Digital, the Office of National Statistics and its own surveys has shown the huge inflationary pressures that dentists are facing, with lab bills increasing on average by 15% and nearly one-fifth of dentists seeing their utility bills rise by more than 50%.   
  
Following the real-terms pay cuts announced this week, the BDA is demanding all UK health departments ensure that uplifts on expenses – anticipated shortly – at least keep pace with inflation, to ensure dentists are not left delivering NHS care at a financial loss. 
  
Dentist leaders are stressing failure to keep pace with rising costs will have real consequences for practices as they struggle to deliver care and recruit and retain dentists and staff.   
   
In setting out its recommendation on pay, the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) noted that: “our recommendations this year are net of expenses and therefore do not take into account fluctuations in operating costs. Ensuring that dental practices’ financial sustainability and dental earnings are not affected by such fluctuations is an important responsibility that lies with the governments, in agreeing expenses uplifts.”
 
The DDRB recommends on pay, the four UK administrations are then responsible for determining an allocation for expenses to deliver an overall uplift in fees and contract values. They add: “Expenses uplifts must be sufficient to both deliver dental services and protect dental incomes, ensuring that our pay recommendations are received by providing-performers and associates alike, in order that they can address issues of recruitment, retention and motivation.”

In England the funding given to practices for training newly qualified dentists has also been frozen since 2010. This payment remains at £5,347, whereas – had it been uplifted in line with inflation – it would now be £8,030, a fall of a third.   
  
Thousands of dentists have left the NHS since the first lockdown. Given the exodus, the BDA is also pushing for full restoration of these training service costs to guarantee the pipeline of young talent entering the service.    

The BDA’s Deputy Chair Peter Crooks said: “Dentists have been handed another real-terms pay cut. It would be foolhardy for officials to apply the same logic to their expenses given the soaring costs of delivering dentistry.   
  
“No frontline health professional should be expected to provide NHS care at a financial loss.   
  
“Dental inflation is soaring. Many dentists are already reconsidering their future in the NHS, and if governments fail to step up it will have devastating consequences for millions of patients.”   

New NHS dentistry reforms receive a mixed response from oral health charity

A new package of proposals to reform NHS dentistry in England has received a mixed response from the Oral Health Foundation

In a letter penned to dental practices, NHS England outlined the first significant changes to the delivery of NHS dental care in 16 years.

Dr Nigel Carter, chief executive of the Oral Health Foundation, says: “The new reforms to NHS dentistry are welcome changes in the right direction.  The long-awaited adjustments to UDAs should make it easier to treat high-need patients and go some way in reducing inequalities.  The dental profession has been calling for such changes for over a decade, so they are long overdue.

“We are also supporting the move of allowing dental therapists to start courses of treatment, although even more must be done to fully utilise the skills of the entire dental team.

“Unfortunately, the new reforms stop well short of addressing urgent issues within NHS dentistry, such as the diminishing workforce and access to NHS dentistry.

“A move towards extending recall intervals will only scratch the surface of current access problems and a plan to address manpower shortages is needed immediately.  It is also extremely disappointing that the new reforms do not in any way tackle the postcode lottery of dental access in England.

“Fundamental reform is still needed.  Whether it is increasing the NHS dental workforce, or improving access across England, there must be a greater commitment toward additional funding for NHS dentistry.  Despite servicing an ever-increasing population, government investment in NHS dentistry continues to decline in the UK.  Ultimately, reforms without the necessary financial investment will only have a limited and short-term effect.”  

A summary of changes to NHS dentistry, which will take effect from this Autumn, include:

  • A minimum UDA (Units of Dental Activity) value. The payment dentists receive for hitting a target is now set at a minimum of £23.00.
  • A higher reward for treating 3 or more teeth. Dentists will now receive 5 UDAs for treating 3 or more teeth. This is an increase on the current level of 3 UDAs which are applied to any number of teeth treated.
  • A new payment rate for complex treatment. Root canal treatment on molar teeth will now be rewarded with 7 UDAs.
  • A greater role for dental therapists. This means that other members of the dental team can start treatments for patients with the hope of reducing access issues.

Better Access To NHS Dental Services Under New Reforms

Patients across the country will benefit from improved access to dental care under changes announced by NHS England today.

New reforms to the dental contract – the first in 16 years – mean NHS dentists will be paid more for treating more complex cases, such as people who need three fillings or more.

Dental therapists will also be able to accept patients for NHS treatments, providing fillings, sealants, preventative care for adults and children, which will free up dentists’ time for urgent and complex cases. 

To make services more accessible for people, dentists must update the NHS website and directory of services so patients can easily find the availability of dentists in their local area.

High-performing dental practices will have the opportunity to increase their activity by a further 10% and to see as many patients as possible.

In March last year, the Government asked NHS England to lead on the next stage of dental system reform to deliver better outcomes for patients and better support dentists.

The new reforms will ensure that dentists, who are operating at full capacity for the first time in two years, will be able to recover dental services following the impact of the pandemic.

Chief Dental Officer for England Sara Hurley said: “The NHS is determined to overhaul dental provision, with a focus on increasing access to necessary dental care and supporting prevention, today’s reforms are the first step on that journey.

“NHS dental staff are working hard to recover services, but the key to delivering this will be reform – these changes announced today will help teams carry out even more treatments and help address the inevitable backlogs that have built up during the pandemic.

“Anyone with concerns about their dental health should contact their local dentist as they usually would or seek advice from NHS 111.”

“Infection prevention and control measures to protect staff and patients were introduced during the pandemic, limiting the number of procedures that NHS dentists could carry out.”

NICE guidance states that dental teams should see patients for an oral check-up based on their health risk which can be once every two years instead of every six months – this will ensure appointments are given to those most in need.

Health and Social Care Secretary Steve Barclay said: “Improving patient access to NHS dental care is a priority and these changes are an important step, while also rewarding dentists more fairly for providing more complex care, allowing the best performing practices to see more patients and making better use of the range of professionals working in the sector such as nurses, hygienists, and dental therapists.

“The NHS commits around £3 billion to dentistry each year and we provided unprecedented support, including £1.7 billion, during the pandemic to protect teams and patients by paying dental practices for the work they would normally have carried out if it were not for Covid regulations.

”The NHS published six aims of dental system reform which have been endorsed by the British Dental Association and the NHS continues to work with the sector to reform NHS dentistry.

NHS England will now move towards the next phase of engagement to introduce wider reforms that benefit patients and staff.

Chris McCann, Director of Communications, Campaigns and Insight at Healthwatch England, said: “This announcement shows the power of the voices of thousands of patients who have spoken up in the last few years about their need to see an NHS dentist. The NHS is listening and taking action. The changes will make it is easier for people to see which dentists are taking on new NHS patients. Those with more complex dental problems should also have better access to care because of the shift in how the NHS pays dentists. Ultimately we hope these combined measures will end long waiting times, the extended periods of pain many people suffer, and the extreme cases of DIY dentistry we have seen. However, these reforms need to be just the start if we are to create an NHS that is able to deliver good dental care for all.”

Jennifer Owen, NHS practice principal in Gateshead and Chair of the Gateshead & South Tyneside Local Dental Committee, said: “I think these changes are a positive step in the right direction. The increase in UDAs for band 2 treatments will help dentists dedicate more time to those who need it most and lifting the cap on performance will mean that NHS practices can increase capacity and allow more NHS patients to be seen”

Abhi Pal, President of the College of General Dentistry, said: “While the NHS dental contract in England needs fundamental reform, we welcome these significant improvements. In particular, the removal of unnecessary restrictions on the roles played by members of the wider dental team, the direction of more resource to the treatment of patients with greater needs, and the potential for practices to deliver additional care so that all funding allocated to dentistry is used for its intended purpose.”

Piers Stennett-Howard, frontline NHS dentist in East Anglia, said “When I heard the news about the contract reform, I wanted to punch the air with the sense of victory for hard working dentists treating high needs patients. Finally, some action which acknowledges and remunerates the time and skill of the dentist. By utilising dental therapists it should enable practices to clear the backlog of work. These reforms should be seen as a new lease of life for NHS dentistry.”

Debbie Hemington, President of The British Association of Dental Therapists said: “The British Association of Dental Therapists are pleased that the full skill set of DCPs has been acknowledged and welcomes these initial reforms to the NHS dental contract, and we particularly look forward in working with NHS England to clarify how skill mix and direct access in NHS practice can be utilised”.

Ravi Singh, NHS dental practice owner in Greater Manchester, said: “It is good to see the NHS valuing clinical engagement and dealing with the real issues in dentistry. These changes recognise the call for a payment system which reflects the needs of the patient and the time taken to provide the appropriate level of care. The barrier of therapists being unable to open an NHS course of treatment has also been resolved leading to a greater application of the theory of skill mix and practices have a new opportunity to grow”.

Neil Carmichael, Executive Chair of the Association of Dental Groups, said: “We welcome these proposals as a first step on the road to NHS dental contract reform and clearing the backlog of care.  The removal of administrative barriers preventing dental therapists from operating within their full scope of practice should be welcomed as full use of the whole dental team has an important part to play in widening access and retention of staff”.

British Association of Dental Nurses (BADN) President-elect Debra Worthington said: “BADN – the professional association for dental nurses in the UK – support this reform and look forward to working with the Office of the Chief Dental Officer in developing it further; in particular in promoting the effective use of dental team skill mix to ultimately improve oral health outcomes. BADN wholeheartedly support the effective utilisation of dental nurses in the clinical environment, using skills achieved by further education leading to post-registration qualifications, thereby expanding the role of the dental nurse and ultimately improving the patient experience.”

Diane Rochford, President of the British Society of Dental Hygiene and Therapy (BSDHT) said: “I welcome the initial phase of changes to the contract for general dental services in England. The focus on access to care for patients and the implementation of the wider dental team providing care within their full scope of practice is essential to assist in reducing oral health inequalities. BSDHT look forward to the next phase work for dental contract reform.”

Professor Claire Stevens CBE, Spokesperson for the British Society of Paediatric Dentistry (BSPD), said: “BSPD recognises that as the first step towards dental reform, the revisions to the NHS dental contract are heading in the right direction. We hope these first stages will help children in areas of high need and those from disadvantaged groups. It is important that every child has a dental home – an ongoing and preventively focused relationship with their oral healthcare team, beginning with a DCby1 (Dental Check by One). We would like to see further contract reform that incentivises evidence-based interventions or moves more towards a capitation-based system for children and young people.  We remain able and willing to join future discussions, continuing our advocacy for children and young people.”

Michael Copeland, regional manager at Wesleyan, the financial services mutual for dentists, said: “The current system simply isn’t working – it doesn’t pay dentists fairly for their work and makes managing a career as an NHS dentist in England incredibly challenging. The modest tinkering announced today isn’t going far enough and serious reform of the contract is now well overdue. Getting this right will help reassure dentists working in the NHS, and those with ambitions to join them, that they have a long-term future providing dental care through the National Health Service. Failure to address it is only going to compound staff shortages and access to NHS treatments.”

NHS dentistry: Ministers papering over cracks, as dentists push for real reform

The British Dental Association has said government must press ahead on fundamental reform of NHS dentistry, following plans announced today that will do little to arrest the exodus of dentists from the service, or address the crisis in patient access.

The current target-based system funds care for little over half the population and sets perverse incentives to dentists, rewarding them the same for doing one filling as ten. The unsuitability of this model during the pandemic has accelerated the drift of dentists away from the NHS into a full-on exodus. Thousands of dentists have left the NHS in England since lockdown, with almost half reporting having significantly reduced their NHS commitment.

The plans – elements of which will require secondary legislation so cannot take force until after summer recess – include:

  • A minimum UDA value. The payment dentists receive for hitting a target – the Unit of Dental Activity – will now be set at a minimum of £23.00. The BDA has noted that only around 3% of practices will benefit, stressing that any increase will not reverse a decade of savage cuts in the service, which can leave practices providing NHS care at a financial loss, particularly to high-needs patients.
  • A higher reward for treating 3 or more teeth. Dentists will now receive 5 UDAs for treating 3 or more teeth, an increase on the current level of 3 UDAs, which applied to care delivered to any number of teeth. The BDA stress that given patients are now presenting requiring as many as 20 fillings, perversity will remain baked into the system, with less complex work still rewarded at the same rate as treatments that take hours. 
  • A new payment rate for complex treatment. Root canal treatment on molar teeth will now be rewarded with 7 UDAs, as opposed to the current 3, as a result of BDA lobbying. However the BDA stress the move is unlikely to be a game changer, given the nature of the challenging and time-consuming treatments – which can take up to 3 hours on a single tooth.
  • A greater role for dental therapists. There is no hard evidence of a workforce waiting in the wings for the chance to work under the failed NHS contract.

The dentists’ professional body is taking a neutral position on the new package of changes, neither endorsing nor rejecting what it characterises as modest and marginal fixes to the widely discredited NHS dental contract. It has stressed that it remains focused on wholesale change to the broken system, where formal negotiations with NHS England have yet to begin. It has expressed some concern that the Government has offered no guarantees that pledges of fundamental reform will be honoured, stressing this package cannot form a final destination for the service.

The BDA has stressed that these changes – which come with no new investment – show the limits of what can be achieved for patients without greater commitment from the Treasury. The BDA estimate it would take an extra £880m simply to restore funding to levels seen in 2010. [2] Over 44 million NHS dental appointments have been lost since lockdown in England alone – more than a year’s worth of care in pre-COVID times. [3]

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee, said: “These are modest, marginal changes that will not fix the rotten foundations this service is built on. Our patients need Ministers to do more than paper over the cracks. These tweaks will do precious little to keep dentists in the NHS or ensure millions get the care they urgently need.

“The simple fact is not a penny of new investment has been pledged, and government targets will still come before patient care. Today is little more than a small step on the road to real reform. If government considers this a final destination then it will mean the death of NHS dentistry in England.”

NHS dentistry on the brink as Ministers cut vital support, says BDA Scotland

The British Dental Association Scotland has warned Ministers they risk undermining the future sustainability of NHS dentistry, as they move to scale down vital financial support for the service.  

For the last three months practices have received a 1.7 multiplier to the fees paid to provide NHS care, a reflection of the unprecedented backlog practices have faced as they try to ‘live with Covid’. The Scottish Government has now moved to pare the multiplier down to 1.3 for the next 3 months. This reduction follows no dialogue with the profession despite the BDA calling for regular discussions with the Government about the latest activity data and any proposed changes.

The discredited low margin/high volume model dentists in Scotland work to means treatment can often be delivered at a loss, a growing problem given the growing levels of unmet need, particularly among those from move deprived communities.   

Official data suggests the total number of high street NHS dentists in Scotland has fallen by over 5% since the onset of Covid. The BDA warn heavy-handed policies will only push Scottish dentists down the road of their colleagues in England, where thousands of dentists have left the NHS since lockdown, amid warnings from MPs south of the border that NHS dentistry now faces a ‘slow death’. 

The BDA has again urged the Scottish Government to, in the short term, develop a suitable interim funding package to support dentists and their teams as they work through the backlog, and begin work on a new, sustainable long-term model for NHS dentistry. Dentists remain anxious that the Government will look to remove the multiplier altogether at the first opportunity despite its stated intention not to return to the pre-pandemic financial arrangements. The BDA has repeatedly voiced its strong opposition to a return to the pre-Covid “treadmill”.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said:“Ministers are playing with fire, pulling away the life support from a service millions depend on.  

“This multiplier helped ensure NHS dentists received fees for care that actually covered their costs.  Slashing them will leave colleagues churning out dentures at a loss while thinking twice about their future. 

“Scotland has already lost too many NHS dentists since lockdown. Ministers are now blindly heading down the path the Westminster Government has chosen, which has sparked an exodus. 

“Cuts have consequences. The Scottish Government promised free NHS dentistry for all. Short-sighted policies like this will likely result in the exact opposite, and stark oral health inequalities will only widen further.”

New Director of Dentistry of NHS Lanarkshire

A new director of dentistry has been appointed in Lanarkshire. Following a formal interview process, Shelley Percival has accepted the role after fulfilling the interim post since 1 January 2022. Shelley will continue to provide leadership on all issues relating to dentistry in NHS Lanarkshire, ensuring high quality, safe and effective oral care across the area.

“I’m absolutely delighted to accept the position” said Shelley.

“Where my interim role has given me the opportunity to support colleagues during all the challenges of the pandemic, as we recover and look to the future, I look forward to building on the strong relationships and culture of partnership that exists in Lanarkshire. Our unremitting focus, of course, remains on looking after the dental and oral health of local people.”

As well as promoting the improvement and overall quality of care, Shelley will also provide leadership in reducing any oral health inequalities across the area. She will report to Soumen Sengupta, director of health and social care for South Lanarkshire.

“A fundamental and guiding principle of our future direction is the continued expertise, compassion and focus of our staff and partners supporting the health and wellbeing of people Lanarkshire” said Soumen.

“As we take careful steps out of the pandemic, the dental community has a really important and continued contribution to make to the overall effort of delivering health and care fit for the demands of today – and the future.

“Shelley brings a wealth of experience to the role and she is well placed to continue the excellent leadership she has demonstrated in the interim position. We are delighted to formally welcome her to the director post.”

Shelley replaces Anne Moore who officially retired on 31 March 2022. Prior to taking up the post of interim director at the turn of the year, Shelley was clinical director for general dental services in Lanarkshire in October 2020. She has, and will continue to, fulfil a clinical director role alongside her director responsibilities, providing a single professional source of advice regarding all aspects of dentistry.

Shelley graduated from Glasgow University in 1997 and worked in practices in Whitburn, Hamilton and Falkirk before setting up Clyde Valley Dental Practice in 2006. She has pursued post-graduate education by completing a diploma in Forensic Medical Science in 2001 and gained the Membership of the Faculty of General Dental Practitioners in London in 2007.

Shelley has been a vocational trainer and also a tutor for the Faculty of General Dental Practice diploma.

In her spare time, she enjoys time with her family and running marathons throughout the world.

Government paying the price for failing to fix crisis in NHS dentistry, says BDA

The British Dental Association has responded to reports that access to NHS dentistry ranked alongside issues with local schools and Partygate in fuelling the Conservatives landslide defeat in the Tiverton by-election.

The news comes in a week in which MPs have pressed Ministers for urgent change in NHS dentistry in two major debates, and follows warnings from the BDA to the Health and Social Care Committee last month that the service faces ‘slow death’ without real reform and fair funding.

The current system funds care for little over half the population and sets perverse incentives to dentists, rewarding them the same for doing one filling as ten. The unsuitability of this model during the pandemic has accelerated the drift of dentists away from the NHS into a full-on exodus. Thousands of dentists have left the NHS in England since lockdown, with many more significantly reducing their NHS commitment.

Modest, marginal changes to the current discredited target-based NHS dental contract are set to be announced before summer recess. Formal negotiations on meaningful wholesale reform of the contract are yet to begin. 

British Dental Association Chair Eddie Crouch said:

“The Tiverton by-election underlines the real political cost of failure to fix the crisis in NHS dentistry.

“It’s easy to understand why the inability to access basic healthcare services is resonating on the doorstep.

“The barriers facing millions of people in pain are made in Westminster. Until government turns the page on a decade of underfunding and failed contracts we will not see progress.

“Patients and voters deserve better.”