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Overview of NHS dentistry

Commissioning and funding

In 2013, NHS England became responsible for commissioning primary dental care services to meet local needs and priorities, managed through its local area teams. Between April 2022 and April 2023 NHS England expects regional Integrated Care Boards (ICBs) to take on delegated responsibility for primary, secondary and community dental services.

Primary care dentists are self-employed and can provide a mixture of private and NHS funded care. Service delivery provided on the NHS is agreed under contract between the NHS and the dentist.

Dental contracts require dentists to complete a set number of units of dental activity (UDAs) – these do not relate to the number of patients. Despite attempts to review and reform the dental contract since it was introduced in 2006, the current contract has remained largely unchanged until reforms announced on 19 July 2022.

Stakeholders such as the British Dental Association have argued the reforms don’t go far enough and the UDA system is fundamentally flawed.

NHS dentistry in England is funded by a combination of payments from NHS England and NHS Improvement (via the NHS Business Services Authority) and patient charges. Some groups of patients are entitled to free dental treatment.

The contribution of NHS England to total funding for dental services fell by 9% in real terms between 2010/11 and 2019/20. Over the same period income from patient charges increased by 17%.

Workforce

NHS England and NHS Improvement have said that whilst overall national workforce numbers appear adequate, they are aware of “certain geographic shortfalls limiting service provision”.

The uneven distribution of dentistry schools – six in the North, two in London, two in the South West, one in the Midlands and none in the East of England – has made it difficult to maintain the workforce in remote areas.

Concerns have also been expressed about the number of NHS dentists turning to private practice. In May 2022, the BDA reported 3,000 dentists had stopped providing NHS dental services since the start of the pandemic and their survey of high street dentists found nearly half (45%) reported reducing their NHS commitment since the onset of the pandemic. 75% said they were likely to reduce their NHS commitment in the next year.

Access to NHS dentistry

The Care Quality Commission (CQC) highlight that access to NHS dental care was an issue  long before the pandemic, but there are “clear signs” of problems having been compounded by Covid-19.

Concerns about lack of access to NHS dentistry, particularly in more remote areas of the UK, have been the subject of several parliamentary debates and received widespread media coverage. Amongst these concerns have been media reports of people turning to “DIY dentistry” and others resorting to paying for private treatment.

In May 2021, Healthwatch reported examples of patients turning to private dentistry to access routine treatment. The article said “whilst some people were asked to wait an unreasonable time of up to three years for an NHS appointment, those able to afford private care could get an appointment within a week.”

Advice on how to find an NHS dentist from the NHS advises that dentist practices do not have a catchment area and patients do not need to “register” with a dentist in the same way as with a GP (though practices may have their own registers to store personal details and waiting lists).

Government policy

Response to the Covid-19 pandemic

Between 25 March and 8 June 2020 NHS dental practices in England ceased routine dentistry in response to the pandemic. Around 600 urgent dental care hubs were set up to deliver care for patients. Infection and control requirements were put in place on reopening, reducing the capacity of dental services. Over the course of the pandemic, the British Dental Association have estimated over 38 million dental appointments have been missed.

The Office of the Chief Dental Officer England and NHS England published a Standard operating procedure: Transition to recovery (PDF) on 4 June 2020 which set out how patients should be prioritised according to greatest clinical need. The dental Standard Operating Procedure has now been withdrawn.

During the pandemic, activity targets were reduced. Based on clinical advice and modelling from the office of the Chief Dental Officer, and the amount of activity being achieved by dental practices at the time, targets were gradually increased over time. In response to a parliamentary question answered on 7 July 2022, Maria Caulfield MP said dentists have now been asked to meet 100% of contracted UDAs.

The Government announced an additional £50 million in funding for dentistry on 25 January 2022 to spend before the end of the financial year to help deal with the backlog.

Reform of dental contracts

The Government have committed to reforming the unpopular 2006 dental contract.

In response to an oral parliamentary question on NHS dental care services on 14 June 2022, Maria Caulfield, Parliamentary Under-Secretary of State for Health and Social Care, said:

[…] the contract is the nub of the problem; it is currently a perverse disincentive for dentists to take on NHS work. We are serious about reforming it, we are in discussions with the BDA, and we will make the announcements before the summer recess.

In a written statement on 19 July 2022, the Government announced changes to the remuneration system:

We will make changes to the way dentists are remunerated for the range of treatments that are currently covered in Band 2 treatments. Dentists will be paid more when they need to do three or more fillings or extractions and provide endodontic care.

The statement also said high performing practices will be allowed to perform up to 110% of contracted dental activity. For poorly performing practices, NHS England will be able to rebase contracts and release unused funding to commission other providers.

Workforce

In September 2021, Health Education England published their Advancing Dental Care Review report. Their recommendations included more flexible entry routes into training, exploring ‘Centres of Development’, supporting the development of apprenticeships “to diversify and promote the concept of a local dental workforce approach”, and distributing postgraduate training posts so they are better aligned to areas with the highest levels of oral health inequalities.

The Government said it is working with HEE to implement these reforms and working with the General Dental Council to streamline the process for overseas dentists to pursue dentistry in the UK.

In a written statement on 19 July 2022, the Government said it will take forward legislative change to support the General Dental Council (GDC) to streamline processes and identifying alternative pathways for international dentists wishing to work in the UK.


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