NHS dentistry in England

How is NHS dentistry organised?

Primary care dentists (sometimes called ‘high street dentists’) are self-employed and can provide a mix of NHS and private dentistry. To provide NHS services the provider must hold a contract with the NHS. Dental services are also provided in the community, for people who cannot access high street dentists, and in hospitals.

Patients can receive treatment from any dentist because there is no system of registration for dentistry, unlike for general practice. This means that once a patient has finished their course of treatment, they are not guaranteed access to the same dentist again in the future.

Integrated Care Boards are responsible for commissioning dental services for their local area. They are accountable to NHS England.

Dental services are inspected by the Care Quality Commission as part of its role as the statutory regulator for the health and care services.

Dental professionals are regulated by the General Dental Council.

NHS dental contract

Under the current NHS dental contract, introduced in 2006, the provider agrees in advance to complete a set amount of dental activity per year, measured in units of dental activity (UDAs). Commissioners can ‘claw back’ money from providers that under-deliver and providers have little scope to provide more activity, even if they have the capacity and time to do so. This is why some patients are told their dentist cannot see them for an NHS appointment but can see them as a private patient.

The NHS dental contract has been widely criticised by professionals, unions, and all political parties. Stakeholders have argued it is inflexible and does not fairly reward dentists for seeing more complex and time-consuming patients. Since July 2022, some changes have been made to the contract. However, it remains based on the UDA system. The government has committed to reforming the dental contract.

Funding

NHS dentistry in England is funded by a combination of payments from NHS England and patient charges. Some groups of patients are entitled to free dental care.

NHS England allocates funding to Integrated Care Boards based on the dental activity services provided in 2006 (when the current national contract model was introduced) rather than current need, and contracts were established without a time limit. Public Health England (since abolished) has explained that this effectively capped dental care spending.

The real-terms contribution of NHS England to total funding for dental services (taking into account the effect of inflation) has fallen by around 26% since 2010/11, down from £2.9 billion in 2010/11 to £2.2 billion in 2023/24. Over this period the income from patient charges fell by 9%. This means the total cost of dental services in England has decreased by 22% in real terms between 2010/11 and 2023/24.

In 2023/24 dental charges to patients provided around 26% of total funding. In April 2023 the Department of Health and Social Care raised dental patient charges, which had been frozen from December 2020 to April 2023, by 8.5%. A 2024 report by the Nuffield Trust, noted that increases in patient charges have been above inflation.

NHS dentistry workforce

Official data shows how many dentists carry out any amount of NHS work. The 2023/24 number of dentists with any NHS activity (24,193) was 2% higher than a decade earlier in 2013/14. However, the increase in dentists has not kept pace with population change. The number of dentists per 100,000 population was 41.9 in 2023/24, lower than the 44.0 in 2013/14.

The NHS recently estimated the number of full time equivalent NHS dentists. This data should be treated with caution, but it suggests that in March 2024 there were around 10,500 full time equivalent NHS dentists in England.

It has been argued that there are enough NHS dentists in England, but not enough undertaking NHS work. This has been described as a drift towards the private sector, potentially caused by an unfavourable NHS contract.

Dentists are unequally distributed across England, with the workforce concentrated around metropolitan areas and dental hospitals and schools. Recent reports have referred to areas with low numbers of dentists as “dental deserts”.

Access to NHS dentistry

How many people access NHS dentistry?

According to NHS England, in June 2024, 40.3% of adults had seen an NHS dentist in the last two years (the maximum recommended interval). This is lower than before the pandemic when the proportion was 50.9% in June 2019. Between these dates the lowest proportion was in June 2022 (36.9%). To compare this over a longer period, as of March 2006, 51.7% of adults had been seen by a dentist in the last two years.

Similarly, the percentage of children who had seen a dentist within the maximum recommended interval (one year) in June 2024 (56.1%) is lower than the pre-pandemic proportion of 57.9%. The lowest level recorded was in June 2021 (32.5%).

In 2023, the Commons Health and Social Care Committee warned that there is a “crisis of access” to NHS dentistry, with unequal access across different regions, ethnic groups and socioeconomic groups. A 2024 report by the Nuffield Trust health think tank concluded that “universal dental care has likely gone for good.”  

How many NHS dental treatments are carried out?

The latest full financial year estimates for 2023/24 show there were 34.1 million courses of dental treatment performed in England. This is almost three times the 12.0 million treatments in 2020/21, which were affected by the pandemic, but around 12% lower than pre-pandemic figures for 2019/20.

Government policy

The Labour Party’s 2024 manifesto said a Labour government would:

• provide 700,000 more urgent dental appointments
• recruit new dentists to areas that need them most
• reform the NHS dental contract
• introduce a supervised tooth-brushing scheme for 3- to 5-year-olds, targeted at areas of the highest need

In February 2025, the Department of Health and Social Care wrote to Integrated Care Boards, directing them to make the 700,000 extra urgent appointments available. The extra appointments are funded from existing funding allocations. The government also confirmed it was scrapping the new patient premium (extra payments for dentists who see new patients) introduced under the previous government, after it was found not to have an impact for patients. The government is continuing a ‘golden hello’ bonus incentive payment (first introduced under the previous government), for dentists who agree to work in hard to recruit areas of the country.

The government is making £11 million of funding available to local authorities for the children’s supervised toothbrushing scheme from April 2025.

The government has said it is negotiating with the British Dental Association on reforming the dental contract. A timescale on contract reform has not been provided. In May 2025, the government launched a survey to inform NHS dental contract reform.

The 2023 NHS Long Term Workforce Plan, published under the previous government, set out plans to increase dentistry training places in England by 24% to 1,000 places by 2028/29 and by 40% to over 1,100 places by 2031/32. The government has committed to publishing a ten-year health plan and a refreshed NHS Long Term Workforce plan.

In 2024, a consultation was held on introducing a ‘tie-in’ for graduate dentists, that would require them to spend at least some of their time delivering NHS activity in the years after graduation. The government has not yet responded to the consultation.

In February 2024, the previous government published its plan to recover and reform NHS dentistry. Analysis by the National Audit Office found the plan had failed to deliver improvements in access to NHS dentistry.