Debate on NHS dentistry in England

This is a debate pack. Please refer to the House of Commons Library briefing paper on NHS dentistry in England for more recent information on this topic.

Overview of NHS dentistry

Most dental practices offer a mix of NHS and private dentistry. 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).

NHS England are responsible for commissioning primary dental care services to meet local needs and priorities, managed through its local area teams. 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.

Dental contracts require dentists to complete a set number of units of dental activity (UDAs) – these do not relate to the number of patients. Attempts to review and reform the dental contract have taken place since their introduction in 2006. At present the contract remains the same. The Government has said it is continuing to work to reform the contract.

Access to NHS dentistry

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

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 The dental Standard Operating Procedure has now been withdrawn

In May 2021 Healthwatch reported examples of patients turning to private dentistry to access routine treatment. The article said that “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.”

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.

The Government said the funding would secure up to 350,000 additional dental appointments for those in most urgent need, including people suffering from oral pain, disease and infections.

On 24 January 2022, Health Minister, Maria Caulfield, provided the following response to a Parliamentary Question, explaining the contractual performance threshold and changes made during the pandemic:

The National Health Service contracts with dentists to provide an agreed level of dental activity each year, measured in units of dental activity. Where a dentist holds a contract with the NHS, they must deliver the agreed activity or if performance is below 96%, the NHS can recover the unused funds. Dentists therefore have a strong financial incentive to deliver the contracted service and not prioritise private patients in cases where they have undelivered NHS activity.

Throughout the pandemic, NHS England and NHS Improvement have set contractual arrangements which support safe increases in access, whilst maintaining compliance with infection prevention and control measures. The Department is working with the NHS to increase delivery of dental care. NHS dental practices have been asked to meet as many prioritised needs as possible, focussing first on urgent care and care for vulnerable groups, including children followed by overdue appointments.

A letter to all NHS primary care dental contract holders (PDF) on 5 April 2022 stated that a performance threshold of 95% will apply during April to June 2022/23.

Workforce

In addition to the impact of the pandemic, 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”.

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.

Health inequalities

Public Health England (PHE) published Inequalities in oral health in England in March 2021. The report said that oral health behaviours and outcomes were significantly worse amongst those from lower socioeconomic backgrounds and from more deprived geographical areas. It also included evidence that those from minority ethnic groups were less likely to access NHS dentistry.

PHE also highlighted that some vulnerable groups face “substantial difficulties” accessing dental care, including homeless people, prisoners, travellers and looked after children.

A Healthwatch news item in May 2022 reported that a lack of NHS dental appointments is widening health inequalities. The article states “[Healthwatch] have warned decision-makers that NHS dentistry is in desperate need of reform.”