NHS Dental Crisis Worsening in England, MPs Warn

Efforts by the government and NHS England (NHSE) to improve NHS dental access have “comprehensively failed”, according to a damning report from the Commons Public Accounts Committee (PAC). The spending watchdog warned that NHS dentistry has no future without urgent action to support the workforce.

Patients continue to suffer the effects of a lack of access to care, the PAC said, with the most vulnerable patients most affected. 

Committee chair Sir Geoffrey Clifton-Brown MP, called it “utterly disgraceful that, in the 21st century, some Britons have been forced to remove their own teeth.”

Fewer Patients Seeing NHS Dentists

The report, Fixing NHS Dentistry, found that under current funding and contractual arrangements, only around half of England’s population could see an NHS dentist over a 2-year period. In the 2 years to March 2024, only 40% of adults saw an NHS dentist, down from 49% before the COVID-19 pandemic.

The PAC concluded that the current NHS dental contract is “not fit for purpose” and recommended reforms to remove disincentives for dentists to provide NHS care.

In February 2024, the Department of Health and Social Care (DHSC) and NHSE introduced a dental recovery plan, pledging to fund more than 1.5 million additional NHS treatments or 2.5 million appointments.

However, the PAC report stated that the plan had “comprehensively failed” to improve access. It found that the dental contract remains unfit for purpose and does not incentivise practices to deliver sufficient NHS care.

Key Initiatives Have Failed

The PAC criticised all four major initiatives in the plan:

• The New Patient Premium (NPP), which allocated at least £88 million for new patient credits, resulted in 3% fewer new patients seeing a dentist.
• The ‘golden hello’ recruitment scheme, which offered £20,000 incentives, recruited fewer than 20% of the expected 240 dentists.
• An increase in the minimum contract value to £28 per unit of dental activity failed to deliver any identifiable improvements.
• A proposed mobile dental van programme to deliver treatment in targeted communities was abandoned, highlighting the failure of a national plan to address local needs.

Layla Moran MP, chair of the Commons Health and Social Care Committee, commented in a statement: “The state of Britain’s dental services has been known to be in crisis for several years.” She said that since MPs investigated NHS dentistry in 2023, “the situation has not improved and actually appears to have worsened.”

Dentistry Funding Disparity

The PAC highlighted a fundamental hurdle for improving access: the earnings gap between NHS and private dentistry. Without competitive pay, more dentists are likely to shift towards private practice, exacerbating access problems.

Publication of the report comes after an analysis of the British Social Attitudes survey found that satisfaction with NHS dentistry has plummeted to a record low of 20%, down from 60% in the pre-pandemic year of 2019. Dissatisfaction reached 55%, the highest level recorded in the survey.

In its evidence to the committee, NHSE conceded that the plan had failed, and that work needed to start again. “The time for tinkering at the edges is over,” said Clifton-Brown.

Shiv Pabary, chair of the British Dental Association’s general dental practice committee, agreed, “MPs have arrived at an inescapable conclusion, that tweaks at the margins have not and will not save NHS dentistry.”

Nuffield Trust chief executive Thea Stein, chief executive of the Nuffield Trust health think tank, commented: “This report today from the PAC confirms the worst, with little to show, or even steps backwards.” 

A Department of Health and Social Care spokesperson said the Labour government “inherited a broken NHS dental sector” and was working to fix it through its Plan for Change. The government cited its February rollout of 700,000 extra urgent appointments and plans for a supervised toothbrushing scheme for 3-5 year olds.

Dr Rob Hicks is a retired NHS doctor. A well-known TV and radio broadcaster, he has written three books and has regularly contributed to national newspapers, magazines, and online. He is based in the UK.