NHS Dentistry Crisis

Access and challenges to NHS dentistry

• Limited Access: Many patients in the UK struggle to access NHS dental care due to a shortage of appointments and increasing waiting times.

• Funding and Contracts: The 2006 NHS dental contract is widely regarded as outdated. It places heavy pressure on dentists through UDA targets and does not fully reward prevention or complexity of treatment. Ongoing reforms aim to make the system fairer and more sustainable.

• Impact of COVID-19: The pandemic significantly worsened the backlog of care, extending waiting lists - in some cases, patients now wait up to two years for routine treatment.

• Affordability: Even when patients can access NHS care, some find the costs challenging, with treatment bands ranging from basic check-ups to complex restorative work.

• Shift to Private Practice: Due to financial pressures, rising demand, and dissatisfaction with the NHS contract, many dentists are moving to or expanding private practice, further reducing NHS capacity.

NHS vs private dentistry

NHS Dentistry:

• Focuses on providing affordable and accessible care to the public.

• Often involves high patient volumes, limited appointment times, and prioritisation of urgent or essential treatments.

• Advantages: Opportunity to treat a wide range of patients and gain varied clinical experience.

• Challenges: High workload, limited resources, pressure to meet UDA targets, and restricted time for preventive or elective treatments.

Private Dentistry:

• Offers greater flexibility in treatment options, materials, and appointment lengths.

• Allows dentists to spend more time on cosmetic and preventive treatments.

• Advantages: Better work-life balance, clinical freedom, and potential for higher earnings.

• Challenges: Requires good business management, patient retention, and sometimes limited insurance coverage (some policies only cover NHS or partial private treatment).

Why is the NHS Dentistry Crisis such an issue?

1. Reduced access to affordable care

• The NHS provides low-cost dental treatment, which is essential for people on lower incomes.

• As more dentists move to private practice, fewer NHS appointments are available, leaving many unable to afford care.

• This leads to widening health inequalities, especially in deprived or rural areas.

2. Increase in untreated dental disease

• Patients unable to access care often delay or skip treatment, resulting in:

  • More tooth decay, gum disease, and pain.

  • Higher rates of emergency visits to hospitals and GPs for dental issues.

• Early, preventive care is lost - people only seek help once problems are severe.

3. Rise of “DIY dentistry”

• Some patients resort to self-treating dental problems, such as pulling out their own teeth, due to lack of access.

• This is dangerous and highlights how desperate the situation has become.

4. Impact on public health

• Poor oral health affects overall health, linking to heart disease, diabetes, and infections.

• Worsening oral health at population level adds pressure on other NHS services.

5. Workforce morale and retention

• NHS dentists face low morale, heavy workloads, and financial strain.

• Moving to private practice may improve their work-life balance, but it shrinks the NHS workforce, worsening the crisis.

Addressing the crisis

• Reform the 2006 NHS dental contract → fairer UDA system, reward prevention & complexity.

• Increase funding and ensure equitable distribution across regions.

• Expand workforce support - recruitment, retention, flexible contracts.

• Improve public education & prevention (diet, fluoride, oral hygiene).

• Encourage integrated care between dental teams, schools, and community health.

• Support use of digital tools to reduce waiting times and improve access.

Note: If you get a question like “What do you think about the NHS dental crisis?”, use this flashcard to show optimism about the future, so you’re not being really negative.