Dentistry: Exodus accelerates

The British Dental Association has urged government to drop any pretence that NHS dentistry is on the road to recovery and finally deliver a meaningful rescue package, as the exodus from the service reaches new heights.

Freedom of information requests undertaken by the BDA indicate just 23,577 dentists performed NHS work in the 2022/23 financial year, down 695 on the previous year, and over 1,100 down on numbers pre-pandemic. The crash brings the workforce to levels not seen since 2012/13.

These official figures are at odds with repeat claims from the Prime Minister that recent reforms have boosted dentist numbers, arguments also made by ministers and officials in evidence to the current Health and Social Care Committee inquiry into the crisis in NHS dentistry. The BDA understands several MPs have already sought corrections to the official record, and there are now at least 7 instances where they have a basis to proceed.

The PM has stated time and again that 500 additional dentists recorded as delivering NHS work in the 2021/22 financial year reflect the success of recent government reforms. The minor tweaks to the discredited contract fuelling the current crisis were rolled out in October 2022, so do not even correspond to the year the PM chose to cite. The BDA believes that any ‘bounce’ in 2021/22 likely reflects the unique circumstances from the first year of COVID in which practices were closed from lockdown to June.

The professional body stresses that recent commitments to develop a ‘recovery plan’ for dentistry were made by government based on false assumptions that the workforce had ‘turned a corner’. It says there can be no more tinkering at the margins, and real commitment is now required to form the basis of a rescue package, simply to stabilise the service ahead of longer-term negotiations on wholesale reform.

The BDA believes that the clearest way forward is to utilise record-breaking ‘underspends’ in the dental budget to bring a degree of sustainability to practices on the brink. The BDA estimated in February that funds returned by practices not hitting their contractual targets would likely exceed £400m this year, or over 10% of the total NHS budget. The BDA now believe this was a very conservative estimate. Practices face huge financial penalties often as a result of being unable to fill vacancies.

The BDA say a new higher minimum Unit of Dental Activity (UDA) value could bring all practices in line with areas with the strongest access levels, give them the chance to fill vacancies, support retention and operate more sustainably in the face of soaring costs. The BDA stress any costs could be kept within the anticipated levels of clawback for 2022/23. A minimum UDA level of £23 was rolled out in October, lower than the current patient charge level of £25.80, and below the level required for most practices to cover their costs or attract new dentists.

In August the PM pledged a Five-Point Plan for dentistry, including commitments to ring fence NHS dentistry funding. The BDA’s approach builds on this, and echoes observations made by Broadland’s Jerome Mayhew MP, who in a recent debate urged members to “follow the money”, noting that the best areas for access “spend nearly £80 per mouth per year on dentistry; in the East of England, the figure is £39—a full 50% less.”

The BDA stress the fall in workforce numbers significantly understates the full scale of lost capacity within NHS dentistry. The government counts heads not NHS commitment. A recent BDA survey of dentists in England revealed over half of dentists (50.3%) had reduced the proportion of NHS work they did since the start of the pandemic – by more than a quarter. 74% indicated they plan to reduce – or further reduce – the amount of NHS work they undertake in the year ahead.

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee said:

“Government needs to drop the spin, accept the facts, and provide a rescue package to keep this service afloat. “NHS dentistry is haemorrhaging talent, and further tweaks to a broken system will not stem the flow.

“The PM once called for this budget to be ring fenced. We face an access crisis, and with hundreds of millions set to be pulled away, funds must be put to work solving these problems.

“Ministers have a choice. They can help thousands of struggling practices fill vacancies and see patients, or just pass by on the other side.”