The crisis in dentistry demands real reform

St Pauls Dental Practice
Is rationing back? Queues hundred long form outside a new dental practice in Bristol - Lee Thomas

What does the lengthy queue of people waiting to register at a new NHS dental practice in Bristol tell us about the state of the health service in Britain? The numbers were so large that the police were called to ensure crowd control.

Hundreds were trying to register as NHS patients at a site previously operated privately by Bupa. The local integrated health board has contracted a dental services provider to run the practice after a successful public campaign.

Clearly, there is a demand for dental care in the area, but not one that people were ready to pay for, or not much. In fact, NHS dentistry is not free at the point of delivery, unlike a GP, though it is cheaper than seeing a private practitioner. Charges were introduced in 1951. Some groups are entitled to free care, including people on income-related and pension benefits.

Although NHS dentistry is supposed to provide a service for everyone on demand, the reality is different. Access is hard and for new patients impossible in many areas. A report by the British Dental Association in 2022 found that nine in 10 practices were not accepting new adult patients for NHS treatment.

The Nuffield Trust think tank said last year that the traditional model for NHS dentistry was gone for good and restoring services would be unrealistically costly. In a recent debate in the Commons, Wes Streeting, the Opposition health spokesman, said that, if Labour wins office, it will “rebuild” NHS dentistry with more appointments, more dentists, more support for children and long-term reform to put the service on a sustainable footing. All this will be paid for by abolishing the non-dom tax status, which seems to be funding almost everything Labour proposes. This is pie in the sky.

As we report today, the Government is launching its own dentistry recovery plan to “deliver up to more than 2.5 million additional NHS dentistry appointments across the country”. This will be achieved by offering cash incentives to dentists taking on new NHS patients, and “golden hello” payments to those going to work in so-called dental deserts, where services are lacking.

But neither approach will work and something more radical is needed, including an expansion of the insurance market. The cap on dental students needs to be removed to increase the numbers in training. Fewer than 1,000 dental school places are available each year. That is not enough.

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