The UK population is still struggling to secure dental appointments on the NHS.
This is not news. It is clear not enough dentists are taking on such work to meet demand – meaning more and more people are suffering in silence as they simply cannot afford to go private due to an ongoing cost of living crisis.
Employers are alive to the issue and dental benefits – particularly in cash plans – are certainly growing in popularity amid a degree of market consolidation. But so too are group PMI premiums – meaning employers are seeking more cost effective solutions for their staff.
And while as the UK heads into a general election next month tackling issues with securing NHS dentist appointments feature prominently in party manifestos, one adviser has told Health & Protection more needs to be done to support private dentistry.
Struggling to find NHS dental services
“People across the UK are struggling to find NHS dental services and to pay for their own privately. Dental cover’s a key area where businesses can really help at the front line,” Matthew Reed, managing director, Equipsme, tells Health & Protection.
“It is now taken up by more than 40% of the businesses we work with, and anecdotally we find it often cited as a key deciding factor.”
Clare Lusted, head of product proposition at Unum UK, says when splitting the number of dental claims it receives into NHS vs private, the proportion of NHS claims has dropped from 35% pre-pandemic to just 26% in the rolling 12 months to the end of April 2024.
“Equally, the percentage of the number of claims for private treatment has risen from 65% to 74% in the rolling 12 months from January 2019 to the end of April 2024,” Lusted says.
But amid the ongoing cost-of-living crisis, individuals are finding it more challenging to afford out-of-pocket expenses, Lusted adds – especially those not capped by NHS treatment bands.
“Meanwhile, the rising cost of dental care is evident,” she continues.
“Even for NHS claims, Unum has seen the average claim for the cost of treatment rise by 40% in the rolling 12 months from January 2019 to the end of April 2024.”
Consolidation in the market
Over the summer of 2023 Unum acquired the renewal rights to Cigna’s dental customers as Cigna divested its UK dental business.
A year on, Lusted says that in addition to introducing access to Toothfairy, a digital dentistry service, Unum has refreshed its dental insurance offering by increasing benefit levels, simplifying clinical terminology in a bid to ensure that making a claim is even easier and faster to navigate.
“With our heritage, expertise and caring spirit, we knew we could provide Cigna customers an enhanced, holistic offering, elevating experiences of employee wellbeing and financial protection in the corporate dental market,” she adds.
Elaborating on what further consolidation means for the market, Marcia Reid, non-executive director at Sherwood Healthcare, tells Health & Protection while she was sad to see Cigna leave the market, she believes there is still sufficient choice in the market for “what is, in essence, a fairly simple product”.
But Reid says: “I do think that customers would be disadvantaged if any other provider left the market.
“As with private medical insurance – service enhancements and ‘added value’ services, such as the addition of Toothfairy to the Unum proposition and enhanced oral cancer cover with Bupa Dental. can act as a differentiator and help a client make a choice.”
Dave Middleton, executive chairman at the Association of Medical Insurers and Intermediaries (AMII), adds: “Of course consolidation is always something that we keep an eye on, but this happens in all walks of life and not something that is a major concern at the moment.”
Cost remains a concern
But a further concern is cost of dental healthcare as demand rises.
Emma Wood, director of healthcare at Broadway Insurance Brokers, tells Health & Protection her firm is seeing an increase in demand for dental cover from our clients.
“It’s not so much full-blown dental insurance but more around cash plans and dental and optical cash back add on options within PMI policies,” Wood says.
“I have seen an increased trend towards the cash plan market and dental and optical benefit add-on options to PMI policies.
“Dental insurance, in its own right, is still expensive for a business when they are looking to implement a wellbeing strategy for their whole of workforce.
“A cash plan policy provides some cover towards everyday healthcare and dental costs for employees while providing really good value for money for employers.”
Rising premiums
A further issue comes in the form of rising employer premiums as usage increases, as Brett Hill, head of health and protection at Broadstone, explains.
“Many employers have sought to look after their workforce by expanding coverage on their PMI scheme in recent years and are now grappling with sharp increases in premiums driven by claims inflation,” Hill says.
“Expanding access to company-funded dental benefits while finding the budget for increased healthcare costs can be a big ask of employers, especially when dental premiums are also facing upwards pressure with insurer reports of rising claims incidence and treatment costs.”
In terms of which sectors where dental is regarded as a ‘must have’, Catherine Rutland, clinical director at Simplyhealth which owns Denplan, points to technology, legal and banking sectors.
“We are seeing an increase in demand for hygiene plans, with hygiene treatment becoming increasingly difficult to access via the NHS across the UK, coupled with post pandemic demand for cosmetic and hygiene treatment increasing, particularly among NHS patients and younger age groups,” Rutland continues.
“In Denplan’s bid to provide access to affordable healthcare for all in the UK we have relaunched Denplan Hygiene, with the additional option to add supplementary insurance.”
In terms of what’s driving demand, Rutland reveals that from a Denplan member dentist point of view, there is currently considerable disenchantment with the existing NHS dental contract.
Party proposals
And while in the initial stages of general election campaigning, announcements on dental care were thin on the ground, political parties have since made reference to dental care in their respective manifestos.
The governing Conservative Party’s manifesto commits to unlocking 2.5 million more NHS dental appointments, through a patient premium to encourage dentists to take on new NHS patients.
The party also commits to further reforms to the dental contract to “ensure its future sustainability” as well as ensuring newly qualified dentists have to work in the NHS for a number of years or pay back their training costs.
Meanwhile in their manifesto the Lib Dems promise guaranteed access to an NHS dentist for everyone needing urgent and emergency care by:
- Bringing dentists back to the NHS from the private sector by fixing the broken NHS dental contract and using flexible commissioning to meet patient needs
- Guaranteeing appointments for all those who need a dental check before commencing surgery, chemotherapy or transplant
- Introducing an emergency scheme to guarantee access to free NHS dental check-ups for those already eligible: children, new mothers, those who are pregnant and those on low incomes.
The Greens committed to a new NHS dentists’ contract so that dentists are “properly rewarded for taking on NHS patients”.
And Labour too, who if current opinion polls are to believed will take power come 5 July, has promised to create 100,000 extra dental appointments for children, in a bid to clear backlogs in England.
The new appointments will be for urgent and emergency care and on evenings and weekends, according to the party’s manifesto.
Labour also announced a rescue plan to provide 700,000 more urgent dental appointments and recruit new dentists to areas that need them most.
Labour added it will reform the dental contract, with a shift to focusing on prevention and the retention of NHS dentists.
Call to government
But Kristian Breeze, director of healthcare at Ascend Health, suggests whoever forms the next government could also look into ways supporting private dental care as well as the NHS.
He suggests increasing funding for NHS dental services or introducing incentives for private providers to expand their reach and reducing the regulatory burden on private practices and insurers to facilitate greater accessibility and affordability of dental care.
But Breeze also calls on the next government to look at incentives for preventive care initiatives as well as delivering a strategic reduction in Insurance Premium Tax (IPT).
Tackling the dentist shortfall
In order to tackle the UK’s shortage of dentists, Paul Nugent, CEO of Santé Group, suggests financial incentives could be used to attract dentists to underserved areas.
“This could include offering a premium to dentists who take on new NHS patients or providing bonuses to dentists willing to practice in remote communities.
“Additionally, streamlining the registration process for internationally qualified dentists can expand the dental workforce.”
But for Steve Ellis, managing director – corporate at Prosperis, the shortage of dentists is nothing new. “The obvious answer would be a lack of NHS dentists, but that is not new,” he says.
“The cost-of-living crisis will have had a negative impact on people’s ability to fund treatment which ultimately becomes a vicious circle as costs due to lack of treatment can only increase.
“Therefore, funding a lump sum either via PMI or cash plan could be seen as a valuable employee benefit.
“Dental care is making headlines as NHS provision has become increasingly difficult to find.
“There is a need to train more dentists, then costs may fall due to supply and demand pressures easing.”
DIY dentistry
Perhaps underlining the sheer scale of the problem affecting UK plc and the wider population as a whole was a survey from Canada Life earlier this year which revealed one in five adults in the UK have done a dental procedure on themselves.
Alarmingly, the insurer’s survey of 2,000 UK adults found a fifth (18%) of UK had performed a dental procedure on themselves.
Matt Liggins, head of wellbeing at Health Shield Friendly Society, calls this trend really worrying.
“It’s really worrying that so many UK workers feel the need to put off attending routine dental appointments, to keep teeth healthy and help prevent bigger issues, because they feel they simply can’t afford to pay for them.
“This will be causing them stress and worry and could lead to serious health issues in future.
“Unfortunately, many employees, especially those on lower salaries are feeling the impact the most when it comes to paying for these type of important healthcare check-ups.
“Financial worries, stress, and increased risk of further health issues all have a big impact on the workplace through absence, presenteeism and lost productivity.”
But the cost of inaction on dental issues is only likely to worsen if not dealt with – for individuals and employers alike.
“Employers are also likely feeling the strain,” Nugent warns. “Untreated dental issues can lead to pain, discomfort, and even absenteeism, impacting workplace productivity.
“The rise in dental insurance as a sought-after benefit suggests more employees are seeking coverage, potentially indicating a rise in dental problems within the workforce.
“Unattended dental problems can also lead to more serious health issues down the line, potentially impacting healthcare costs for employers.
“So, while not everyone will turn to insurance, the challenges with NHS access and the value of dental insurance are likely driving a rise in people seeking coverage.”