NHS dentistry is facing a crisis of access, and a complete shake up is needed to prevent further decline in oral health, according to a House of Commons select committee report.
“The government needs to undertake urgent and fundamental reform if people are to receive the dental and oral healthcare they need,” the Health and Social Care Committee of MPs warned.
They also highlighted that many changes recommended in the last major review of NHS dentristry conducted before the Conservatives took government had yet to be implemented 15 years later.
“Without rapid and timely action, we are concerned about the future of NHS dental services and the patients who desperately need access to them,” the report said.
“Many people are unable to access an NHS dentist or are travelling significant distances to get to one. Access varies across the country and is being experienced unequally by different groups.
“We believe everyone should be able to access an NHS dentist when they need one, wherever they live.”
Several industry experts have told Health & Production of the high demand that insurance products are experiencing as patients seek solutions. But the problem is wide according to several surveys.
A YouGov survey of 2,104 people in March found a fifth (22%) of UK citizens were not registered with a dentist.
Of those who were not registered, 37% said it was because they could not find an NHS dentist and another 23% said it was because they could not afford to pay for treatment.
And research undertaken by the BBC and the British Dental Association (BDA) last year showed 90% of dental practices across the UK were not accepting new adult NHS patients.
In evident frustration at the slow moving pace of reform, the report said: “It is frustrating to have to return to recommendations made by our predecessor committee 15 years ago that still haven’t been implemented.
“Rarely has an inquiry been more necessary,” the committee said.
Pain and distress
“Throughout the course of this inquiry, as well as in our roles as constituency MPs, we have heard stories of people in pain and distress due to being unable to see an NHS dentist. This is totally unacceptable in the 21st century,” the report said.
The committee said it fully endorsed the government’s ambition for NHS dentistry, as outlined by Neil O’Brien, undersecretary of state for primary care and public health.
He stated: “We do want everyone who needs one to be able to access an NHS dentist – absolutely”.
But the committee wanted government to address the situation as a matter of urgency.
“The government must set out how it intends to reform NHS dentistry services to deliver on this,” the committee said.
“We are concerned that any further delay will lead to more patients being unable to access dental check-ups and the routine or urgent dental care they need.
“More people, including children, are experiencing poor oral health, and this has a subsequent impact on their physical health and social wellbeing, and leads to dependency on expensive secondary care interventions, placing further pressures on secondary care,” the committee said.
But it is not a completely bleak picture, as the committee noted the government has begun to act.
“Some initial changes were made to the dental contract in July 2022, and we have had assurances of further ‘quite fundamental reform’ by the minister,” it said.
Fundamental change
A fundamentally reformed contract must be implemented at the earliest possible stage, the committee said.
“This should represent a move away from the current system of units of dental activity (UDAs), in favour of a weighted capitation-based system which provides financial incentives for seeing new patients and those with greater dental need, in turn prioritising prevention and person-centred care.
“Failure to do so risks more dentists stopping NHS work, or not starting it, and exacerbating the issues patients are experiencing accessing care,” it said.
That in itself may not be enough, however.
“Nevertheless, even with fundamental reform of the contract, we are concerned this will be too little too late for those dentists who have already left the NHS,“ it continued.
“We are concerned that the government and NHS England have not fully grasped the scale of the challenge for the workforce, and the need to urgently provide compelling incentives to attract new and existing dentists to undertake NHS work.
“Neither is there sufficient acknowledgment of the lack of accurate data about the dental workforce and the amount of NHS work they are undertaking, which is vital for assessing provision in short and long-term workforce planning.
“Being unable to see a dentist at regular intervals can have implications for wider oral, physical health, mental health and social wellbeing.
“It also places additional pressures on already stretched NHS general and urgent health services and resources,” the committee added.