Access to NHS dentistry is one of the top four issues ahead of the forthcoming 2024 general election, according to a recent YouGov survey. This level of public concern has clearly filtered through to the main political parties, with dentistry included in each of the manifestos.
It is perhaps unsurprising that dentistry features so highly when 40% of children are unable to get regular NHS checkups, and some desperate adults are having to resort to removing their own teeth.
The situation is bleak. And with 75% of dentists planning to reduce their NHS commitment over the next year, radical action is urgently needed.
In all likelihood, the responsibility for saving NHS dentistry will sit with a new Labour government. Wes Streeting, the current shadow secretary of state for health and social care, faces a daunting task, one which his predecessors have grappled with yet failed to resolve.
There are many reasons for the UK’s dental crisis, but under-investment and a failure to implement changes to the dental contract are undoubtedly important factors in the demise of NHS dentistry.
These issues have been highlighted in health select committees in 2008 and 2023, in the Steele report in 2009 and by the Nuffield Trust in 2023. Unfortunately, previous governments have been slow to respond and unwilling to act, which has contributed to the current crisis.
The Labour party has proposed a dentistry rescue plan that includes:
• NHS dental contract reform,
• 700,000 extra urgent dental appointments,
• Incentives for dentists to work in areas with the greatest need,
• Supervised toothbrushing in schools for three to five-year-olds,
• A focus on prevention, and
• Ensuring there is an NHS dentist for all who need one.
Streeting has acknowledged that a new dental contract needs to be implemented and has committed to meeting dental representatives in his first week in office.
This is to be welcomed, as is Labour’s commitment to prevention as part of their child health action plan. This includes the introduction of supervised toothbrushing in schools and increased access for routine and emergency care for children.
This might go some way to reduce the number of children having teeth removed under general anaesthesia – the leading cause of hospital admission for five to nine-year-olds.
There is a workforce shortage in dentistry, particularly in the NHS, so Labour’s commitment to deliver 700,000 additional emergency appointments may prove difficult without compromising access to routine care. A proposal to increase the number of training places for dentists and therapists is much needed but will take many years to be realised.
Rural areas often struggle with recruitment and Labour has proposed the introduction of financial incentives to recruit dentists into areas of greater need.
A similar incentive scheme was introduced earlier this year as part of the government’s dental recovery plan, although it is too early to evaluate its success.
These schemes may improve access in certain areas but will be at the expense of others unless we increase the overall number of registered dentists working in the NHS.
The NHS long-term workforce plan has recommended an increase in training places with new graduates encouraged to work in the NHS. This has been included in the Labour manifesto, although no detail has been published on how this might work.
Dental contract reform will again be critical, as forcing recent graduates to work in an underfunded system will be counterproductive and likely to lead to a greater exodus from the NHS at the end of any enforced tie-in.
Given Labour’s commitment to fiscal prudence, their aspiration to provide “an NHS dentist for all who need it” would appear naive and misguided. There is not the funding nor the workforce to provide a comprehensive service for all, let alone one that is free at the point of delivery.
Blair failed to deliver
It is worth reflecting on a similarly ambitious pledge made by Tony Blair in 1999, when he promised “easy access to NHS dentistry for all”. The Blair government failed to deliver on that pledge, despite a substantial increase in funding, which resulted in the former prime minister admitting to underestimating the scale of the problem and declaring that dentistry was “the most difficult aspect of the NHS”.
A massive increase in dental funding is an unrealistic expectation. The only way to deliver Labour’s latest ambition for NHS access “for all who need it”, will be to provide a pared-back or core service, targeted at those with the greatest need. The key will be how “need” is defined. This would be a radical shift for NHS dentistry, but one that many dentists believe is long overdue.
NHS dentistry desperately requires investment and radical reform, but perhaps most importantly, it needs an unprecedented level of honesty about what NHS dentistry should provide for the general population.
If Labour is genuine about implementing change, dental contract reform will need to include an honest discussion about the future of NHS dentistry: what do we need, what do we want and what can we afford?