Iand changes to the NHS dental contract in England will result in fewer people suffering from complex problems because they cannot get treatment, and this will be a great achievement. Tooth and gum pain is debilitating, and dentistry should not be out of reach for everyone who needs it.
The decision to prioritize complex cases, as well as the lack of emergency care in some places, was made after a consultation which highlighted these two issues. From April next year, the NHS payment system will change so that patients will be able to book a package of services rather than a series of individual appointments if they need to be seen more than once. Dentists will be encouraged to offer more places to those who need urgent treatment for problems including severe pain and infections.
But this week's announcement is not (and should not be taken to be) the answer to all of England's dental problems.ScotlandWales and Northern Ireland face similar problems with their NHS dental workforce (including severe shortages in certain locations), but since healthcare has devolved the changes only apply in England). The dry remark made by Shiv Pabari, chairman of the British Dental Association's general dental practice committee, that the changes were “the biggest amendments this failed contract has seen in its history” was apt. The new fee structure announced by Health Secretary Stephen Kinnock represents a major change to the current system. But it's still a tweak, not that one major renovation that most experts agree is necessary.
The NHS Dental Contract, introduced in 2006, marked a radical break with what had gone before. People have lost the right to register with a dentist in the same way they register with a GP, who then acts as a gateway to other treatments and receives payment for each patient on their list. Instead, dentists began to be paid per “unit of activity.” Very soon problems arose with this arrangement, which were pointed out health committee and others. It is alarming to realize that many of the difficulties noted then are similar to those described now, particularly the lack of access to dentists for poor people in poor places.
The situation in some respects has deteriorated sharply. The number of non-emergency calls to NHS 111 about dental problems increased by 20% between July and September compared with the same period in 2024. A&E attendances jumped almost 45% in four years, from 81,773 in 2019-20 to 117,977 in 2023-24. A new report from a patient watchdog includes shocking case reports, including people pull out your teeth.
Areas including the east of England face chronic shortages of health services, and “golden cheers” for dentists in underserved areas have had limited success. Efforts to reduce prevalence caries in young childrenand the fight against dental health inequalities has stalled – although the Labor Party deserves credit for its decision to introduce supervised brushing in schools. This practical measure should change the situation.
A new contract is promised by the end of this parliament. Ministers should go further and promise to restore right to registrationproviding universal access. They should also explain how this week's contract announcement relates to the existing plan to increase the number of urgent appointments by 700,000 – and set a timetable so the public knows what to expect and progress can be checked.
