NHS dentistry is facing a crisis of access, resulting in a decline in oral health. The Government needs to undertake urgent and fundamental reform if people are to receive the dental and oral healthcare they need. It is frustrating to have to return to recommendations made by our predecessor Committee fifteen years ago that still haven’t been implemented.
Rarely has an inquiry been more necessary. Throughout the course of this inquiry, as well as in our roles as constituency Members of Parliament, 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.
We were encouraged and surprised to hear the Parliamentary Under-Secretary of State for Primary Care and Public Health, Neil O’Brien MP, say that the Government’s ambition for NHS dentistry is: “We do want everyone who needs one to be able to access an NHS dentist - absolutely”. We fully endorse this ambition. As a matter of urgency, the Government must set out how it intends to reform NHS dentistry services to deliver on this. 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 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. A fundamentally reformed contract must be implemented at the earliest possible stage. 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.
Nevertheless, even with fundamental reform of the contract, we are concerned that this will be too little too late for those dentists who have already left the NHS. 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.
Integrated Care Boards (ICBs), with their new responsibility to commission NHS dentistry, offer an opportunity to improve access locally, to better integrate services around patients and to address inequalities. Nevertheless, we are concerned that many ICBs do not have adequate resources, tools or expertise to address these issues and are restrained from undertaking more flexible commissioning under the current contract. Whilst we recognise that they are still in their early stages, and that dentistry poses one of the greatest commissioning challenges for them, it would be disappointing if the opportunity to improve access to local services were not taken.
During the course of the inquiry, the Minister announced a forthcoming recovery plan for NHS dental services. The plan has yet to be published. We hope the plan has the scope to meet the Government’s ambition and is accompanied by the necessary funding and swift implementation.
It is important not to forget the repercussions of not resolving this crisis. 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. Without rapid and timely action, we are concerned about the future of NHS dental services and the patients who desperately need access to them.