In a nation renowned for its universal healthcare, a silent crisis is unfolding. Millions of people in England are struggling to access basic dental care through the National Health Service (NHS), leaving them in pain, at risk of serious oral health problems, and facing the stark choice between paying for private treatment or going without. As public outcry grows, leading experts are proposing bold solutions to revitalize the ailing NHS dental system.
A System in Decay
England’s NHS dental care system is in a state of advanced decay. According to recent estimates, over 4 million people have been unable to secure an NHS dental appointment, with some resorting to pulling out their own teeth in desperation. The COVID-19 pandemic has only exacerbated long-standing issues of underfunding, staff shortages, and a contract model that disincentivizes dentists from taking on NHS patients.
The current NHS dental system is broken and failing patients. We need urgent reform to ensure everyone can access the oral health care they need.
– Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee
1. Restoring the Right to Register
One key proposal, championed by Healthwatch England, the NHS patient watchdog, is to restore patients’ right to register with an NHS dentist, as they can with a GP. This guaranteed access was removed in the 2006 dental contract reforms, which many experts believe laid the groundwork for today’s crisis.
“We urge the government to give people the right to register permanently with a dental practice, as they do with an NHS GP,” says Louise Ansari, CEO of Healthwatch England. “This will help them access ongoing care and build a trusted relationship with their dentist.”
2. Rethinking Recall Intervals
Another strategy to free up capacity is to reconsider the standard six-month checkup interval. Mark Dayan, policy analyst at the Nuffield Trust, argues that “a review of the evidence by the expert body Nice found that a gap as long as two years was perfectly safe for many adults.”
By extending recall periods to one or even two years for patients with good oral health, dentists could devote more time to those with high needs. However, this would require a major public information campaign to reassure people of the safety and benefits of less frequent checkups.
3. Scrapping the Dental Contract
Underpinning the access crisis is a widely criticized dental contract introduced in 2006. Based on “units of dental activity,” the contract caps the amount of NHS dentistry that practices can deliver and financially penalizes those that exceed their quota.
“The contract is so dysfunctional that some of the budget to pay for the care patients receive goes unspent,” notes Dayan. Both the British Dental Association and patient advocates are calling for the contract to be scrapped and replaced with a system that rewards prevention and provides dentists with the flexibility to meet population needs.
4. Radically Reforming Funding
Perhaps the most transformative proposal is to overhaul the funding model entirely. Instead of paying dentists per procedure, experts suggest moving to a “capitation model,” where practices receive a set amount per registered patient to cover all their oral health needs.
“This would incentivize dentists to keep patients healthy rather than waiting until they need complex treatment,” explains Dayan. “It’s a radically different approach, but one that could help tackle the crisis at its roots.”
Bolder Action Needed
As access to NHS dental services reaches a tipping point, patients and practitioners are united in demanding bold government action. While a recent “dental recovery plan” has been dismissed by the British Dental Association as inadequate, the National Audit Office has highlighted the unspent funds that could be reinvested to kick-start reform.
The solutions proposed by leading experts – from restoring registration rights to radically reforming funding – offer a roadmap to revitalizing NHS dentistry. But it will require political will, public support, and a shared commitment to oral health equity.
“The government has a choice,” says Charlwood of the BDA. “Continue with a failed system that’s decimating NHS dentistry, or act boldly to give millions the oral health care they deserve. We can fix NHS dentistry, but we need action, not more empty promises.”
As England’s dental crisis deepens, the stakes couldn’t be higher – for patients, practitioners, and the very future of the NHS. The question now is whether policymakers will heed the urgent call for reform, or risk consigning NHS dentistry to the history books.
