27 NOV 2024

According to a new report from the National Audit Office (NAO), the dental recovery plan launched in February 2024 with the aim that "everyone who needs to see a dentist will be able to," is unlikely to deliver an additional 1.5 million treatments by March 2025. Even if achieved would still mean 2.6 million fewer treatments compared to six years ago. 

The report also reveals that, based on NHS England (NHSE) analysis, fewer new patients have received treatment each month since the plan's implementation, compared to the same period in the previous year. 

Access to NHS dentistry across England remains below pre-pandemic levels, with 40% of adults recorded as having seen an NHS dentist in the 24 months to March 2024, compared to 49% in the 24 months prior to the start of the COVID-19 pandemic. There are also 483 fewer dentists providing some NHS care compared to 2019-20.  

By August 2024, the Department for Health & Social Care (DHSC) and NHSE had spent £57 million of the planned £200 million budget, with only two of the four initiatives (see notes to editors) fully rolled out - although the NAO does recognise the general election has impacted progress in some areas over that time. 

Dr Nigel Carter, CEO of the Oral Health Foundation says: "This report lays bare the stark failings of NHS dentistry - failings that have denied millions of people their right to timely, quality care. Access to NHS dental services has plummeted, with rural and underserved communities hit hardest, leaving patients to suffer from preventable oral health issues. This is not only a crisis for patients but also for dental professionals, who are overworked, undervalued, and facing unprecedented pressure, with many leaving the NHS for better opportunities.

"The Department of Health and Social Care, along with NHS England, must be completely transparent about their true plans for NHS dentistry and the funding required to implement them. The public has a right to know what the government's strategy is and how much money they are willing to invest to address this crisis. While there are potential solutions - including a new NHS Dental Contract focusing on prevention and capitation - no measures can hope to be effective without real, meaningful investment and clear, achievable targets.

"The time for complacency has passed. The government must act urgently to ensure that everyone who needs dental care can access it in a timely manner, and that dental professionals are supported and valued. The current plan is insufficient, and the government must provide clarity and urgency in their approach. Without decisive action, the gap between what is promised and what is delivered will continue to grow, and the public, NHS workers, and the system as a whole will bear the consequences. The question is no longer whether NHS dentistry can be saved, but whether the government has the will to make it a true priority before it's too late."

DHSC and NHSE have completed the roll-out of the new patient premium and an uplift to the minimum amount the Government pays dentists for treatments, known as Units of Dental Activity (UDA), from £23 to £28. NHSE data suggests that there has been about a 14-percentage point increase in dental practices reporting that they are accepting new adult patients, when availability allows, between December 2023 and September 2024. 

There has been a small increase in the number of UDAs delivered in the early months of 2024-25, but this is in line with DHSC expectations that, even without the plan, there would be a small increase (see notes to editors) in delivery. As NHSE and DHSC are reliant on Integrated Care Boards (ICBs) and dental practices to deliver the plan, there is significant uncertainty about the plan's impact. 

The ‘Golden Hello’ incentives of £20,000 (phased over three years) to recruit 240 dentists into specific areas of the country have not yet contributed to the 1.5 million additional treatment target. While 274 practices have had their application approved to recruit a 'golden hello' post, the first dentist was not appointed until October this year.  

The last initiative of mobile dental vans, aimed at delivering some dental services to targeted communities has also not been rolled out, as no vans have been procured. Any further progress on this initiative paused when the general election was called and new ministers stated in November that it would be left for ICBs locally to decide whether they go ahead with procuring vans during the remainder of 2024-25. 

The NAO’s report confirms that access to NHS dentists varies across the country, with some areas of England on average receiving twice as much care as others. Courses of treatment per 1000 people ranged from 382 in Somerset to 800 in South Yorkshire in 2023-24. 

There are several challenges facing the Government if it wants to increase access to NHS Dentistry, including: 

• The dental contract, is widely perceived as needing reform, with many in the sector viewing the contract as a disincentive to perform NHS care when practices have the choice of offering private care too. 
• A fall in the number of dentists providing some NHS dental care, has fallen by 483 since 2019-20, a decrease of 2%. There were 34,520 dentists registered with the General Dental Council (GDC) in England in April 2023, but their survey suggests that 22% of the dentists in England did not provide any NHS dental care, only private dental care. 
• A reduction in overall spending in real terms, dropping from £3.7 billion in 2019-20 to £3.1 billion in 2023-24, a drop from £65.15 to £53.88 per person in England. 
• In 2023-24 there was an underspend of £392 million against the total ringfenced NHS dental budget.

Sir Geoffrey Clifton-Brown, Chair of the Committee of Public Accounts: “NHS dentistry is in a state of crisis. People across the country are struggling to access NHS dentists, particularly in rural areas.

"The roll out of dental vans and ‘golden hello’ bonuses to under-served communities has been slow and the Dental Recovery Plan is now unlikely to deliver its ambitions for 1.5 million extra treatments.

"The Department of Health and Social Care and NHS England must take stock of what works if they are to address the serious challenges facing NHS Dentistry.”