“Dental deserts” are emerging across England after more than 2,000 dentists quit the NHS last year, leaving millions of people struggling to get checkups or have toothaches fixed, a new report reveals.
The exodus is exacerbating a crisis that has seen patients battle to get dental treatment because so few dental surgeries will see them as NHS patients.
The number of dentists providing NHS care in England fell from 23,733 at the end of 2020 to 21,544 at the end of January this year, according to the latest NHS figures, which have been obtained by the Association of Dental Groups (ADG) under freedom of information laws.
Given that dentists each have a caseload of about 2,000 patients, the depletion of the workforce has left an estimated 4 million people without access to NHS care. The NHS now has the smallest number of dentists it has had for a decade, according to the ADG, which represents major chains of surgeries.
Access to NHS dental care is so limited that people in some areas are forced to wait three years for an appointment. The difficulty obtaining treatment is one of the public’s main sources of frustration with the health service, with just one in three people satisfied with dental services.
Many are forced to go private, after seeking an NHS dentist in vain, in order to have problems resolved. Some have rung dozens of surgeries in their area in a vain quest to be accepted as an NHS patient, or had to travel outside their home area to get it. A growing number of dental surgeries do little or no NHS-funded work, citing problems with the dental contract.
Covid, Brexit and government underfunding of NHS dental services have combined to create a “critical” situation which is likely to get worse before it gets better, the ADG warned.
Patient groups voiced alarm at the “unacceptable” situation facing those needing dental care.
“People are struggling to get the dental treatment they need when they need it. This is a hugely worrying issue. Some dental practices have either shut down or have gone fully private, with some dentists having used up their total NHS capacity and are asking people for private fees instead,” said Louise Ansari, the national director of NHS watchdog Healthwatch England. Children, disabled people and people living in care homes are the worst affected, she added.
The loss of 2,000 NHS dentists last year follows a decline the previous year of 951.
NHS dentistry has become “a rotten system” which lets down patients and deters practitioners of dental care, said the British Dental Association (BDA), which represents the UK’s 42,000 dentists. It blamed patients’ inability to get NHS care in England on ministers only providing enough money in the dental contract to cover the cost of treating just over half the population.
Successive governments since 2010 have pledged to reform the dental contract but not done so, although negotiations are ongoing. NHS England spends about £3bn a year on dental care, though that sum has remained flat for some time. Dentists dislike what they call a “broken” contract that involves targets for the amount of care given and, they say, can pay them the same amount for doing one filling as for doing 10 and discourages them from treating complex cases because they do not get paid for the time involved.
“Dentists are simply not seeing a future in the NHS, with a broken contract pushing out talent every day it remains in force,” said Shawn Charlwood, the chair of the BDA’s general dental practice committee.
“We need to halt an exodus that’s already in motion. Millions are going without the care they need, and quick fixes are no substitute for real reform and fair funding.”
The ADG’s report says that as a result of the decline in NHS dentists “we are now seeing ‘dental deserts’ emerge across the country where there is almost no chance of ever seeing an NHS dentist for routine care. Dental deserts present a serious risk to the dental health of millions of NHS patients in England.”
The trend is likely to worsen as dental practices increasingly rely on private work to stay open, it warns. The deserts are particularly concentrated in rural and coastal areas.
It names the area covered by the NHS clinical commissioning group (CCG) in North Lincolnshire as the part of England with the smallest number of NHS dentists per 100,000 people – just 32. North East Lincolnshire and the East Riding of Yorkshire are joint second worst, with only 37 NHS dentists for every 100,000 people. Lincolnshire and Norfolk and Waveney are next, on 38.
The report also reveals that just 26.1% of adults in Thurrock in Essex have seen an NHS dentist in the previous two years – the lowest percentage in the country – followed by West Essex (27.3%) and then Kent and Medway (29.3%). Thurrock is also where the lowest proportion of children have seen an NHS dentist in the last year – just 30.7% – followed by north-east London (32.2%) and North Lincolnshire (35.3%).
“Dental deserts not only stretch across the whole of the east of England, from east Yorkshire, through Lincolnshire and down to Norfolk, but are now emerging in many other ‘red wall’ constituencies that the government wishes to level up,” said the ADG’s chair, Neil Carmichael, a former Conservative MP.
The ADG is also warning that the decline in access to dental checkups raises the prospect of “a looming health crisis” in which cases of mouth cancer and type 2 diabetes get missed rather than being picked up by a dentists.
It wants ministers to tackle the growing shortage of NHS dentists by taking action including increasing the number of training places for dentists in the UK and extending beyond the end of this year recognition of the qualifications of EU-trained dentists.
Urging reform of the dental contract Rachel Power, the chief executive of the Patients Association, said: “Our helpline regularly takes calls from patients who cannot find an NHS dentist. We know of patients joining three-year waiting lists, just to get on the books of an NHS dentist. This is an unacceptable situation.
“Dental deserts can not be allowed to develop. Dentists are often the health professional who spot serious health problems early.”
A Department of Health and Social Care spokesperson said: “We’ve given the NHS £50m to fund up to 350,000 extra dental appointments and we are growing the workforce so people can get the oral care they need – in December 2021, there were 264 more [private and NHS] dentists registered than the previous year.
“We are committed to levelling up health outcomes across the country – we have set up the Office for Health Improvement and Disparities to address the long-standing health disparities and will publish a white paper this year to ensure everyone has the chance to live longer and healthier lives, regardless of background.”
