BBC reveals true extent of NHS dentistry crisis
BDA declares NHS dentistry at a 'tipping point', as BBC reveal true extent of access crisis.
9/10 NHS dental practices unable to offer appointments to new adult patients, in the most extensive survey of patient access ever undertaken
The British Dental Association has pressed government to step up and deliver urgent reform, as new research from the BBC underlines the scale of the access crisis facing NHS patients across the country.
Between May and July, BBC researchers reached out to every UK dental practice with an NHS contract to ask if they were taking on new patients. Working with the BDA, the BBC identified 8,533 dental practices across the UK that were believed to hold NHS contracts and attempted to call them all. The survey found:
• Across England, 91% of NHS practices were not accepting new adult patients, 4,933 of 5,416, rising to 97% in the East Midlands, and 98% in the South West, North West and Yorkshire and the Humber
• Of those practices not taking on adults in England, 23% (1,124) said they had an open waiting list, and 16% (791) said the wait time was a year or longer, or were unable to say how long it would be.
• Out of 152 local authorities in England, BBC researchers did not successfully reach any practices accepting new adult NHS patients in 56 (37%) local authorities.
• In England, 79% of NHS practices were not accepting new child patients, 4,293 of 5,416.
The crisis facing the service across England is being fuelled by a discredited NHS contract, which funds care for barely half the population and puts government targets ahead of patient care. NHS England recently announced modest, marginal changes to this system.
However, dentist leaders say that the changes, which come without any new investment, will not address the problems patients face accessing services or keep dentists in the NHS.Thousands of NHS dentists have left the service since lockdown. Last week the House of Commons Health and Social Care Committee dubbed the contract ‘not fit for purpose’, called for urgent reform and pledged a dedicated inquiry into the crisis in the service.
The BDA has pressed the UK government to stop ‘rearranging the deckchairs’ and to finally commit to a fair funding settlement and fundamental reform of the service as a matter of urgency. After a decade of savage cuts the BDA estimate it would take an additional £880 million a year simply to restore funding to 2010 levels.
Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee said: “NHS dentistry is at a tipping point, with millions unable to get the care they need and more dentists leaving with every day that passes.
“We’re seeing the results of years of chronic neglect, set into overdrive by the pressures of the pandemic. The question now is will Ministers step up before it’s too late? Nothing that we’ve heard from government to date gives us any confidence this service has a future. Without real reform and fair funding NHS dentistry will die, and our patients will pay the price.”
BDA Scotland has warned the Scottish Government risks undermining the future sustainability of NHS dentistry, as they scaled down vital financial support for the service.
From April to June practices received a 1.7 multiplier to the fees paid to provide NHS care, a reflection of the unprecedented backlog practices faced as they tried to 'live with Covid', and the continued suppressed activity compared with pre-pandemic levels.
This was cut down to 1.3 from July, following no discussion with the profession, leaving many dentists at risk of delivering some NHS treatments at a loss.
Official data suggests the total number of high street NHS dentists in Scotland has fallen by over 5% since the onset of Covid. The BDA has again urged the Scottish Government to, in the short term, develop a suitable interim funding package to support dentists and their teams as they work through the backlog, and begin work on a new, sustainable long-term model for NHS dentistry.
David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee, said: “The Scottish Government promised free NHS dentistry for all, but the public are now living with the harsh reality.
“You can’t run a health service on soundbites and slogans. Ministers need to take a long hard look at the evidence, and bring forward the reforms and resources we need to deliver for patients across Scotland.”
The Welsh Government recently unveiled a package of minor reforms, which it claimed would generate 112,000 new appointments. The BDA rapidly refuted many of the ‘back of an envelope’ calculations on which this policy was based.
Ministers suggested that moves to ensure healthier patients receive less frequent check-ups would enhance access, ignoring the fact that NICE guidance, in place for 18 years, has advocated recall intervals from every three months to two years, and these guidelines are not changing. Officials also claimed over 2800 dental hygienists and therapists were ready to step in and play a larger role in delivering NHS care, when little over 500 are actually practicing in Wales.
BDA Wales has again stressed that meaningfully boosting access and halting the exodus from the NHS workforce can only be achieved through sustained investment, which the Welsh Government has thus far declined to offer.
Russell Gidney, Chair of the British Dental Association’s Welsh General Dental Practice Committee said: “This service faces a crisis unlike any in its history, but sadly the Welsh Government has failed to offer any concrete solutions.
“We’ve heard half-baked policies based on ‘back of an envelope’ calculations. Until we see real commitment the future of NHS dentistry in Wales remains in doubt.”
Health service dentists – who work as independent contractors – have seen incomes fall by 40% in real terms since 2008/09. Practices are confronting soaring costs, with ‘dental inflation’ now estimated at over 11%, meaning many face the prospect of delivering HS care at a financial loss.
BDA Northern Ireland is pressing for an end to the discredited high volume/low margin model the service has worked to 30 years, is no longer delivering for patients or the dental profession. It has stressed a new system must ensure HS dentistry is financially sustainable in its own right, without being kept afloat by income from private work undertaken by practices. Dentist leaders are pressing for interim support measures to be put in place until a new contract is implemented.
A process has recently begun with the Department of Health to take forward work on a new contract for high street HS dentistry. However, there remains huge uncertainty about whether the level of investment needed for this service to survive will be forthcoming.
Ciara Gallagher, Chair of the British Dental Association’s Northern Ireland Dental Practice Committee, said: “We can only hope dental care in Northern Ireland had not yet reached the point of no return. Dentists are already moving on and practices are struggling to remain viable, because the numbers Health Service dentistry is based on simply don’t add up. This postcode lottery our patients now face will only end when we see real reform backed up by fair funding.”
UK-wide 90% of NHS practices were not accepting new adult patients, 6,193 of 6,880. Of those practices not taking on adults in the UK, 25% (1,572) said they had an open waiting list, and 17% (1,039) said the wait time was a year or longer, or were unable to say how long it would be. Out of 217 local authorities in the UK, BBC researchers did not successfully reach any practices accepting new adult NHS patients in 77 (35%) local authorities.
80% of NHS practices were not accepting new child patients, 5,506 of 6,880. Of those practices not taking on children in the UK, 1,480 (27%) said they had an open waiting list, and 16% (902) said wait time was a year or longer, or were unable to say how long it would be. Out of 217 local authorities in the UK, BBC researchers did not successfully reach any practices accepting new child NHS patients in 25 (12%) local authorities.