If changes to the NHS dental contract in England result in fewer people being left to suffer with complex problems because they cannot get treatment, that will be a big gain. Sore teeth and gums are debilitating, and dentistry ought not to be out of reach for anyone who needs it.
The decision to prioritise complex cases, as well as the lack of urgent care in some places, has been taken following a consultation that highlighted these two issues. From next April, the NHS payment system will alter so that patients can book a package rather than a series of individual appointments if they need to be seen more than once. Dentists will be incentivised to offer more slots to those needing urgent treatment for issues including severe pain and infections.
But this week’s announcement is not, and should not be mistaken for, a solution to all England’s problems with dentists (Scotland, Wales and Northern Ireland all face similar challenges with their NHS dental workforces – including acute shortages in particular places – but as health is devolved the changes apply only in England). The dry remark made by Shiv Pabary, the chair of the British Dental Association’s general dental practice committee, that the changes are the “biggest tweaks this failed contract has seen in its history”, was apt. The new fee structure announced by the health minister, Stephen Kinnock, is a big tweak to the existing system. But it is still a tweak, and not the overhaul that most experts agree is needed.
The NHS dental contract introduced in 2006 marked a radical break with what went before. People lost the right to register with a dentist in the same way that they register with a GP, who then acts as a gateway to other treatments and who receives a payment for each patient on their list. Instead, dentists began to be paid per “unit of activity”. Very soon, problems with this arrangement emerged and were pointed out by the health select committee and others. It is disturbing to realise that many of the difficulties noted then are the same ones described now, in particular the lack of access to dentists for poor people in poor places.
The situation has in some respects acutely worsened. Calls about dental issues to the NHS’s non-emergency 111 number rose by 20% between July and September compared with the same period in 2024. A&E attendances jumped by nearly 45% in four years – from 81,773 in 2019-20 to 117,977 in 2023-24. A new report by the patient watchdog includes shocking case histories, including people pulling out their own teeth.
Areas including the east of England face chronic shortages, and “golden hellos” for dentists in underserved locations have had limited success. Efforts to reduce the prevalence of tooth decay in young children, and to tackle dental health inequality, have stalled – though Labour deserves credit for the decision to introduce supervised toothbrushing in schools. This hands-on measure ought to make a difference.
A new contract is promised by the end of this parliament. Ministers should go further with a pledge to restore the right to register, ensuring universal access. They must also explain how this week’s contract announcement relates to an existing plan to boost the number of urgent appointments by 700,000 – and set out a timeline so that the public knows what to expect and progress can be checked.
