The Secret Dentist – how to fix NHS dentistry

the secret dentist discusses the ideal scenario for the future of NHS dentistry

Following on from his discussion of the current issues presented by NHS dentistry last month, The Secret Dentist describes the ‘drastic change’ needed to fix the system.

So, bear with me, as we need some blue sky thinking to get the profession out of the mess that is general practice in its current form. I do not believe that ‘tinkering at the edges’ is enough. We need drastic change to save the profession from itself. This is the only thing that would enable it to provide a fit for purpose system for the UK population.

Fact one: There will be no new money/increase in budget.

Fact two: The current budget can only deliver a very limited service.

Fact three: There is going to be some trauma and severe financial implications for some practices in order to transition to the new world.

Here’s a best-case scenario of how the next five years could progress:

General dental practice in the NHS

Ideally, in 2028, every single dentist leaving dental school will be offered a place in Dental Foundation Training (DFT), which is the only place that NHS dentistry is delivered. This will be located in expanded community service locations with the addition of some locations which have been taken over as a result of them losing their NHS contracts over the previous years.

The NHS dental service in this community will be run from within the NHS. Accordingly, all employees will be NHS employees.

The service will treat children and those who have been means tested and/or are on benefits. Offering this core service will put the emphasis on prevention.

This salaried service will be open to DFTs for two years. After that, dentists will need to decide to apply for the 50% of places which will continue into the third year or branch out into private general dental practice.

It may be that some part-time working on both sides of the fence will be possible. The fourth year will see only 25% of places remaining in the NHS system. There will be a requirement for an ongoing cohort of dentists to remain in the salaried service providing this core service.

This will thus leave 80-90% of general dental practice outside the NHS and market forces will prevail. Private general dental practice (PGDP) will then have had the millstone of NHS dentistry removed from around its neck. It will get on with delivering a patient-focused service to its customers. There will be the bottom end and top end of the market.

Putting the mouth back in the body

It will, however, give dentists the ability to change the career pathway and allow us to organise as other professions do – associates, seniors and partners. This will allow for much more delegation.

It will also allow the mouth to be put back into the body. I would especially like to see general health and wellness become part of PGDP – not just looking after the mouth. This would put the profession very much back into mix of being true healthcare professionals.


Obviously, the devil is in the detail, particularly when the NHS gives notice that all general dental service (GDS) contracts will be ceasing at a certain point. The beauty will be that the profession and the public can look forward to much more professional, customer-focused service in the future.

So, it’s all good news!

Catch up on the Secret Dentist’s previous columns:

Follow on Instagram to keep up with all the latest dental news and trends.

Get the most out of your membership by subscribing to Dentistry CPD
  • Access 600+ hours of verified CPD courses
  • Includes all GDC recommended topics
  • Powerful CPD tracking tools included
Register for webinar
Add to calendar