This week, a new investigative report was released looking into the NHS dental recovery plan and what it has achieved so far. We break down what it says, what it means and how the dental profession has reacted.

What is the dental recovery plan?

The NHS dental recovery plan was released in February this year. Published under the previous Conservative government, the plan set out a number of initiatives aimed at tackling access issues within NHS dentistry.

The £200 million plan was intended to deliver more than 1.5 million additional NHS dentistry treatments (or 2.5 million appointments) in 2024-25. It had
three components:

• Expanding access in 2024 so that ‘everyone who needs to see a dentist will be able to’, beginning with incentives to dental practices to deliver NHS care and introducing mobile dental vans for under-served communities
• Launching Smile for Life, a focus on prevention and good oral health in young children alongside a consultation on water fluoridation in north-east England
• Supporting and developing the dental workforce through measures in the NHS long-term workforce plan, and setting the trajectory for further contract reforms.

It proposed a number of initiatives that would help to deliver the extra treatments, such as:

• A new patient premium where participating dental practices receive a credit of units of dental activity (UDAs) equivalent to £15 or £50 (depending on the course of treatment) for eligible new patients
• ‘Golden hello’ incentive – around 240 dentists will be offered one-off payments of up to £20,000 for working in under-served areas for up to three years
• The minimum value of NHS activity increasing to £28 (from £23)
• Dental vans sent to rural areas to help reach the most isolated communities.

Other proposals not aimed at increasing treatment courses but intended to have a more long-term impact included:

• A Smile for Life initiative, which would offer advice to parents and parents-to-be on the right care for baby gums and milk teeth
• A dental graduate tie-in
• A water fluoridation programme to be rolled out by government (subject to consultation).

Some progress was made on these aspects of the wider plan before the 2024 general election, including consultations on a dental graduate tie-in and water fluoridation in the north-east of England. Beyond that, however, these are currently awaiting decisions by the new government.

What is the investigation into the NHS dental recovery plan?

Put together by the National Audit Office (NAO), this week saw the release of a report titled ‘Investigation into the NHS dental recovery plan’.

It was compiled to provide clarity on the current state of NHS dentistry, how the plan was developed and whether it is on track to meet its objectives.

The report reads: ‘We decided to investigate the dental recovery plan because of a widespread perception among the public, parliament and media that NHS dentistry is in a state of crisis.’

It adds that when referring to ‘the plan’, the report is considering four main initiatives: the new patient premium, the ‘golden hello’ payments, the UDA value increasing and the dental vans.

These initiatives were expected to have impact in 2024-25. As a result, reporting in November 2024 provides an update on the plan more than halfway through that period. The report acknowledges, however, that the general election will have impacted progress in some areas over that time.

What does the dental recovery plan hope to deliver?

The dental recovery plan aimed to deliver 1.5 million courses of treatment at a cost of £200 million by march 2025. Broken down, this looks like:

• New patient premium – 1,130,000 treatments at a cost of £164 million
• UDA uplift – 270,000 treatments at a cost of £25 million
• ‘Golden hello’ incentive – 280,000 treatments at a cost of £2.4 million
• Dental vans – 30,000 treatments at a cost of £8.4 million.

The DHSC predicts that if the plan delivers the anticipated additional courses of treatment, and if dentistry continues to recover in line with its current post-pandemic trajectory, courses of treatment in 2024-25 will reach 37.1 million. This would be 2.6 million short of the 2018-19 pre-pandemic baseline of 39.7 million.

What has the dental recovery plan achieved so far?

By the end of August, £57 million had been spent on the plan. So far, the Department of Health and Social Care (DHSC) and NHS England (NHSE) have completed roll out of two of the four initiatives: the new patient premium and the unit of dental activity (UDA) uplift.

New patient premium

The new patient premium launched on 1 March 2024, with further guidance on patient eligibility issued by NHS England on 10 May 2024.

UDA uplift

The UDA uplift has been applied to all of the 876 contracts that fell below the £28 threshold.

‘Golden hello’ incentive

For ‘golden hellos’, there were some ministerial decision-making delays in agreeing allocations for posts across England before the general election was called.

Out of an expectation of at least 240 ‘golden hellos’, 274 practices have had expressions of interest approved across England, and the first dentist had been appointed in October.

Dental vans

No dental vans have been procured so far. Potential market suppliers said that there may be challenges around the availability of vans and funding beyond 2024-25 but any further progress on this initiative paused when the general election was called.

New ministers stated in November that it will be left for integrated care boards (ICBs) locally to decide whether they go ahead with procuring vans during the remainder of 2024-25.

What impact have initiatives had on additional treatment targets so far?

Since the new patient premium launched in March 2024, fewer courses of treatment for new patients have been completed in every month than in the equivalent month in the previous year.

The DHSC and NHSE assumed that dental vans and ‘golden hello’ payments would deliver around 60% of their full year possible delivery of treatments (280,000 courses of treatment and 30,000 courses of treatment, respectively), due to the lead-in time for their implementation. This would have required the initiatives to be fully operational by September 2024, which has not been achieved. These initiatives have delivered no additional courses of treatment.

Is the plan on track to deliver its targets?

Based on initial analysis, the report says the plan is not on track to deliver the additional courses of treatment. NHSE expects the new patient premium to deliver 1.13 million of the more than 1.5 million additional courses of treatment expected through the recovery plan. NHSE has thus far analysed data up to the end of September 2024, showing that fewer new patients had been seen in the first seven months of the premium than the equivalent period in the previous year.

In September, NHSE began further analysis to better understand the impact that the new patient premium is having, including whether locally commissioned activities could be impacting claims. The review says that so far, data does not suggest that the new patient premium is on course to deliver the expected additional courses of treatment by March 2025.

However, NHSE also has data showing a 14% increase in dental practices reporting that they are accepting new patients between December 2023 and September 2024.

NHSE has not yet assessed what impact the uplift to minimum UDA values has had against what was expected. Overall dental activity levels are up slightly in 2024-25 compared with 2023-24. The report says this is in line with DHSC’s predictions about improvements in delivery for 2024-25 without the additional impact of the plan.

NHSE and DHSC have also agreed an evaluation of the plan that will aim to report in the next 12 months.

Reactions from the profession and beyond

Oral Health Foundation

Dr Nigel Carter is CEO of the Oral Health Foundation. He said: ‘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.’

British Dental Association

Shawn Charlwood, chair of the British Dental Association’s General Dental Practice Committee, said: ‘We warned at the outset that this recovery plan was unworthy of the title.

‘Unfunded, unambitious policies failed to make a dent in a crisis hitting millions.

‘A new government must show it is willing to learn from its predecessor’s mistakes.’

You can read the full report here.

Toothless in England

Toothless in England is a campaign group pushing for an ‘NHS dentist for everyone’. In a statement, it said: ‘We wish to express our gratitude once more to the National Audit Office for inviting Toothless in England to participate in their enquiries.

‘Health ministers’ and the NHS’s lack of ambition, coupled with repeated failures, are depicted in today’s report.

‘With the state of NHS dentistry being where it is right now, the government’s dental recovery strategy does not go anywhere close to properly resolving the dental crisis.

‘In order to address this, it is critical that the new government heeds the report’s conclusions and does not conceal its own inadequacies. At the very least, let patients know—120 days after they were voted into office—when their manifesto promise of 700,000 extra emergency dental appointments will be made available.

‘Toothless in England still hopes that our voice—that of millions of dental patients behind us—will be heard and that one day accessible NHS oral healthcare in our country will be back to something we can all be happy with and benefit from.’

Association of Dental Groups (ADG)

Neil Carmichael, executive chair at the ADG, said: ‘The National Audit Office report is disappointing. It shows a clear lack of understanding of the complexities of the issues that are responsible for the crisis in dentistry. The NAO report has focused on contract reform, rather than workforce planning. Unfortunately, this finds both the Conservative’s dental recovery plan AND the report on it ‘pie in the sky’. If you don’t have the workforce to deliver dental treatments, ANY plan, is never going to work.

‘The ADG believes an official public inquiry is the only way forward. The Public Accounts Committee need to have a look at the plan and also why the NAO report lacked meaningful consultation that would have shown how a recruitment and retention focus for the full spectrum of the dental workforce is the solution. The dental workforce includes other Dental Care Professionals (DCPs) such as dental nurses and dental therapists who are critical to providing patient care. Remember DCPs are now trained to carry out 70 percent of the treatments that dentists can.

‘We talk to large and small dental practices up and down the country every day, and our insights from our members should be part of what informs this official inquiry. It is the only way we will get the full picture and a robust recovery plan. The ADG is here to support the new Government to deliver on dentistry reform.’

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