Experts are calling for contract reform to maintain the dental workforce as a new report identified more than 5,500 unfilled NHS dental vacancies.
The Fixing NHS Dentistry report was released by the Public Accounts Committee (PAC) today (4 April). As of March 2024, it found that there were more than 5,500 unfilled NHS positions including 2,700 dentist roles. Many of these postings had been vacant for at least 180 days.
The report suggests that the root of workforce issues in an NHS dental contract that is ‘not fit for purpose’. It says there is ‘no future for NHS dentistry without reform’ due to ‘fundamental issues around the affordability of NHS work’.
The British Dental Association (BDA) presented evidence to the PAC which found that the average practice loses approximately £42 delivering a set of NHS dentures. The PAC also highlighted the huge difference between earnings for NHS and private dentistry. It said: ‘Without proper remuneration it is likely that even more will move exclusively to the private sector.’
‘An avalanche of harrowing stories’
In particular, the PAC called for the government to ‘rip the contract up and start again’. It added that ‘fiddling around with the contract fails to address the real problem’.
The Labour government has committed to fundamentally reforming the NHS contract, though no timeline has been laid out. The PAC report expresses concern over the lack of detail in these plans. It said clarity over the cost of reforming health service dentistry would be necessary to address the issue of affordability.
Sir Geoffrey Clifton-Brown MP, chair of the PAC, said: ‘This country is now years deep in an avalanche of harrowing stories of the impact of dentistry’s system failure. It is utterly disgraceful that, in the 21st century, some Britons have been forced to remove their own teeth.’
Previous reform is ‘a complete failure’
The PAC dubbed the government’s existing attempts to improve NHS dental access ‘a complete failure’. The report found that at best only half of the UK’s population could see an NHS dentist within two years under the current funding and contractual arrangements.
It also found that the dental recovery plan proposed by the previous Conservative government had ‘comprehensively failed’ and was ‘never actually ambitious enough’. The following statistics were cited:
- The new patient premium which pays practices for each eligible new patient actually resulted in 3% fewer new patients seeing a dentist since it was introduced
- Less than 20% of the expected 240 £20,000 ‘golden hellos’ incentivising dentists to relocate had been appointed by February 2025
- The mobile dental unit proposal was dropped
- The uplift to the minimum value of contractually agreed dental activity to £28 failed to deliver any identifiable improvements.
‘NHS dentistry is broken’
Sir Geoffrey Clifton-Brown said: ‘Almost unbelievably, the government’s initiatives appear to have actually resulted in worsening the picture, with fewer new patients seen since the plan’s introduction.
‘NHS dentistry is broken. The government could hardly fail to agree on this point, and indeed I am glad that it is not in denial that the time for tinkering at the edges is over. It is time for big decisions.’
Shiv Pabary, chair of the BDA General Dental Practice Committee, said: ‘MPs have arrived at an inescapable conclusion that tweaks at the margins have not and will not save NHS dentistry.
‘We’ve never budged from our view that government’s past and present have needed to go further and faster. We’re ready to roll up our sleeves and start on the fundamental reform required to give this service a future.’
Solutions to the workforce crisis
Neil Carmichael, chief executive of the Association of Dental Groups (ADG), said that addressing the workforce crisis would require a ‘total team approach’. He emphasised that ‘every appointment with a dentist requires a dental nurse to be present’.
Dental experts have previously highlighted skill mix as a solution to workforce problems. Simon Thackery, president of the British Association of Private Dentistry, touched on the concept at a Dental Leadership Network event focused on optimising the dental workforce in 2024.
He said: ‘Some dentists will have a chip on their shoulder that they are the best person to do everything but that’s not necessarily the case. If I’m going to delegate a task to someone else, it’s because they are going to do it better.’
Another potential solution to dental workforce shortages that has been suggested is expansion of the Overseas Registration Exam (ORE). However the examination was not mentioned with the PAC report.
Neil Carmichael said: ‘We need to cut red tape to get the trained dentists who are currently working outside their profession re-engaged through revising the ORE system.’
In November 2024, the GDC confirmed that the ORE is now operating at the ‘maximum capacity possible under the current contract’. This followed the announcement in September 2024 that there would an additional sitting of both parts of the exam in 2025.
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