Nigel Jones considers whether NHS dentistry has a future as political caution, contractual drift and the growth of private care leave the service increasingly reliant on a safety-net model.
Since 1990, I’ve been paying careful attention to the politics of UK dentistry and watched successive governments of all colours kick the NHS dentistry can down the road.
As frustrating as it has been to watch that continued failure to grasp the nettle, I have a degree of sympathy for any government trying to tackle deeply rooted problems that need long term solutions within the framework of an electoral system that encourages short-termism.
This summer’s Nuffield Trust report The Great Extraction spoke about the demise of NHS dentistry in England and how those that cannot afford to pay privately lose out most. I would hesitantly suggest that it is often those same people who find it hardest to access what NHS dental provision still exists locally as they get squeezed out by savvy patients who can afford to pay privately but wish to exert their ‘right’ to state subsidised dentistry.
The fear that such attitudes among motivated voters would manifest themselves at the ballot box must act as a deterrent to substantive action for any politician however much they understand what’s needed.
Besides which, procrastinating has its advantages when it allows the service to be gradually privatised without an official policy announcement to that effect. During one of the first conversations I ever had with a dentist, he put forward his view that what was happening to NHS sentistry amounted to constructive dismissal from the health service. For many, such thoughts still hold water today, 36 years later.
Difficult decisions
And yet there are signs that our new(ish) prime minister is, for now at least, willing to take the kind of difficult decisions that have scared off many of his predecessors. Even when linked to the funding of a national care service, announcing changes to the state pension triple lock is a bold move. Publicly floating the possibility of rejoining the EU is also politically high risk for obvious reasons.
The economic context in which such announcements have been made, including, for example, the probable need to provide targeted support for the looming exacerbation of the energy crisis, means we all know the answer to one of the questions posed by the Nuffield Trust about whether NHS dentistry will truly return to being a universal service.
The willingness of those savvy voters to, albeit often reluctantly, be maneuvered into paying privately for their oral care suggests that the Nuffield Trust’s reference to a service stripped back to act as a safety net for the poorest and for groups like children and pregnant women, is far more likely to be the ultimate destination.
The obvious challenge is how to navigate a way there that is quick enough and politically safe enough. The constructive dismissal route is arguably proving too slow and quietly damaging but working out how to accelerate the journey while minimising the political pain is not straightforward.
What is the future of NHS dentistry?
Perversely, the wave of optimism that accompanied the election of Labour and the promise of the cavalry coming to save the day will have persuaded many in the profession to hang fire on plans to leave the NHS, temporarily slowing the drift to private.
That at least allowed the new administration to take stock of the situation and the government then bought itself more time with the contractual tweaks introduced in April and the promise of a consultation.
Furthermore, any significant announcements about the changes to NHS dentistry seem highly unlikely given the launch by the Competition and Markets Authority (CMA) of the market study into the provision of private dental services in the UK. It would be unwise to make public any meaningful reform intentions that could lead to a rapid expansion of the private dental market until it has been established it is working appropriately for consumers.
The statutory deadline by which the CMA must publish its final report, along with any remedies, is 4 March 2027. That edges perilously close to the next general election, so at that late stage in the electoral cycle, the ADG is likely to get its wish for incremental, rather than fundamental contractual change.
However, the clock is ticking and the ramifications of those contractual changes that will emerge in the new year may not make for comfortable reading. The patience of NHS dentists, who have seen their health and wealth suffer trying to make NHS contractual arrangements work, is running out if September’s survey by the BDA is anything to go by. There is only so much road left down which to kick that can.
Considering your own future in NHS dentistry?
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