The government has announced changes to the NHS dental contract in England, but leading dental bodies warn the measures are insufficient to address a deepening crisis that sees patients resorting to pulling out their own teeth.
A System in Chronic Crisis
From April next year, the NHS payment system will be altered to allow patients needing multiple appointments to book a single package of care, rather than a series of individual visits. Dentists will also receive new incentives to offer more slots for urgent treatment, targeting severe pain and infections.
These changes, announced by Health Minister Stephen Kinnock, follow a consultation that highlighted critical gaps in access to both urgent and complex dental care. While any step to reduce suffering is welcome, the British Dental Association (BDA) has dismissed the reforms as mere 'tweaks' to a fundamentally broken system.
Shocking Evidence of a Failing Service
The scale of the crisis is starkly illustrated by recent data. Calls about dental problems to the NHS non-emergency 111 line rose by 20% between July and September this year compared to the same period in 2024. Even more alarming is the near 45% jump in A&E attendances for dental issues over four years, from 81,773 in 2019-20 to 117,977 in 2023-24.
A damning report from the patient watchdog includes harrowing case studies, with some individuals forced to extract their own teeth due to an inability to access professional care. Chronic shortages plague regions like the east of England, and initiatives like 'golden hellos' to attract dentists to underserved areas have had limited impact.
Why Tweaks Are Not Enough
The core of the problem lies in the 2006 NHS dental contract, which replaced patient registration with a system paying dentists per 'unit of activity'. This model has been widely criticised for over a decade for creating access barriers, particularly for poorer communities.
Shiv Pabary, chair of the BDA's general dental practice committee, aptly described the latest announcement as "the biggest tweaks this failed contract has seen in its history." Experts agree that what is required is not adjustment, but a complete overhaul.
Progress on public health goals has stalled. Efforts to reduce tooth decay in young children and tackle dental health inequality have made little headway, though Labour's plan for supervised toothbrushing in schools is a positive, hands-on intervention.
The government has promised a new contract by the end of this parliament. Campaigners urge ministers to go further by pledging to restore the right to register with an NHS dentist, ensuring universal access. They also demand clarity on how this week's changes relate to an existing plan to create 700,000 more urgent appointments, and a clear public timeline for delivery.
