NHS dentistry is rotting. Will the plan to fix it work?

## Summary
In the past two years, hundreds in Bristol have queued for hours to register with an NHS dentist "Without fundamental change, NHS dentistry will remain a service that has gone for good in many parts of the country," says Mark Dayan, an analyst at the Nuffield Trust, a health think tank. "At this stage, it's just unhelpful to pretend there is still some kind of comprehensive system in place." But will the reforms, which the government is calling the most significant in 20 years, be enough to save a system that has not been working for millions of patients? Cancer treatment and osteoporosis had damaged her teeth, leaving her with six lost fillings and toothache. "We had a great NHS dentist where I used to live," she told me. "Over the last four years I must have phoned every dentist in Suffolk and not a single one is taking on new NHS patients. "You hope and pray your nerve dies so the pain goes away, which cannot be right." Jean's only long-term option is to go to one of the many private dentists in her area, but she says the amount of work she needs could cost thousands. Healthwatch England, a watchdog which represents patients, says it receives more complaints about dentistry than any other subject. "It's a constant source of frustration, anxiety and distress," says Rebecca Curtayne, its acting head of policy. "Too many on low incomes are being forced into private care they struggle to afford or are going without treatment altogether." The watchdog's own polling suggests the situation has got worse since the pandemic. The BDA has long argued it's too complicated and does not fairly reflect the cost of treating patients, particularly those with high needs. "The whole system is just absurd and unfit for purpose," says Dr Shiv Pabary, a dentist from Newcastle who chairs the BDA's general dental practice committee. "The government wants us to take on more high-risk patients, but if we do that then we lose money and that's the problem." The union's main gripe is that total government spending on NHS dentistry in England has been falling over the past decade, once inflation is taken into account.

## Article Content
NHS dentistry is rotting. Will the plan to fix it work?
48 minutes ago
Share
Save
Jim Reed
Health reporter
Share
Save
BBC
As queues go, this one was impressive.
It started on a quiet residential side street, then turned left past a giant blue mural before snaking 100m down the main road to the doors of a new dental practice.
Carol Sherman, a local artist, was second in line when the doors opened back in 2024.
"I was that desperate, I put some chairs and blankets in the car and got there at five in the morning," she says. "So many people round here can't get a dentist… so it's been an absolute lifesaver."
Three times in the last two years, hundreds of people in Bristol have been forced to queue for hours just to register with a NHS dentist in the city.
Other parts of the country face the same situation.
In both England and Wales changes are about to come into force meant to make it easier to access dental treatment on the NHS.
In the past two years, hundreds in Bristol have queued for hours to register with an NHS dentist
"Without fundamental change, NHS dentistry will remain a service that has gone for good in many parts of the country," says Mark Dayan, an analyst at the Nuffield Trust, a health think tank. "At this stage, it's just unhelpful to pretend there is still some kind of comprehensive system in place."
But will the reforms, which the government is calling the most significant in 20 years, be enough to save a system that has not been working for millions of patients?
The race for appointments
Back in 1948 when Labour's Aneurin Bevan founded the NHS, dental care became free alongside hospitals and GPs.
But the country's teeth were in an appalling state after World War Two and pent-up demand was much greater than politicians anticipated.
To keep a lid on costs, the first routine charges (of £1) for NHS dental work were quickly introduced, alongside fees for prescriptions and glasses. Bevan, by then minister of Labour, resigned in protest.
From the earliest days, that decision to charge patients set dentistry apart from almost every area of the health service. Except for some groups (like children) who get free treatment, patients in England can expect to pay £27 for a checkup, rising to £75 for a set of fillings and £327 for a bridge or dentures.
But – crucially – those prices are meaningless if patients cannot get an NHS appointment in the first place.
Getty
Demand for dentistry was huge when the NHS was founded in the 1940s
In 2021, Jean Ann Green, 66, moved from Hertfordshire to Beccles in Suffolk. Cancer treatment and osteoporosis had damaged her teeth, leaving her with six lost fillings and toothache.
"We had a great NHS dentist where I used to live," she told me. "Over the last four years I must have phoned every dentist in Suffolk and not a single one is taking on new NHS patients.
"You hope and pray your nerve dies so the pain goes away, which cannot be right."
Jean's only long-term option is to go to one of the many private dentists in her area, but she says the amount of work she needs could cost thousands.
When I ask if she can afford it, she laughs.
"Because of my postcode I can't have the treatment on the NHS that I desperately need and that's just immoral," she says.
Going private
In the UK there are around 12,000 high street dental practices, from large chains to small businesses. Those firms can decide to bid for an NHS contract, carry out private work instead or, more likely, juggle a combination of the two.
It's that balance which has shifted dramatically.
Back in 1990, spending on private dental care made up just 14% of the market, rising to 42% by 2010 and a record 69% in 2024, according to the consultants LaingBuisson.
Healthwatch England, a watchdog which represents patients, says it receives more complaints about dentistry than any other subject.
"It's a constant source of frustration, anxiety and distress," says Rebecca Curtayne, its acting head of policy. "Too many on low incomes are being forced into private care they struggle to afford or are going without treatment altogether."
The watchdog's own polling suggests the situation has got worse since the pandemic. Around 32% of people said they used private dentistry last year, a sharp increase from 22% in 2023.
Official data shows that more complex care, in particular, has become much harder to access on the NHS. Over the last ten years, the number of routine NHS examinations has fallen by 6% in England while the number of root canals, where an infection is removed from deep inside the tooth, has dropped by 49%.
"I have lots of colleagues who just won't touch [NHS] root canals now, it's a complicated procedure and such hard work," says one dentist from the east of England, speaking anonymously so she can speak freely. "It's ridiculously remunerated so you can end up spending so much time on it and lose money."
Some patients are given a choice: have the tooth removed on the NHS or have specialist root canal work to save it, b

---

## Expert Analysis

### Merits
- In the past two years, hundreds in Bristol have queued for hours to register with an NHS dentist "Without fundamental change, NHS dentistry will remain a service that has gone for good in many parts of the country," says Mark Dayan, an analyst at the Nuffield Trust, a health think tank. "At this stage, it's just unhelpful to pretend there is still some kind of comprehensive system in place." But will the reforms, which the government is calling the most significant in 20 years, be enough to save a system that has not been working for millions of patients?
- That might cost around £2bn a year according to some estimates, a fraction of the total £196bn NHS budget in England but still a significant amount in cash terms.
- But many of the patients who would benefit from that access might already be well off and happy with private treatment.

### Areas for Consideration
- Anger over the contract At the heart of this whole problem is the NHS dentist contract - described as "ridiculous and discredited" by the British Dental Association (BDA), a trade union.
- The BDA has long argued it's too complicated and does not fairly reflect the cost of treating patients, particularly those with high needs. "The whole system is just absurd and unfit for purpose," says Dr Shiv Pabary, a dentist from Newcastle who chairs the BDA's general dental practice committee. "The government wants us to take on more high-risk patients, but if we do that then we lose money and that's the problem." The union's main gripe is that total government spending on NHS dentistry in England has been falling over the past decade, once inflation is taken into account.
- Unpopular options The problem for politicians is that all the long-term choices look unpalatable. "I do worry that we're beyond the point that NHS dentistry can be saved," says the BDA's chair Eddie Crouch. "If we've got no money to improve the service, then we need to have a serious conversation… about what sort of minimum level of dental service is available, or who will actually get NHS dental services in the future." One option is simply to throw more money at the problem, boosting the value of contracts and maybe even setting up more NHS-run community clinics which can employ dentists directly.

### Implications
- Will the plan to fix it work? 48 minutes ago Share Save Jim Reed Health reporter Share Save BBC As queues go, this one was impressive.
- In the past two years, hundreds in Bristol have queued for hours to register with an NHS dentist "Without fundamental change, NHS dentistry will remain a service that has gone for good in many parts of the country," says Mark Dayan, an analyst at the Nuffield Trust, a health think tank. "At this stage, it's just unhelpful to pretend there is still some kind of comprehensive system in place." But will the reforms, which the government is calling the most significant in 20 years, be enough to save a system that has not been working for millions of patients?
- Except for some groups (like children) who get free treatment, patients in England can expect to pay £27 for a checkup, rising to £75 for a set of fillings and £327 for a bridge or dentures.
- Cancer treatment and osteoporosis had damaged her teeth, leaving her with six lost fillings and toothache. "We had a great NHS dentist where I used to live," she told me. "Over the last four years I must have phoned every dentist in Suffolk and not a single one is taking on new NHS patients. "You hope and pray your nerve dies so the pain goes away, which cannot be right." Jean's only long-term option is to go to one of the many private dentists in her area, but she says the amount of work she needs could cost thousands.

### Expert Commentary
This article covers nhs, private, dental topics. Notable strengths include discussion of nhs. Areas of concern are also raised. Readability: Flesch-Kincaid grade 0.0. Word count: 2547.