A House of Commons committee is calling for "urgent and fundamental" reform to dentistry in England to end a "crisis of access", after MPs heard testimonials from people left in pain and distress because they were unable to get dental treatment on the NHS.
The Health and Social Care Committee launched an inquiry in the wake of a survey that showed 90% of dental practices across the UK were not accepting new adult NHS patients. It considered to what extent the current NHS dental contract disincentivised dentists from taking on new patients, as well as issues of staff recruitment and retention, and the possible impact of changes to be introduced in April 2024 to make new integrated care systems and integrated care boards responsible for the provision of dental services.
Committee chair Steve Brine said such an inquiry had rarely been more needed after members heard harrowing examples of neglected dental and oral health, including one would-be patient who "resorted to using pliers to extract their teeth".
The current situation was "totally unacceptable in the 21st century", according to the MPs, who branded the current dental contract "not fit for purpose".
The British Dental Association (BDA) described the inquiry report as "a damning verdict on NHS dentistry".
MPs called for a move away from the current system of payments for units of dental activity "in favour of a weighted capitation-based system which provides financial incentives for seeing new patients and those with greater dental need".
However, the committee warned that even contract reform could be "too little too late for those dentists who have already left the NHS", and that neither Government nor NHS England had fully grasped the challenge of attracting new and current dentists to undertake NHS work. The report also expressed concern that many integrated care boards "do not have adequate resources, tools or expertise" to address these issues.
Inequitable Access to NHS Dentistry
A YouGov survey in March this year of more than 2000 people across the UK found that 22% of Britons were not registered with a dentist and of those, 37% said this was because they couldn't find a dentist who would accept them for NHS treatment.
A roundtable session held by the committee with people who had lived experience of dentistry, as well as patient organisations, revealed stories of patients extracting their own teeth at home, people forced to travel for hours to appointments, and individuals experiencing severe social isolation due to their worsening oral health and the toll this can take on mental health and social wellbeing.
Official statistics show that people from the most deprived areas of England were less likely to contact a dentist when they need treatment, compared with those from the least deprived areas, whilst fewer ethnic minority people than White people said they were planning to go to a dentist for regular check-ups since the COVID-19 pandemic.
MPs endorsed comments by the primary care and public health minister, Neil O’Brien, who told the inquiry that everyone who needs an NHS dentist should be able to access one, but said the Government must urgently set out how the dental contract will be reformed to achieve this.
"We believe there is a crisis of access in NHS dentistry," the report stated.
MPs also expressed "frustration" that recommendations made by their predecessors on the committee 15 years ago had still not been implemented.
Mr Brine said: "The problem is compounded by people being unaware of what they're entitled to, and a contract that is unfit for purpose when it comes to paying dentists for treating NHS patients. Today we register in the strongest terms possible our concern for the future of NHS dental services and the patients who desperately need access to them."
BDA Calls for Workforce Survey
The BDA said it endorsed the committee's call for a dental workforce survey to establish how many full and part time dentists are working in NHS dentistry, "so we can actually pinpoint where the 'dental deserts' actually are ".
The Department of Health and Social Care told Medscape News UK in an email that it was "working to improve access to NHS dental care". A spokesperson said : "We invest more than £3 billion a year in dentistry and have already increased the funding practices receive for high needs patients to encourage dentists to provide more NHS treatments.
"We also recently announced a 40% increase in dentistry training places and have amended the guidelines so dental therapists and hygienists can deliver more treatments, and will set out further measures to improve access shortly."
NHS dentistry report. Published 14 July 2023.
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