The NHS has lost around 600 dental practices providing general NHS dentistry in England since 2017, with almost every part of the country seeing a decline as more practices move towards private care, analysis from the Nuffield Trust reveals.
The analysis shows the proportion of dental practices offering general NHS dentistry has fallen from around 65% in 2017 to around 56% in 2026. Over the same period, the number of practices holding an NHS general dental contract has fallen by around 600 – equivalent to around one in ten NHS dental practices – while the number of practices without an NHS contract, largely private or specialist providers, has increased by almost 1,000.
The decline has been almost universal across England, with the number of NHS dental practices falling in 41 of the country's 42 integrated care boards. However, the effect is not evenly spread. The Southwest and East of England have seen particularly steep declines, highlighting persistent regional inequalities in access that reflect long-standing problems with the NHS dental contract.
The analysis suggests the trend has accelerated since the Covid-19 pandemic, as growing pressures within the NHS dental contract have continued to push practices away from NHS work. While reforms introduced in April, including making urgent dental care a contractual requirement and increasing payments for some complex treatments, should improve access to urgent care, the authors argue they do not address the underlying incentives driving practices away from NHS dentistry.
The authors warn that this trend may help explain the poor results from the GP Patient Survey, which showed that half of adults have not sought an NHS dental appointment in the past two years. Among those who did not try, one in four said it was because they didn’t believe they would be able to get an appointment. Of those who attempted to get a new appointment, just 38% were successful.
The Nuffield Trust says the success of the government's promised fundamental contract reform should be judged not simply by changes to the payment system, but by whether it succeeds in bringing practices back into NHS dentistry and reversing the long-term decline in access. Paying practices to care for a population, based on local need rather than the number of individual treatments they complete, would create stronger incentives for dentists and help restore access based on need, not ability to pay.
Nuffield Trust policy analyst, Mark Dayan said: "The retreat of NHS dentistry was never an announcement or a policy. There has been no closure programme for people to oppose. But it amounts to the quiet transformation of dentistry into a two-tier service over the last decade, where access increasingly depends on what people can afford to pay and where they happen to live.
“As the government delivers the contract reform it has promised, it will face a stark choice. Either it makes NHS work attractive enough to turn this trend around and bring back enough practices to cover everyone, or it will need to give up on the promise of a universal service and prioritise those who need preventive care most, or do not have the money to pay privately.
“If the government tries to dodge this decision, the gradual drift away from NHS treatment will mean we have abandoned the health service's promise of comprehensive care for those in need, with some parts of the country hit much harder than others.”