Fixing the foundations in dentistry

Last month the Government unveiled its long-awaited 10-Year Health Plan for England, a 168-page document which sets out proposals to reinvent the NHS through three radical shifts: hospital to community, analogue to digital, and sickness to prevention.

Alongside plans for a network of neighbourhood health centres across the country are proposals for widespread reform of dental services.

Here, we look at the key points in the plan.

Fit for the future

The report reveals that satisfaction with NHS dentistry has fallen to a record low; from 85% in 2019 to 69% in 2024.

The British Dental Association estimates 13 million adults – over one in four – are struggling to find NHS dental care.

Worse still, evidence shows that even among those who do get appointments, it is patients with the greatest clinical need who miss out.

“Today, more people are paying for private treatment, while those who cannot afford the cost go without, leaving them unable to eat properly, work, or, in some instances, forced to resort to DIY dentistry,” it states.

“We will continue our urgent action to improve NHS dentistry in the short term and lay the foundations to make it fit for the future.”

The plan says that, by 2035, the NHS dental system will be transformed so it provides high-quality care at the right time and that nobody goes without because they cannot afford treatment.

The first step will be to stabilise NHS dentistry and make sure the budget is spent on those who need care most.

Initially, this will mean prioritising urgent care and creating capacity for 700,000 additional urgent appointments.

In parallel, the plan will deliver a step change in prevention, with children an urgent priority.

Tooth extraction is the leading cause of hospital admission among children aged 5-9 years old, yet it is almost entirely preventable.

This is a pivotal moment for UK oral healthcare and we are encouraged by the Government’s pro-active approach in recognising the need for long-term solutions to enhance oral health services

“We will improve access to dental care for children, making better use of the wider dental workforce, especially dental therapists, including through a new approach to upskill professionals to work at the top of their clinical potential beginning in 2026-2027,” the plan states.

“This will build on our supervised toothbrushing programme and expand the use of fluoride varnish and fissure sealants — proven interventions that significantly reduce decay.”

Community water fluoridation in the North East of England will be expanded from 2028 so that it reaches 1.6 million more people by April 2030.

And there are plans to refurbish older, existing water fluoridation schemes in the North East, West Midlands, and East of England, benefitting a further six million people by 2030.

Investing in the workforce

But none of this will be successful without investing in the dental workforce and the plan pledges to ‘build a service which is attractive to, and values, dental care professionals’.

Training a dentist costs the taxpayer up to £200,000 and, having consulted on the principle of requiring all dentists to work in the NHS for a minimum period, the Government intends to make it a requirement for newly-qualified dentists to practice in the NHS for a minimum period, expected to be at least three years.

We want a contract that matches resources to need, improves access, promotes prevention, and rewards dentists fairly, while enabling the whole dental team to work to the top of their capability

That will mean more NHS dentists, more NHS appointments, and better oral health.

The Government is also planning major changes to the dental contract.

“From financial year 2026-2027, payments will better reflect the cost of treating patients with higher needs, and we will reduce low-value activity — including check-up frequency exceeding that stipulated in the National Institute for Health and Care Excellence (NICE) guidance, through changes to financial incentives and improved system oversight,” says the plan.

“These changes will improve access to care and ensure dentists are rewarded fairly.”

It adds: “We are clear that even greater change is needed.

“This year, we will begin the process of more-fundamental contract reform.

“We want a contract that matches resources to need, improves access, promotes prevention, and rewards dentists fairly, while enabling the whole dental team to work to the top of their capability.

“Our neighbourhood health service will provide opportunities for dental care professionals, including dental therapists and dental nurses, to work as part neighbourhood teams to provide integrated and pro-active care in a way that meets individual needs while also maximising the capacity and capability of the workforce.

“Dental therapists could undertake check-ups, treatment, and referrals, while dental nurses would lead individual and community oral health education efforts.

“The work therapists cannot do would be safely directed to dentists.”

A fresh approach

This approach is already working in some areas of the country.

For example, a paediatric dentistry advice clinic model has transformed the Whittington’s Community Dental Service’s ability to enable every child in its catchment of north west and north central London to get timely access to specialist-led dental care.

Under the programme a consultant dentist in London provides virtual support to a community dental team, enabling them to treat children within their service and preventing referral to secondary care.

The plan states: “We will introduce two new contracts, with rollout beginning next year.

“The first will create ‘single neighbourhood providers’ that deliver enhanced services for groups with similar needs over a single neighbourhood (c.50,000 people).

“In many areas, the existing primary care network (PCN) footprint is well set up as a springboard for this type of working.

“The second will create ‘multi[1]neighbourhood providers’ (250,000-plus people).

These larger providers will deliver care that requires working across several different neighbourhoods (e.g. end-of-life care).

“Multi-neighbourhood providers will also be responsible for unlocking the advantages and efficiencies possible from greater scale, working across all GP practices and smaller neighbourhood providers in their footprint.

We are committed to helping shape a future where dental hospitals continue to provide the high-quality, specialist care that the public deserves

“They will support sustainability and professional autonomy by delivering a shared back-office function, overseeing digital transformation and estate strategy, and by providing data analytics and a quality improvement function.

“They will be large enough to create new commercial partnerships, including clinical trials, so that the neighbourhood health service becomes a hotbed for innovation.

“And they will actively support and coach individual practices who struggle with either performance or finances, including by stepping in and taking over when needed.

“In some places this role is already being played by GP federations, with excellent results.

“We will also give integrated care boards (ICBs) freedom to contract with other providers for neighbourhood health services, including NHS trusts.”

Welcome and essential

Responding to the publication, Dr Katie Petty-Saphon, chief executive of The Association of Dental Hospitals, said: “This is a pivotal moment for UK oral healthcare and we are encouraged by the Government’s pro-active approach in recognising the need for long-term solutions to enhance oral health services.

“We support the emphasis on expanding community care and early intervention, especially for young children.

“Expanding access to preventative care is a crucial step in reducing future pressures on dental hospitals, where patients currently face long waits for complex treatments that could have been avoided with timely, accessible community-based care.

“The focus on these areas is both welcome and essential.

“At the same time, it is vital to acknowledge the unique and irreplaceable role of secondary care.

“Dental hospitals deliver complex, specialised treatments that are critical to patient care, including services like maxillofacial surgery.

“Ensuring these services are adequately supported will be key to a comprehensive strategy for improving oral health across the nation.

“We look forward to opportunities to collaborate with the Government on these initiatives and to respond to the plan in more detail.

“We are committed to helping shape a future where dental hospitals continue to provide the high-quality, specialist care that the public deserves.”

But Dr Becks Fisher, director of research and policy at the health think thank, the Nuffield Trust, warned: “Our failure to get dentists working in the NHS is at the heart of why a comprehensive service has collapsed.

“The Government is right to think about how to address that, and how to make use of a wider range of staff.

“But a three-year work requirement for new dentists isn’t a full or simple solution.

“NHS rates are simply not competitive with the private sector in many areas.

What we need is a proper reform of a dental contract which successive governments have seen as unfit for purpose for more than 15 years

“While this remains the case, it’s all very well to force dentists to do three years work for the health service, but they will still tend to simply drift away afterwards.

“What we need is a proper reform of a dental contract which successive governments have seen as unfit for purpose for more than 15 years.

“Making more use of other staff like dental therapists is an excellent idea, but the recent NHS history with roles such as physician associates, which caused confusion and backlash, shows that this needs to be handled very carefully.

“There must be plenty of time for rollout, a proper understanding from the start of the role and its limits, and regular monitoring.”