Exclusive: No new funding for key Labour pledge, says NHSE document

A letter from NHS England to integrated care boards, marked “confidential draft” and dated 28 October, says this year’s tranche of the additional activity is “to be funded from within the dental ringfence.”

It says commissioners should consider what is “affordable” and that they “may need to reprioritise” existing spending.

Mark Dayan, from the Nuffield Trust think tank, warned delivering the new appointments “would have to displace other dentistry work” if extra cash was not provided.

NHSE stressed the letter had not yet been issued. A spokesperson told HSJ: “This is an unapproved draft that hasn’t been issued – it is currently for internal discussion only as no decisions have been made.

“It is right that the NHS looks at how to use all available resources to deliver additional dental care for patients.”

A Department of Health and Social Care spokesperson said the draft was wrong and was not sent.

In its manifesto, Labour committed to a dentistry rescue package including 700,000 urgent appointments each year, funded by £125m raised from the closing of non-dom tax loopholes and cracking down on tax avoidance.

Dentistry budgets are supposedly ringfenced. However, recent years have seen record underspends under the widely discredited dental contract, which Labour has pledged to reform.

In some areas, close to a third of the dentistry budget is unspent. NHSE has flexed rules to allow ICBs to commission more activity, although it also told systems last year they could use the funding to balance pressures elsewhere.

The last government implemented firmer rules but some ICBs have indicated they will be relying on dental underspends to balance the books, meaning it is not clear that the funding will be available for extra appointments.

Black Country ICB, for example, said in board papers that its financial plan “relies upon assumptions in respect of dental underspends,” while Derby and Derbyshire ICB said it was unable to spend its budget in full and was anticipating a £7m shortfall.

The letter says extra appointments are to be delivered from the start of December and sets out indicative targets per ICB, which add up to 230,000 extra in the last four months of 2024-25.

Commissioners should consider the “extent of unmet care need” beyond additional services when drawing up their plans, according to the document. They should also take into account “what is an affordable level of additional urgent care capacity within their dental ringfence. ICBs may need to reprioritise spending from other local flexible commissioning initiatives”.

The British Dental Association said using existing budgets to deliver extra work was “wholly unsustainable.”

Chair Eddie Crouch said: “Promises of new investment in NHS dentistry have turned into a raid on existing budgets. These are funds that could be used to keep practices afloat, and millions of patients seen.

“Instead of a ‘rescue plan’, the Treasury are offering a modest exercise in recycling.”

Mr Dayan, the Nuffield Trust’s head of public affairs, said: “The correspondence — which asks ICBs to commission extra urgent dental capacity for December through to March 2025 — implies there is now some underspend in the dental budget, illustrating that yet again the dental contract is not attractive enough to ensure dentists take on the expected number of NHS patients.

“Without dedicated additional funding from next year, the provision of extra urgent appointments to meet the manifesto pledge would have to displace other dentistry work – so while the extra appointments have merit, they fail to address the problem that NHS dentistry does not provide dental care for a huge proportion of the English population.”

Updated after publication 29th October to include DHSC comment.