Increased spending on dental services blocked by a quarter of ICBs

NHS England has authorised ICBs to pay dentists for up to 110 per cent of contracted activity in 2023-24 where resources are available. But 12 ICBs have now said they will not do so because their finances are too tight. 

Dental budgets have been routinely underspent, meaning ICBs have access to considerable sums to boost activity. But this money is instead being used to tackle financial shortfalls and other priorities. 

There is mixed messaging over whether dental funding is ringfenced. Health and social care secretary Victoria Atkins said before Christmas that dental funding is protected, but NHS England told ICBs they could move dental funding to other areas. 

The East Midlands region – which constitutes the Leicester, Leicestershire and Rutland, Nottingham and Nottinghamshire, Derby and Derbyshire, Lincolnshire and Northamptonshire ICBs – and South Yorkshire ICB confirmed to HSJ that they will not pay for the extra work because of budgetary pressures. 

These come in addition to the six West Midlands ICBs which have ruled out paying dentists for additional work, as reported by the BBC earlier this month. 

An analysis by the Nuffield Trust last month described NHS dentistry as “in terminal decline”. Its research showed that less than 40 per cent of adults and 50 per cent of children had seen a dentist within the “recommended timeframe”, largely as a result of practices no longer accepting NHS patients.

Correspondence from the East Midlands region, seen by HSJ, reads:  “It has been agreed that, due to the financial position, the East Midlands ICBs are not in a position to support a non-recurrent investment scheme for over delivery up to 110 per cent in 2023/24. We appreciate that this will be disappointing.”

It added in a statement to HSJ: “We have considered all primary care investment plans and have had to make difficult decisions to achieve financial balance.” 

The East Midlands group agreed to this approach as part of revised financial plans submitted to NHSE, which ICBs must complete by April in response to the service’s growing funding crisis. 

South Yorkshire ICB also confirmed to HSJ that “additional resources to fund up to 110 per cent are not available this year” as it had “already committed to £4.2m of funding for urgent access sessions” in several dental practices. 

Dental and ICB sources say there is little oversight from NHSE around the extent of funding being shifted away from dentistry, and that more areas are likely to follow suit in restricting funding for dentistry. Both Humber and North Yorkshire and Cheshire and Merseyside ICBs have indicated in board papers that dentistry funding will be squeezed to help them balance their books.  

An NHS England spokesperson said: “NHS England has ringfenced dental budgets and on behalf of patients we continue to support dental contractors to deliver on their commitments in full so that budget is spent. However, if dental contractors underdeliver on their commitments that public money is returned. In the first instance ICBs have been required to use this money to try to improve dental access. After that, this year ICBs have the option to use the money to help offset other inflationary pressures”.

A Department of Health and Social Care spokesperson said it funds more than £3bn of NHS dentistry a year and is “taking preventative measures to improve oral health”, such as expanding water fluoridation schemes, as well as “further measures to improve access”. 

It added that it will “increase the number of NHS dentists through our dental recovery plan” which “will be set out shortly”.