NHS dentistry must be remodelled along GP lines

Years of campaigning by Healthwatch and others have exposed widespread problems faced by people across England who cannot get care from an NHS dentist.

Last year, MPs concluded the NHS dental system was broken. As a result, the previous government tried to improve dental access by offering dentists a new incentive payment to encourage them to see people who hadn’t had an NHS appointment in the past two years. No official figures have been published to show whether this has had any impact, but our findings show people continue to struggle to book NHS dental appointments.

As the new government came to power in July, health and social care secretary Wes Streeting promised a new Dental Rescue Plan.

To inform future government action on dentistry, we’ve carried out what we believe to be the first polling of its kind in England to test the public’s understanding of how NHS dentistry works and what people want from it.

More than two-thirds of respondents (68 per cent) believed they had a “right” to register with an NHS dentist, just as they do with an NHS GP.

When they were told this wasn’t the case, more than half (54 per cent) said they would prefer a GP-style system in the future.

People lost their right to register permanently with an NHS dentist in 2006 when a new NHS dental contract was introduced to pay dentists only per “unit of dental activity” rather than getting paid per person registered on a list of permanent patients along with set fees per treatment given.

This has affected people’s access to NHS dentistry, with NHS dental appointments falling rapidly.

People being unable to book new NHS appointments is a frequently occurring issue, as the dentist treating them has given up NHS work, resulting in loss of continuity of care

The unpopularity of the NHS dental contract — which dentists feel fail to cover the actual cost of the work involved — means more are choosing to stop seeing NHS patients altogether. They aren’t required to warn patients who aren’t currently in active treatment about this change.

We regularly hear of instances where people can’t book new NHS appointments as the dentist treating them has given up NHS work. As a result, people lose the continuity of care from a valued health professional (more than 80 per cent of people said in our poll that individual NHS dentists treated them with respect and put them at ease) and face the inconvenience of shopping around for a new NHS dentist or having to go to a private dentist.

This differs for people seeking a new GP practice after being deregistered from their current GP. In those cases, the person’s local NHS integrated care board must help to place them with a new NHS practice if they can’t find one themselves.

Dental patients don’t have the same security, even if they’re moving to a new area:

Even dental practices that remain committed to providing NHS work can’t guarantee that patients who’ve had an appointment with them before will get one in the future.

Some patients have told Healthwatch that their practice removed them as regular NHS patients for not attending a check-up in the last two years, even if they weren’t aware this was a condition of staying on the books.

For GP patients, there is no ambiguity – they can only be deregistered if they choose to sign up with another surgery, if their relationship with the surgery breaks down, or if they move out of the practice’s catchment area.

The government has promised a Dental Rescue Plan to deliver 700,000 extra urgent NHS dental appointments for patients in the short term.

No details have yet been set on this rescue plan or the timetable or terms for long-term reform.

We urge those plans to be based on the principle of giving patients a permanent link to a practice throughout their life. We also urge them to learn lessons from initiatives that have been tried to increase dental appointments in the short term, such as the new patient payment that came in on 1 March.

In the meantime, the NHS and dental practices must improve public awareness of how patient “registration” works and any attendance obligations to stay on a regular list. This could help reduce tensions or ill-feeling between patients and practices if they are “removed” as NHS dental patients.