Revealed: The ICSs furthest behind on dental access

The figures show a particular problem in the South West, where dentists in four out of the seven systems had delivered less than 51 per cent of their total “contracted activity” for the financial year as of January.

If the same pattern continued in the final two months of the year, they will have reached less than 60 per cent of their targeted activity.

Under NHS primary dental contracts, integrated care boards agree targeted annual activity based on local need and capacity, so they are already likely to underestimate real need.

In three of the South West’s ICBs – Cornwall and the Isles Of Scilly, Devon, and Somerset – dentists had carried out less than half the total contracted activity as of the end of January (see map below – Dental access is lowest for integrated care boards in the South West - and full table at the bottom of the article).

It comes amid widespread concern about dental access, with parts of the South West having been described as “dental deserts”.

Dentists delivering under their contracted activity say there is high NHS demand but NHS reimbursement rates for “units of dental activity” – such as fillings, extractions or examinations – is too low. Many are therefore moving to private care instead of offering NHS activity.

Those which do not deliver contracted activity can have funding clawed back, which has resulted in NHS dentistry underspends which are this year forecast to hit around £350m.

HSJ obtained the activity figures up to the end of January from the NHS Business Services Authority through a Freedom of Information request. 

Generally, urban areas are closer to their contracted activity than rural and coastal areas, likely because recruitment problems are less severe, and there is more choice of practice. All five London ICBs, for example, are in the top ten for delivering on agreed activity – although all areas had delivered less than 75 per cent, more than three-quarters of the way through the year.

‘Worst in the country’

Ben Bradshaw, Labour MP for Exeter, last month said Devon and Somerset were “the worst in the country” for dental access and accused the government of delivering an “NHS desert” in the areas.

Minutes from a Devon ICB meeting in December cited “significant gaps in the system”, adding that “whilst the workload had increased, the resourcing had not”. It had raised concerns to NHS England because the “[access issues] required resolution”, it said.

Cornwall and Devon ICBs told HSJ that ”workforce shortages, high demand and a backlog to address” were causing severe “pressures”. Some of the systems’ forecast underspend “can be attributed to these pressures as well as to dental contract handbacks”, they added. 

They continued: ”We don’t have the level of NHS dental provision that we need in [Devon and Cornwall and the Isles of Scilly], and since taking on commissioning responsibility on 1 April 2023, we have been working hard with our dental providers to increase availability and create the best service for our local people and our local dentists.”

Both ICBs said they are looking at how to “reinvest dental underspend” to increase the dental workforce, support new services and expand on existing programmes.

Cornwall ICB also cited a joint pilot project with NHSE where a surgery in Lostwithiel is aiming “to focus the practices’s limited NHS capacity on people with the greatest need” by retaining NHS care for only patients over 80, under 18 or with specific health needs. 

North West London ICB – one of the highest performing areas – told HSJ it was working with providers “to try to get the most out of our contracts and improve the reach and uptake of dental services”, including additional funding this year to increase capacity in areas of high demand. 

Limits of contract

NHS Confederation warned last April, when NHSE delegated dental commissioning to ICBs, that several were concerned the “dental contract still holds back desired transformation”.

The British Dental Association has consistently criticised the contract as inflexible and underpaying, with dentists often carrying out NHS work at a loss, but it has not been reformed since its introduction in 2006 and is unlikely to be before the upcoming general election.

The union has previously said varying funding rates in different areas of England help explain gaps in NHS activity and access. The government has also argued ICBs can do more to spend their dental funding.

In a statement, the Department of Health and Social Care pointed to its recent dental recovery plan which offers ”golden hellos” of up to £20,000 to “those going to work in underserved parts of the country”, and dental “vans” to increase access in rural and coastal areas. 

It added: “We already invest £3bn a year in dentistry and we’re starting to see positive change. Last year 1.7 million more adults and 800,000 more children saw an NHS dentist compared to the previous year.”

When approached, NHSE said dentistry was in the remit of ICBs. HSJ also contacted other low and high-performing ICBs for comment.