What does NHS dentistry look like from the BDA’s perspective?

The new Health Secretary, Wes Streeting, mentioned that he thought the NHS was broken. From the BDA's perspective, NHS dentistry is close to breaking. Colleagues are watching to see what might change following the general election. This uncertainty may cause some to reconsider leaving. Currently, NHS dentistry is in its worst position. I’m meeting with the minister responsible, Stephen Kinnock, soon, and I hope he senses the urgency needed to make changes.

 

Could things get any worse within NHS dentistry?

Yes, it could get worse. We’ve heard many promises from the government but, without action, more dentists may leave the NHS, making access even harder for the 13 million people already struggling to get it.
 

Labour has promised 700,000 new dental appointments. How could it be implemented?

We need clarity on where and how these appointments will be commissioned. If they’re only commissioned in areas where NHS dentistry is already doing okay, access won't improve in areas where it’s difficult. In regions with workforce problems and struggling contracts, delivering these new appointments will be challenging. One suggestion is to substitute UDAs with a system focused on urgent and emergency appointments, moving away from a target-driven system.

We've seen successful examples in the north-east of England, where dentists are paid for sessions with blocks of patients. This model could work if additional money is utilised correctly. The government has pledged new money, unlike the previous government's recovery plan, which recycled the existing budget.

 

Would an influx of new money resolve all the NHS dentistry issues?

Money will make a difference, but it won’t solve the problem on its own. More investment is needed, along with contractual reform that makes NHS dentistry an attractive place for dentists and their teams to work.

 

Where do we stand with regards to NHS contract reform?

There was never enough enthusiasm for significant contractual reform during NHS prototyping and piloting. The problems that developed post-pandemic have encouraged a revisit. The Health Select Committee’s report last year suggested learning from these pilots and prototypes, but the current contract reduces access, which is risky for the government and the population. If analysed properly and adjusted, it could still be popular with both the profession and patients.

 

What do you think could be done to resolve the staffing crisis in NHS Dentistry?

Some pre-election proposals, like tying new graduates into the NHS, were questionable. Our response, along with the GDC’s, was negative because no one should be tied to a failing system. However, if such a plan came with incentives, like student debt relief, it might work, but only if the contract is reformed. Otherwise, morale will be low, and the workforce will lack experience.

Regarding overseas recruitment, demand remains high to work in the UK, but as more practices go private, the number of dentists needed may need re-evaluation. The current number of dentists on the register doesn’t necessarily mean we have the right amount for the UK population. We’re not opposed to overseas recruitment, but it’s complex to ensure their qualifications and skills are appropriate.

 

Do you feel dental hygienists and dental therapists are being utilised to their full capacity?

No, and neither do they. The changes made so far don’t encourage them to use their full range of skills within the NHS. A system that properly remunerates them, perhaps with NHS pensions, is needed to compete with what they can earn privately.

Looking at the oral health of the population, skill mix is essential. The current UDA contract’s target-driven system isn’t suitable for the whole dental team, but the pilots and prototypes showed how this could work when focused on improving oral health.

 

Do you feel there is a future for NHS dentistry?

I hope so. Public service dentistry is still needed, but its future depends on the government’s enthusiasm. If they continue to tweak the contract as the previous administration did, the long-term future of NHS dentistry is uncertain. The Nuffield report suggested that without significant investment, we may need to target NHS dentistry at those who can’t access private care, which isn’t a system I’d want. I still believe in universal access, but hard decisions may be necessary depending on the country’s financial situation.

 

What will you be discussing at Dentistry Show London?

I'm hopeful that by the time of the show, I'll have a clearer direction. As I mentioned earlier, I've met with Wes Streeting and have more meetings planned with Stephen Kinnock. It's encouraging that they've appointed a dedicated minister for dentistry, showing commitment. There's always plenty happening in dentistry - regulation, consultation, workforce issues - so there will be no shortage of content. A lot is likely to unfold before the show.