Why is it so hard to find an NHS Dentist?

Andrew Bain
6th Mar 2024

The exodus of dentists from the National Health Service (NHS) paints a concerning picture for oral health in the United Kingdom. A shortage of public dental services is leading to a crisis where individuals are resorting to extreme measures, such as people desperately pulling out their own teeth, due to difficulties in accessing professional care. This article delves into the factors driving dentists away from the NHS, the consequent access challenges, and how we at Ouch are trying to do our bit to help patients and dentists.

A Brief History of NHS Dentistry

NHS dentistry in the UK was established alongside the National Health Service in 1948, aiming to make dental care accessible and affordable to all. Initially, the service was free, but due to rising costs, charges were introduced in 1951. Over the decades, the structure and funding of NHS dentistry have undergone various reforms to balance demand, cost, and quality of care. NHS dentistry has faced challenges such as funding constraints, dentist shortages, and access issues, leading to ongoing debates about its sustainability and effectiveness.

The majority of NHS dental care is provided by Primary Dental Services in dental practices. There are around 11,000 dental practices in England and about 60-75% of these practices have contracts to provide NHS services. They are all independent practices free to do NHS or Private work if they are registered with the Care Quality Commission. Those practices and the dentists that provide NHS treatment are 'contracted to' the NHS, not 'employed by' the NHS.

Up until 2006, the model of remuneration was based on a fee-per-item system where dentists received a fee for every item of treatment they provided to their patients. If the patients were not exempt from charges they would contribute some of the fees up to a given maximum charge. I worked under this system for nearly 10 years at the beginning of my career. Of course, like any system, it had its faults and bad actors certainly abused it. However, and this might be simply nostalgia, I found it a workable system where many dental practice owners could sustain profitable businesses with NHS income as the main underpinning to their revenue.

In 2006 there was a significant reform of the contract to a system based on 'Units of Dental Activity' (UDA) which was touted in the government's 2002 document 'Options for Change' as a 'shift towards preventative-based dental care'.

In this system, dentists are given a certain amount of UDAs to do in a year and are given a fee per UDA. The money is paid upfront and underperformance means money is 'clawed back' and over-performance is not funded.

Patients who are not exempt from paying for dental treatment (see details) pay a contribution to the treatment and this is banded into 3 bands:

  • Urgent dental treatment – £25.80 This covers urgent care in a primary care NHS dental practice such as pain relief or a temporary filling.

  • Band 1 course of treatment – £25.80 This covers an examination, diagnosis (including X-rays), advice on how to prevent future problems, a scale and polish if clinically needed, and preventative care such as the application of fluoride varnish or fissure sealant if appropriate.

  • Band 2 course of treatment – £70.70 This covers everything listed in Band 1 above, plus any further treatment such as fillings, root canal work or removal of teeth but not more complex items covered by Band 3.

  • Band 3 course of treatment – £306.80 This covers everything listed in Bands 1 and 2 above, plus crowns, dentures bridges and other laboratory work.

Source NHS Website (Figures correct as of 5th Mar 2023)

So for example:

If a patient requires a filling they are in Band 2 and the dentist receives the negotiated value for 3 UDAs and the patient pays £70.70. If the patient also needs a second filling and further appointments the dentist receives no more UDAs despite the increase in time and material cost.

*Recently there has been a change to this by introducing a 5 UDA Band 2b for multiple or complex treatment items.

The other big change that this system brought in was that patients are not officially 'registered' at a dental practice. Unless a patient is in the middle of an NHS treatment plan the dentist has no obligation to see them under the NHS. Dentists can look at their remaining quota of UDAs and decide if they can accept a patient.

To find out more about the structure of NHS Dentistry you can read this excellent article.

So how's that going? Do patients pay for NHS dental treatment?

The 2006 target-based system has been much criticised by the dental profession and one only has to have a quick look at the glut of media articles about NHS dentistry of late to conclude that the overall dental care of the nation is not in good shape. The Nuffield Trust's 2023 Policy Briefing - Bold action or slow decay? opens with the line, 'NHS dentistry in England is at its most perilous point in its 75-year history'. Now we cannot entirely blame the 2006 contract but they do go on to state that the contract is 'unfit for purpose'.

In response to the crisis the government in February announced an NHS Dental Recovery Plan which is backed by £200 million and includes:

  • A ‘new patient’ payment of between £15-£50 for patients not seen in the last 2 years

  • A ‘Smile For Life’ programme which will see parents and parents-to-be offered advice for baby gums and milk teeth

  • One-off payments of up to £20,000 for working in under-served areas for up to three years.

  • Increase in the minimum UDA value from £25.33 to £28

  • New ways of delivering care in rural and coastal areas ('Dental Vans')

  • A water fluoridation programme (subject to consultation)

The response from the profession to this plan has NOT been favourable. The BDA's response states that:

"Any additional investment will barely begin to compensate for a decade of frozen budgets... In real terms the budget has been cut by over £1bn since 2010."

“This ‘Recovery Plan’ is not worthy of the title. It won’t halt the exodus from the workforce or offer hope to millions struggling to access care."

Source https://www.bda.org/media-centre/nhs-recovery-plan-unworthy-of-the-title-say-dentists/

So due to:

  • The underlying structure of this system as discussed above

  • UDA values despite raising the minimum value are not keeping pace with a huge increase in the costs of running a dental practice (materials, compliance, staffing)

  • The administrative burdens and the pressure to meet these UDA quotas and penalties for not doing so

Many practitioners are migrating to the private sector where they can ensure a higher standard of care and stronger financial viability.

How do I find an NHS Dentist near me?

For patients, the repercussions of this trend are severe. As more dentists move away from the NHS, the pool of available services shrinks, resulting in longer waiting lists and travel distances for basic dental care. As access to regular check-ups and treatments disappears and the emergence of 'dental deserts', there’s a heightened risk of preventable oral health issues developing into severe conditions. Alarmingly, some individuals left with no options, are taking drastic actions such as extracting their own teeth—a stark indicator of a system in distress.

How Ouch Is Trying to Help

Ouch's mission is to use AI and other digital tools to improve access to dental care and to improve the efficiency and profitability of dental practices.

Helping Patients

Our new Find A Practice page will let you find a practice near you. If the practice is an NHS Provider we will give the most up-to-date information we can on who/if they are accepting. This is not the only "find a dentist" website on the internet, however where we are unique is in our AI Screening Tool which will ask personalised questions relevant to a patient's concerns, whether they be emergency dental issues or cosmetic concerns. The answers to these concerns are processed into a detailed report which is sent to the dentist so they can optimise their care delivery.

Helping Dentists

Dentists are trained healthcare professionals, we want to help patients and we want to provide care to those most at" need. However Primary Dental Care providers are small businesses that have to survive financially. We believe that by helping dentists be more efficient and by helping them attract/convert more more patients for elective higher value treatments they will be able provide more NHS treatment to those that currently cannot access it. In addition to the AI screening Tool mentioned above, Ouch offers subscribing practices:

  • AI Chatbot

  • Video Appointments

  • Mobile App

  • CRM Platform

to help them

  • Generate and Qualify more leads

  • Convert more leads

  • Run more efficiently

  • Screen emergencies

  • Delight patients


So these are my thoughts on the current situation in NHS Dentistry, please do get in touch using the chatbot if you have any questions.

If you are a dental practice please do get in touch and we can arrange a product demo to show you how Ouch can help you in your practice. For more information visit https://ouch.ai/brochure

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