The Current State of NHS Dentistry
As I reflect on the recent changes to the NHS dental contract in England, I am acutely aware that while new provisions for urgent and complex care are a step in the right direction, they fall short of addressing the systemic issues at play. The abrupt move to prioritise complex cases is commendable, yet insufficient. We must not let this be a distraction from the urgent need for comprehensive reform in our dental healthcare system.
Urgent and Complex Care: A Welcome Development
The shift allowing patients to book a treatment package instead of piecemeal appointments starting next April could reduce the pain and anxiety for many struggling with debilitating dental issues. However, this change represents just a tiny adjustment to a fundamentally flawed system. The notion that patients should be able to seek treatment for conditions that range from severe pain to infections should not necessitate a contract overhaul in the first place.
Sore teeth and gums are debilitating, and dentistry ought not to be out of reach for anyone who needs it.
As NHS's own data suggests, the need for urgent dental treatment is soaring. The health authorities are finally acknowledging that the dire shortage of urgent care options in certain areas is untenable. Yet, we need to examine why this situation has come to pass and how these recent changes merely treat symptoms rather than the root causes.
A Band-Aid on a Wounded System
It's vital to recognize that these recent updates to the payment structure are just that—a band-aid. Health Minister Stephen Kinnock's assertion that these changes represent the 'biggest tweaks' reflects a painful reality: a mere adjustment to a failing system that many experts deem obsolete.
The NHS dental contract initiated in 2006 fundamentally changed how dentists operate—no longer can they act as gateways to comprehensive dental care for their patients. Instead, they're incentivized to produce a certain number of procedures. That setup has bred inconsistency and inequity, particularly for marginalized communities who require access to care more than anyone else.
Deepening Inequities in Dental Care
The rise in emergency room visits for dental issues—spiking nearly 45% in just four years—demonstrates a system in crisis. Patients are presenting with dental infections and pain that should be manageable; instead, they crowd our A&Es, severely impacting other emergency services.
This reality underscores the gap that the government's recovery plan fails to fill. For instance, people are resorting to extreme measures, such as self-extraction of teeth, because they simply cannot secure timely access to necessary care.
Shortages and Missed Opportunities
Areas of the East of England, in particular, face chronic shortages of dental professionals. The efforts to incentivize dental work in underserved areas, through measures such as “golden hellos”, have proven ineffective. Meanwhile, initiatives to reduce childhood tooth decay and address dental health inequalities seem to stall permanently. While we ought to commend the Labour party for introducing supervised tooth brushing in schools, such initiatives do not address existing inequalities in access.
A Clear Call for Systematic Change
Moving forward, we need a commitment from our elected officials to restore the right to register with a dentist, ensuring equitable access for all citizens. It's imperative for ministers to confirm how these new contractual changes relate to their existing goal of boosting the number of urgent appointments by 700,000 and provide a time frame for the public to track progress.
Conclusion: On the Path to Real Reform
NHS dentistry cannot afford more cosmetic changes. The public demands more than simple tweaks; they require a system that recognizes the essential need for dental care as a public good. Real reform must puncture through the veil of bureaucracy to address accessibility, affordability, and quality in dental healthcare. As we move forward, we must remain vigilant in our pursuit of justice for those suffering in silence.
Source reference: https://www.theguardian.com/commentisfree/2025/dec/16/the-guardian-view-on-dentists-contractual-tweaks-wont-stop-the-rot
