Richard Tyler
In vast swathes of the UK, it is now impossible to find a dental practice willing to enroll new patients onto their National Health Service (NHS) lists. Millions can no longer access routine inspections, extractions or treatment for tooth and gum disease.
A survey of 7,000 NHS dental practices conducted by the BBC found that nine out of 10 were not accepting new adult patients for any treatment paid for under the health service, with adult patients unable to register in a third of the UK’s 200 local authority areas.
The crisis is particularly acute in working-class areas. In Yorkshire and the Humber, the North West and the South West of England, 98 percent of practices are not accepting new adult patients.
Eight in 10 practices are not accepting children and one in ten local authorities have no practices taking on the under-16s.
The BBC found that most practices did not even have waiting lists which prospective patients could join. Of those that did, the length lists at some meant it could take years to access treatment.
In the aftermath of the BBC report, local media were full of stories about people unable to access a dentist in their area.
The Sheffield Star reported patients having to travel miles for a dentist. According to Nottinghamshire Live, no dentists in Nottingham were taking on new NHS patients, with 96 percent of practices in the county closed to new patients. A reporter from the Liverpool Echo “spent hours trying to get an NHS dentist appointment” in the city, without success after ringing 50 practices. The Manchester Evening News reported that nine in 10 practices in the city were not accepting new adult patients.
British Dental Association (BDA) spokesman Phil Gowers, who also chairs the Hampshire and Isle of Wight local dental committee told the Times, “In Hampshire four surgeries stopped doing NHS work in the last three months. And that’s going to continue more and more.”
The situation is not much better in Wales and Scotland, which have devolved responsibility for health issues. Wales is run by a Labour administration and Scotland by the Scottish National Party. For example, WalesOnline found only three practices out of 43 in Cardiff were taking NHS patients. According to the Daily Record, older people in Scotland face particular difficulties, with four out of five practices turning away new adult patients.
People unable to access dental treatment are resorting to desperate measures. The Independent reported a mother pulling out her own teeth three times after being unable to find treatment for tooth infection at a dentist within 70 miles of her home. A woman in Blackpool told the BBC she had been forced to make her own dentures after failing to find a dentist in her home city.
Regular dental inspections and treatment are not only important for maintaining oral health—they can provide an early warning of more serious medical conditions such as cancer. Jane Wilcock, chair of the Royal College of General Practioners North-West faculty told the Daily Mail, “Patients often aren’t aware of a problem in the mouth until a dental hygienist or dentist notices something suspicious, such as a red or white patch inside the cheek or on the gums.”
“The problem is many people just can’t get to see an NHS dentist at the moment. With fewer examinations, inevitably cases of mouth cancer will go undiagnosed,” she warned.
Professor Patricia Price, chair of Radiotherapy UK and co-founder of the #CatchUpWithCancer campaign, told the paper, “With oral cancer, speed of diagnosis and treatment is hugely important. If opportunities to catch it early are missed, more oral cancer patients will die needlessly.”
In a press release, Shawn Charlwood, Chair of the British Dental Association’s (BDA) General Dental Practice Committee said NHS dentistry was “at a tipping point, with millions unable to get the care they need and more dentists leaving every day.” This was the result of “years of chronic neglect, set into overdrive by the pressures of the pandemic.”
“Nothing we’ve heard from government to date gives us any confidence this service has a future. Without real reform and fair funding NHS dentistry will die, and our patients will pay the price.”
The BDA press release points to a decade of savage cuts, estimating it would take an additional £880 million a year just to restore funding to its 2010 level. The organisation accuses the government of “putting targets ahead of patient care” under a funding regime that barely provides resources for half the population.
After years of austerity and cuts, the coronavirus pandemic has severely exacerbated the situation facing patients and dentists.
Surrey dentist Nighat Rasool told the Times the pandemic had led to massive backlog. “In my NHS list I’m probably fully booked for about two months, so I haven’t got capacity to see new patients. If my own patients are waiting two months, it’s not fair. And this is the situation across the board.”
She knew of many dentists who had left the profession, “It’s not easy wearing all the PPE and seeing patients face to face in very high-risk procedures.”
This has led to increasing workloads for dentists who remain and take on NHS patients, with take-home pay for associates in dental practices having dropped by 40 percent over the past 10 years as a result of government cutbacks.
Dental treatment on the NHS is only free for those aged under 18 (or 19 if in full-time education), pregnant women or those who have had a baby in the last year, and those receiving certain means-tested benefits. For everyone else, treatment is subsidised and typically costs between about £24 for emergency pain relief and temporary fillings, routine inspections and cleaning if clinically needed. Those requiring fillings, root canal work or extractions pay £65 and £283 for fitting crowns, dentures, bridges, and other laboratory work.
Having such procedures done privately can cost between £85 (scale and polish), £175 (filling), £970 (root canal), £1,180 (crowns), £2,520 (dentures/bridges). Such charges are way beyond the reach of millions on minimum wage. Even families with those in better-paying jobs would struggle to afford such costs with incomes drastically squeezed by inflation.
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