The NHS in 2050: Will NHS Dentistry Exist?
This article was written for the Oxford Labour Club's in-house journal 'Look Left'. It is part of a series which focuses on the future of the NHS in 2050, with this one focusing on NHS Dentistry.
Let’s face it most people dread going to the dentist… who can blame them? With Reform on the rise and NHS dental contracts being unfit for purpose, the future of NHS dentistry remains questionable. NHS dentistry needs serious reform, or else it risks disappearing by 2050.
The Current Assessment
Dentistry began life under the NHS in 1948 as free at
the point of delivery. However, this was short-lived as charges were introduced in 1951. Most people using the NHS service today can be expected to
pay in a ‘band’ system. This three-tier system is famously the bane of
dentists' lives - or at least that's what my friends' dad says. However, the charges for NHS Dentistry – as they currently stand – do
not cover the cost of materials and labour. It is unsustainable.
Alongside the issue of financial support, the number of
dentists is in decline. We have a growing population and a small workforce. In 2023,
there were approximately 23,577 NHS dentists in England. A
tiny proportion compared to the 57 million population. Population growth has
meant that fewer people are seeing their NHS dentist. Meanwhile, studies from 2019 highlighted that only
50.9% of people had seen their dentist, compared to 51.7% in 2006.
The decline in patients accessing treatment is also due to
the lack of universities offering dentistry as a course. There are two reasons for this: demand and funding. Only 11 universities
in England, 2 in Scotland, 1 in Northern Ireland and 1 in Wales offer the course, and little has been done to expand the number of courses. In actuality, one may be tempted to argue
that there has actually been a decline. Long before I decided to come to Oxford
to read for a degree in History, I once had ambitions of helping people by
becoming a dentist. Long
are those days when there were 3 accessible courses into dentistry, now only 1
remains. Student
Finance England funds the first four years of budding dentists’ degrees, and the
NHS pays for the last year. This is because the NHS gets a huge benefit out of
training these skilled employees – in essence, making them work for the NHS, for free, in
their final year. It is a sort of quid pro quo. However, with the decline of
those going into NHS work, is it fair that the state pays in this way and sees so
little return?
What Needs to Be Done
The Labour government is already pushing for more
appointments in the NHS. This model is unsustainable, though. Cost, as cited
above, is a huge factor in dentists (self-employed workers) choosing to ‘go
private’. They can no longer afford to support NHS work alone, without private
work alongside it.
Over the vacation, I spoke to my friend’s father, a practising
dentist, and he commented that to take on patients with complex needs, the
current system disadvantages this. Currently, a system of ‘units of dental
activity’ exists. Within this framework, NHS Dentists are given a set number of
activities to complete that year. (They can thank the 2006 contract for that).
Here, they can see a certain number of cases, not patients. The system
prioritises the volume of treatment and not overall patient attention. As such, the first step must be a huge reform
of the contract. Speaking to Health Secretary Wes Streeting MP at Labour
Conference 2025, it is clear that fixing the contract is in the works. But it
must happen sooner rather than later in order to retain dentists and allow for
patients to be seen.
To quote a former PM, “education, education, education”. As
I stated above, there simply are not enough training facilities for dentists.
The system is long, difficult to access (A*AA-AAA required at A-Level), and,
frankly, costly. The state's return on investment from individuals it
trains is low, and more must be done to ensure we have enough professionals for
the population as it currently stands. MPs on all sides of the House have been
lobbying for new dental schools, for example, at the University of Lincoln and
the University of East Anglia. However, these need to be built faster. The British Dental Association has raised concerns about allowing new
schools to open so quickly, but given the circumstances, I believe we must take
a collaborative approach. Schools should be built, existing ones supporting new
ones, and more graduates qualifying. The answer is simple: investment,
education and retention.
Can we do it?
The dentistry crisis has gone on for too long. I meet
constituents who have resorted to extracting their own teeth – painful,
traumatic and dangerous. I believe we can make a good attempt to save NHS
dentistry. The system itself is part of Labour’s blood, and we must try our
hardest to ensure its longevity. Without crucial changes, we risk losing an
invaluable service. Invest, educate and retain – that is how we can ensure NHS
Dentistry in 2050. Dentistry is a human right, not a luxury.
Sources:
https://commonslibrary.parliament.uk/research-briefings/cbp-9597/
https://www.bda.org/advice/career-hub/how-to-become-a-dentist/dental-schools/
https://www.nhs.uk/nhs-services/dentists/how-much-will-i-pay-for-nhs-dental-treatment/
Booth, A., Hurry, K. & Abela, S. The current dental
school applicant: an overview of the admission process for UK dental schools
and the sociodemographic status of applicants. Br Dent J 232,
172–176 (2022). https://doi.org/10.1038/s41415-022-3927-1
https://www.bbc.co.uk/news/articles/cqxqwdwy20ro
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