23 April 2026
The problems with NHS dentistry go back years. People in line outside the St Pauls Dental Practice, Bristol in February 2024 after it opened registrations for NHS patients. Photo Ben Birchall/PA Images/Alamy Stock Photo.
On 1 April, English dentists converged on Westminster to demand that the government funds proper NHS dentistry services for all. They were calling for an end to the long term problems suffered by dentists and their patients.
The dentists were marking the twentieth anniversary of what the British Dental Association (BDA) describes as a “flawed” NHS payment contract. An open letter, dubbed “An Unhappy Birthday” and signed by 1,300 dentists, was delivered to Downing Street demanding change.
The contract introduced in England in 2006 does not pay dentists for each procedure they carry out, or for the time spent with a patient. Instead there is a banded points system.
Too complicated
The BDA has long argued that the system is too complicated and that it does not fairly reflect the cost of treating patients, particularly those with high needs. As a result, many NHS patients are forced to agree to private treatment even when they are registered with an NHS dentist.
It’s now much harder to get NHS treatment for complex care. Over the last ten years, the number of NHS-funded root canal treatments, where a tooth is saved by removing infection from deep inside the tooth, has dropped by nearly a half.
Losing money
Many dentists now refuse to carry out this complicated and time consuming treatment on the NHS because they effectively lose money. Some patients have to choose between private and expensive root canal treatment or having the tooth removed on the NHS.
The BDA says that so far the government has only implemented “tweaks” to the flawed contract. The government plans to massively increase dentist numbers by allowing more dentists trained overseas to work in the NHS. In response, the BDA said this “will not fix a contract that is forcing dentists out”.
“Tweaks are no substitute for fundamental reform and proper funding...”
BDA chair Eddie Crouch said: “NHS dentistry has faced twenty years of failed contracts and savage cuts. These tweaks are no substitute for fundamental reform and proper funding. They cannot be reasonably expected to keep a sinking ship afloat.”
The total budget for NHS dentistry in England has remained at around £3 billion since 2010. It is currently only enough for half the population to get a dentist when they need one. There have been no increases to keep pace with inflation or population growth. The BDA estimates that this translates into a real-terms budget cut of over one-third.
Spending less
The UK government spends almost 50 per cent less on dental services for each person in England than the devolved administrations for Wales, Scotland and Northern Ireland. But the BDA says they have problems too – for example with the new contract in Wales.
A survey by British Social Attitudes in 2024 showed that only 20 per cent of those surveyed were satisfied with NHS dentistry, down from 60 per cent before the Covid pandemic. This has marginally improved to 22 per cent under the Labour government.
Hopes of increasing numbers of British-trained dentists has been tempered by the government announcement of a modest increase in dental student places, not starting until 2032.