Summary
NHS-funded dental services in England are in near-terminal decline: nearly six million fewer courses of NHS dental treatment were provided last year than in the pre-pandemic year; funding in 2021/22 was over £500m lower in real terms than in 2014/15; and there are widespread problems in accessing a dentist.
So what is to be done? This major new policy briefing from the Nuffield Trust proposes a series of short-term actions relating to appointment recall intervals, commissioning and the workforce. It also sets out two approaches for longer-term action, which involve improving the current dental model or adjusting the NHS offer.
Content
The report sets out a series of short- and long-term actions that any future Government must consider.
In the short-term, the authors argue that action must be taken to shore up the service as it currently exists, through measures like increasing the intervals between routine check-ups to a year; tempting dental therapists into the NHS from the private sector; providing incentives for local commissioners to provide mobile clinics and targeted work in schools and care homes; and investing in preventative care in children and young people.
In the longer-term, two ways forward are set out:
- Improving the current model through a move to a fee-for-service payment model for low-volume, high-cost and complex procedures, combined with a shift to a needs-based approach like general practice through making use of patient lists following initial assessments; keeping more dentists in post through a student loans forgiveness scheme; and investment in public health including checks in schools.
- Adjusting the NHS offer either by expanding it with a huge injection of funding, which the authors note is unrealistic; or scaling back NHS dentistry to a minimum offer for patients. This offer may include universal access to emergency care, pain relief and check-ups with preventative work. Access to more extensive NHS dental services would be protected for older people and children. Coverage would be limited and means tested to ensure the service only targets those with the greatest difficulties accessing care.
The report states that “even with extensive contract reform and the full use of new groups of staff, restoring universal access would cost billions each year”, much of which would pay for care that people are currently getting privately. It calls for an urgent imperative to provide enough access for a basic core service for children, older people and those who cannot afford private care. This would mean “removing some of the rights to NHS services which people currently enjoy in theory – but usually go without in reality”, the authors add.
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