Are NHS dentists doing less NHS work?

Our report, Bold action or slow decay?, laid bare the problems in NHS high street dentistry. It concluded that NHS dentistry in England was at the most perilous point in its 75-year history, and that full, universal access to NHS dentistry had probably gone for good. 15 months on from our report, the outlook doesn’t appear any brighter, with any brief optimism after the previous government’s NHS Dental Recovery Plan proving short lived.

One of the many concerns highlighted in our report was the unchecked drift of NHS dentists to the private sector. Since then, a paper from the National Audit Office (NAO) has found there were 483 fewer dentists providing some NHS care in England in 2023/24 compared to four years earlier. While it’s unknown where those dentists went, it is probable that some will have moved into private practice for good.

But the concerns go further than dentists completely leaving the NHS to do private work. With NHS high street dentistry allowing a dentist to provide a mix of NHS and private work, it is vital that dentists who do NHS work keep up the amount of NHS work that they do, in order to ensure access for patients. But has this been the case?

The findings in NHS England’s report, Dentists' Working Patterns, Motivation and Morale, would suggest not. That publication, which provides information on working patterns, motivation and morale for self-employed primary care dentists (based on survey data), reveals a concerning drop between 2018/19 and 2022/23 in the number of hours per week that an NHS dentist spent on NHS work (see chart below).

NHS dentists in England in 2022/23 spent an average of 24.8 hours per week on NHS work (70% of their working week), which was down from 27.3 hours (74% of their working week) in 2018/19 – a decrease of 2.5 hours. If an NHS dental appointment can take up to 30 minutes, that would equate to at least five fewer NHS appointments per dentist per week.

The surveys only cover a sample, but if that sample was representative of all NHS dentists, then scaled up it would represent a considerable loss of NHS dental appointments across the country.

With the NAO report showing that there are decreasing numbers of NHS dentists, and with morale already known to be very low among the NHS dentistry workforce, the worry is that more and more NHS dentists consider their long-term career options. If they carry on working fewer hours for the NHS, or end up leaving their work altogether, as the British Dental Association warns, it would be yet another blow to NHS dentistry’s hopes of recovery.