NHS Dentistry is broken.

The NHS dental contract forces dentists to work without pay to treat the patients in greatest need. Without urgent reforms to ensure that NHS dentists are paid fairly for all the treatment they provide, the system will soon collapse completely.

The NHS Dental contract introduced by Labour in 2006 gives dentists a quota of "Units of Dental Activity" per year.

A typical full-time contract is 6,000 units, so a dentist working 7.5 hours per day, five days per week, 50 weeks per year would need to average one Unit of Dental Activity every 15 minutes. The problem is that patients often require more than 15 minutes per unit. Basic checkups and straightforward treatments are OK, but the dentist cannot claim more than 12 "UDAs" for any course of treatment (which might be spread over several appointments).

The financial situation is even worse: The contract puts a value of approximately £25 on each Unit of Dental Activity. This has to cover the wage of the dentist, the dental nurse, the admin staff, all equipment, materials and other costs associated with running a dental practice.

So if a patient needs more than three hours of work, the dentist doesn't just have to work unpaid overtime in order to meet the annual quota, they actually have to pay out of their own pocket to cover the other costs, including the extra hours of staff time. And when a patient needs a set of dentures or other appliance, the cost of making these falls on the dentist too!

And of course the people most likely to need an expensive course of treatment are those who have spent years on a waiting list with no access to dentistry at all. As dentists leaves the NHS, the length of time patients spend on waiting lists increases, putting even more pressure on those who remain. This is why 98% of dentists in Cornwall have closed their doors to new adult NHS patients.

Ironically this has led to an "underspend" in the NHS Dentistry budget, because there simply aren't enough dentists willing to take on NHS contracts, and many of those who do are unable to fulfil their annual quota because of the amount of time they spend doing "unpaid overtime" to treat complex NHS patients.

The solution:

  • Changing UDAs from £25 for 15 minutes to £40 for 24 minutes would give dentists the time and money they need to provide most treatments. It is effectively the same hourly rate, but gives the dentist a more realistic amount of time to complete each task.
  • More complex cases should be taken out of the UDA system altogether, and up to one day per week of the dentist's contract should be paid on an hourly rate, so that they can give proper treatment to those in the greatest need without worrying about their UDA quota.

These two simple changes would transform the landscape for NHS dentistry. Existing NHS dentists would be able to reopen their doors to new patients without fear of the financial consequences, and other dentists would see the NHS as an attractive career choice with a predictable income.

The cost of these changes could be covered by the current "underspend", but NHS England has put pressure on NHS Cornwall (the "Integrated Care Board") to use this dentistry money to fill holes in other parts of the budget!

Colin Martin listening to Lostwithiel Dentist Fin Bason