NHS dentistry facing ‘existential crisis’ with more practices going private amid tax hike
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England’s dentists warn that without a serious increase in government funding and an overhaul of contracts, NHS dentistry could cease to exist when the April tax hike forcing more practices to go private to make ends meet.
Shiv Pabary, chair of the British Dental Association’s General Dental Practice Committee, said: “The future of NHS dentistry is in [Chancellor] Rachel Reeves’s hands”.
Dr Pabary said dentists have been struggling for years to and cover rapidly rising costs with no substantial increase to NHS funding, and April’s increase to National Insurance contributions could force many more dentists to abandon NHS dentistry altogether.
“It’s going to be horrendous for many practices,” he said. “And it’s a political choice, it really is, if they want NHS dentistry to exist. Because genuinely, I’ve been in this for 40 years, I think it faces an existential crisis.”
It comes as the Liberal Democrats urged the government to exempt the health and social care sector from the National Insurance contribution increase coming in April, saying pharmacists, dentists and other health and care providers will face a combined £3 billion tax hike in the next financial year.
Figures from the NHS Business Services Authority show that over the past five years the number of dentists providing NHS services has fallen, from 24,676 in 2019/2020 to 24,193 in 2023/24.
Over the same time, fewer adults and children have seen a dentist within the recommended timeframe, which is affecting the nation’s dental health: in 2023, NHS data showed more five-to-nine-year-olds were going to hospital for tooth extractions than to get their tonsils out.
Most dentists provide a mix of NHS and private dental services, but a survey of BDA members from last year found many dentists were also reducing the amount of NHS dentistry they did. Some, Dr Pabary said, were walking away from the NHS altogether and going “totally private”.
“It really is crucial within the spring Spending Review, when [Chancellor Rachel Reeves] is thinking about this, to think whether she really wants NHS dentistry to exist, because it is going to need additional funding,” Dr Pabary said.
Last month England’s chief medical officer Professor Sir Chris Whitty told the Public Accounts Committee the NHS dental system was “very weak and has got weaker over time”, and outgoing NHS chief executive Amanda Pritchard agreed the current contract for NHS dental services was “not fit for purpose”.
A Department of Health and Social Care spokesperson said: “This government inherited a situation where hundreds of thousands of people are unable to get urgent dental care.
“We are rebuilding NHS dentistry but it will take time. We have started by delivering on our commitment of an extra 700,000 urgent dentistry appointments to help those who need it most and we will reform the dental contract to encourage more dentists to offer NHS services to patients.”
Vijay Sudra is among the minority (roughly 15 per cent) of dentists that only provide NHS treatments, eschewing the “sexy stuff” of private cosmetic treatments for the basics of dentistry.
“For me, that’s what dentistry is about. It’s about alleviating dental pain, fixing broken teeth,” said Dr Sudra, who has treated people who, like him, grew up “on the wrong side of the railroad tracks” in Birmingham for about 30 years.
“For me, money has never been a driver, never: not interested,” Dr Sudra said. “But it’s now getting to the point where it’s just not viable.”
The problem is managing ever-rising expenses from the same envelope of funding from the NHS, and Dr Sudra said while he supports the increase to the minimum living wage it will add thousands to his monthly wages bill when combined with the higher National Insurance contributions.
“The only way I’m going to address this, if the government doesn’t support me, is either sell up or get out,” he said, adding he worries for his community. “It’s with a heavy heart, but I think I’d walk away from it.”
On March 26, the Chancellor will deliver an economic statement, which is expected to either set out minor changes or provide further details on upcoming spending plans.
Liberal Democrats health and social care spokesperson Helen Morgan said Ms Reeves should use the statement to scrap the National Insurance increase for health and care providers, which will add an additional $15.7 billion to their tax bills over the next five years.
“Social care is on its knees, wait times for GPs are still through the roof, and dental deserts seemingly span the length of the country, yet ministers now risk only prolonging this misery with these increased costs,” she said.
“Rachel Reeves has just one month to save health and social care from this jobs tax bombshell.”
