The British Dental Association (BDA) has said government must press ahead on fundamental reform of NHS dentistry, following plans announced on 19 July 'that will do little to arrest the exodus of dentists from the service, or address the crisis in patient access'.

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The current target-based system funds care for little over half the population and sets perverse incentives to dentists, rewarding them the same for doing one filling as ten. The unsuitability of this model during the pandemic has accelerated the drift of dentists away from the NHS into a full-on exodus. Thousands of dentists have left the NHS in England since lockdown, with almost half reporting having significantly reduced their NHS commitment.

The plans - elements of which will require secondary legislation so cannot take force until after summer recess - include:

  • A minimum UDA value. The Unit of Dental Activity will now be set at a minimum of £23.00. The BDA has noted that only around 3% of practices will benefit, stressing that any increase will not reverse a decade of savage cuts in the service, which can leave practices providing NHS care at a financial loss, particularly to high-needs patients

  • A higher reward for treating three or more teeth. Dentists will now receive five UDAs for treating three or more teeth, an increase on the current level of three UDAs, which applied to care delivered to any number of teeth. The BDA stress that given patients are now presenting requiring as many as 20 fillings, perversity will remain baked into the system, with less complex work still rewarded at the same rate as treatments that take hours

  • A new payment rate for complex treatment. Root canal treatment on molar teeth will now be rewarded with seven UDAs, as opposed to the current three, as a result of BDA lobbying. However, the BDA stress the move is unlikely to be a game changer, given the nature of the challenging and time-consuming treatments - which can take up to three hours on a single tooth

  • A greater role for dental therapists, who will soon be able to accept patients for NHS treatments, providing fillings, sealants and preventive care for adults and children. The BDA say that there is no hard evidence of a workforce waiting in the wings for the chance to work under the failed NHS contract.

The BDA is taking a neutral position on the new package of changes, neither endorsing nor rejecting what it characterises as modest and marginal fixes to the widely discredited NHS dental contract. It remains focused on wholesale change to the broken system, where formal negotiations with NHS England have yet to begin. It has expressed some concern that the government has offered no guarantees that pledges of fundamental reform will be honoured, stressing this package cannot form a final destination for the service.

The BDA has stressed that these changes - which come with no new investment - show the limits of what can be achieved for patients without greater commitment from the Treasury. The BDA estimate it would take an extra £880 million simply to restore funding to levels seen in 2010.

Shawn Charlwood, BDA's General Dental Practice Committee, said: 'These are modest, marginal changes that will not fix the rotten foundations this service is built on.

'Our patients need Ministers to do more than paper over the cracks. These tweaks will do precious little to keep dentists in the NHS or ensure millions get the care they urgently need.

'The simple fact is not a penny of new investment has been pledged, and government targets will still come before patient care.

'Today is little more than a small step on the road to real reform. If government considers this a final destination then it will mean the death of NHS dentistry in England.'

CGDent welcome any change

Responding to the announced changes to the NHS England dental contract, Abhi Pal, President of the College of General Dentistry (CGDent), said: 'While the NHS dental contract in England still needs wider and more fundamental reform, we welcome these changes - the first in 16 years - as positive and significant improvements.

'In particular, we have previously called for the removal of unnecessary restrictions on the roles played by members of the wider dental team, and are pleased to see that steps will soon be taken in this direction. The College believes that greater recognition and use within NHS dentistry of the full range of skills of all team members will benefit patients, enable the delivery of more preventative care, and support professional satisfaction and staff retention.

'We have also said that while truly universal access to NHS dentistry can only be achieved with greater funding, access can still be improved through better allocation of existing resources. We therefore welcome the direction of more resource to the treatment of patients with greater needs, as well as the potential for practices to deliver additional care so that all funding allocated to dentistry is used for its intended purpose.'