King's Lynn is a typical coastal town in West Norfolk. It is one of the least affluent towns in the county, with a significantly higher-than-average unemployment rate and lower-than-average educational attainment levels. In common with many other coastal and rural areas, its local economy has suffered in recent years. Much like the rest of the East of England and mass swathes of the country, NHS primary care dental services are few and far between. This is why one practice recently saw queues of around 300 people when they announced they were accepting new patients under the NHS.1

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The practice appears to have been the only one in the county accepting new NHS patients, but it would have to turn most of them away. For reference, Norfolk is a county of around 860,000 people. If this practice couldn't see them, the nearest practices accepting NHS patients would be in Northamptonshire, Essex or Nottingham.

Queues to see the dentist aren't new. More seasoned readers will remember regular news features in the early 2000s, pre-'new' contract, showing patients lining up to register with an NHS dentist. But the current problems are leading to an irreversible breakdown of the system as more and more practices withdraw from the NHS altogether.

A prime example of this is the recent decision by Bupa to close, merge or sell 85 of its clinics.2 Described by the company as a 'consolidation of their UK portfolio,' this loss of access will disproportionately affect those at the lower end of the socioeconomic spectrum. Many of the sites earmarked for closure are in coastal or rural areas. Towns like Skegness, Boston and Rhyl, already suffering from generalised deprivation, will have fewer choices regarding their dental care. There are multiple reasons behind the practice closures. It would be easy to blame the current economic pressures and increased cost of living. But Bupa themselves say that this is not solely to blame. They simply cannot get enough people to work in these areas.

In some ways, the current NHS crisis results from a political reliance on free markets, although perhaps not in the way many would expect. Primary care NHS dentistry is already a mostly privately run service, with service providers subcontracting from local NHS bodies. The NHS contracts tie their owners onto their terms of service. However, the provision of care is often further subcontracted out to associates, especially in the case of corporate bodies like BUPA. Towns like King's Lynn and Skegness have suffered dramatically over the last few decades, with struggling economies and a lack of investment for regeneration.3 Many associates are choosing not to work in areas of high socioeconomic need when they could earn more from the NHS system in more economically buoyant areas.

Dentistry is the canary down the mineshaft for the future of healthcare in the country. Any further shift towards privatisation of the system without understanding how the broader economy affects the localised workforce spells disaster for patients and practices.