New analysis by the Nuffield Trust reveals that 1 in 10 dental practices in England have stopped providing NHS dental services since 2017.
Despite an increase in the number of dental practices in England, the number that hold an NHS general dental contract has reduced. The experience of diminished NHS dental provision is echoed up and down the country, with the South West of England experiencing the sharpest reduction in NHS dental care, consolidating its status as a ‘dental desert’.
The consequences of a so-called ‘two-tier’ system for the nation’s teeth – whereby access to treatment is contingent upon where you live – are already visible. The length of time between dentist appointments for adults has reached a two-year period for six in ten adults. Hopeful dentist patients are, in some cases, becoming emergency unit patients, arriving with dental problems that should have been addressed earlier were it not for limited accessibility. In late 2025, Healthwatch England accumulated horror stories involving desperate patients performing at-home tooth extractions, because they could neither access NHS dental care nor afford private treatment, with vital recommendations for the government, amidst efforts to review and accelerate the NHS dental contract reform.
The decision for dental practices over whether or not to take on or renew an NHS dental contract is not taken lightly; considerations include not just patient need, which is great, but also commercial viability. It is the latter that has pushed some dentists towards relinquishing their NHS contracts, citing financial pressures which cannot strictly be overcome by expanding one’s private patient base to subsidize the NHS system.
Several dentists, interviewed by the BBC, spoke about operating at a loss because of ongoing NHS dental provision and the emotional decision to move away from NHS work.
The difficulty of the decision is compounded by misleading headlines that describe dentists as ‘abandoning’ the NHS and patients. It has instead been argued that the decisions of dentists to move into private practice or limit their NHS dental provision is driven by financial necessity and an NHS dental contract that is not fit for purpose.
There are concerns, both inside dentist practices and amongst the general public, that NHS goodwill is simply unsustainable without reforming the NHS dental contract itself, and which is described by the British Dental Association as ‘discredited’.
Dentists, patient representatives, and MPs lament that incremental changes do not go far enough. For example, the NHS ‘tie-in’ requirement that newly-qualified dentists in England deliver a certain amount of NHS dentistry for at least 3 years – intended to increase the number of NHS dentists – may actually have a negative impact on the profession. The British Dental Association raised initial concerns during the government consultation on a ‘tie-in’ to NHS dentistry, and have maintained a critical position ever since the government published its 10 Year Health Plan for England, where proposals were announced with the view of making the dental contract more attractive and increasing the size of the dental profession.
Increasing the number of dentists and dental schools in England is, of course, a good thing; however, it does not address the fundamental challenge of retention and unequal access that is threatening service viability in parts of England, chiefly the South West and East of England.
Put simply, more dentists does not translate to more NHS dentist appointments.
Image credit: Unsplash.
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