NHS dentistry declines as practices abandon public contracts
Nearly 600 English dental practices have withdrawn from NHS work over the last decade, creating a growing two-tier healthcare system where access depends on affordability.
Analysis by the Nuffield Trust reveals that nearly 600 dental practices in England have abandoned NHS dentistry over the past 10 years. This shift has resulted in more than one in 10 practices previously providing public care now withdrawing those services, making appointments difficult for many communities to secure.
The data indicates that NHS dental activity is currently 8% lower compared to pre-Covid levels. According to the NHS GP Patient Survey, six in every ten adults have not seen an NHS dentist in the last two years. Of those who attempted to book a new appointment during that same period, only 38% were successful in finding a slot.
Regional disparities and 'dental deserts'
The decline in NHS-funded care is most acute in the South West and East of England. In Cornwall, more than a quarter of practices that once offered NHS treatment have stopped doing so. In Somerset, fewer than one in five practices now provide NHS services. Northamptonshire and Devon have also seen some of the largest reductions in availability.
While ministers have made pledges to address 'dental deserts', dental professionals argue the current contract is no longer viable. Many providers have returned their contracts because performing NHS work has become loss-making. Mark Dayan, head of public affairs at the Nuffield Trust, stated that repeated contract handbacks across the country over a decade are quietly transforming dentistry into a two-tier system where care depends on geography and wealth.
Impact on patients and providers
| Region | Status of NHS Practice Availability |
|---|---|
| Cornwall | More than 25% of practices withdrawn |
| Somerset | Fewer than 20% of practices offer NHS services |
| Northamptonshire | Significant reduction in NHS care |
| Devon | Significant reduction in NHS care |
Dent Vivak Shah, who operates three practices in Northamptonshire, continues NHS treatment but reports operating at a loss. He no longer accepts new NHS patients. He warned that without these services, patients may be left in pain or forced to use hospital accident and emergency departments.
Jim Sykes, a dentist in Hexham who handed back his contract in 2024, described the decision as emotional but necessary due to financial losses. He was told he could not treat only children; he had to accept adults or forfeit the NHS work. Sykes expressed a breakdown in trust, noting that none of his graduating classmates still work within the NHS. Local residents are also struggling, like 83-year-old Alan in Somerset, who gave up on searching for local appointments due to the lack of availability.
