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NHS dentists in England were forced to return £147mn of government funding last year after failing to meet their treatment targets, an Financial Times analysis has found.
The sector said the underspend was the result of a “broken” NHS dental contract system that was forcing dentists into private practice at a time of severe staffing shortages and long appointment waiting lists.
Under NHS contract terms, dentists are paid a set income to deliver a certain number of “units of dental activity” (UDAs), or treatments, a year. The amount of procedures dentists receive payment for annually is capped.
Dentists said the system had left them struggling to cover their costs, with simpler dental work sometimes remunerated at the same rate as complicated treatments. This had acted as a disincentive to taking on more patients with complex needs, they said.
Practises are usually required to return government money if they fail to deliver 96 per cent of their contracted UDA target. But last year the threshold was temporarily reduced to 90 per cent to reflect the financial pressures facing dentists.
“Underspends do not reflect any lack of demand for NHS dentistry — but are the result of struggling practices unable to hit their punitive targets”, said British Dental Association chair Eddie Crouch.
“Practices in the same high street receive different levels of payment, and the BDA stresses that underspends are highest in areas where UDA rates are lowest,” he added.
In 2022-23, dentists returned £147mn to the government in payments after thousands of practices failed to hit treatment targets, a comparable figure to previous years.
The FT analysis of data from NHS Business Services Authority, a non-departmental part of the Department of Health and Social Care, looked at general dental services (GDS) contracts — the arrangement used by four in five practices.
In Somerset, repayments were more than three times higher than the England average of 5.5 per cent, with 17 per cent of funding returned in 2022-23.
Across the south west, the share or money repaid increased from 7 per cent in 2018-19 to 13 per cent in 2022-23.
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Practices are also paid different amounts for the same procedure, creating further regional variation in treatment care. The analysis found that in parts of the south west, dentists were paid a quarter less per unit of care than the most well-funded area in north east London.
The House of Commons health and social care committee has dubbed the UDA-contract system as “not fit for purpose” and called for “urgent reform” to boost recruitment and retention in NHS dental services.
Many practices have reported being unable to hit their targets due to recruitment issues, as more dentists leave the NHS for the private sector.
Dr Jenna Murgatroyd, chair of the Local Dental Committee for Cornwall and Isles of Scilly, said her own practice was 1,000 UDAs short of its target, in part because she lost two dentists in the past year to private dentistry.
Dentists, who carry out a mix of private and health service work, are meanwhile spending less time on NHS treatments. Data from NHS Digital showed the average hours spent treating NHS patients in England fell almost a tenth from 27.3 hours a week in 2018-19 to 24.8 in 2022-23.
“We have seen a rise in dentists in the last year forced into leaving the NHS to work privately and it would take a complete overhaul of the contract for morale to change”, said Murgatroyd.
“We are penalised for taking on new patients, because they take more of our time and yet we are paid virtually the same amount of money to care for them”, she said.
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The Department for Health and Social Care said practices were already accepting new patients as a result of the “dental recovery plan”, which promises to create up to about 2.5mn more appointments this year.
The plan includes offering dentists £20,000 “golden hellos” to work in underserved areas and rolling out mobile dental vans to rural and coastal areas where access is more difficult.
An NHS spokesperson said it had this year announced fresh support for practices to deliver on contractual obligations and improve delivery.
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