Where have all the dentists gone?

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It’s now a common cry: ‘Does anyone know of an NHS dentist?’ But why is the lack of NHS dental care such an issue? Rachael Rowe investigates the problem in Dorset

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When was the last time you saw a dentist? Are you even able to access an NHS dentist?
With NHS dentistry becoming harder to find – but across the entire country – what is happening to the provision of dental health care?
‘After many many months of searching and calling and emailing different dentists, I am yet to find one taking on NHS patients. I have a severe need to see an NHS dentist as I’m really unable to eat because of the pain which has led to weight loss and other health complications. I am a young adult who doesn’t work currently due to disability and illness and am unable to pay for private dentistry treatment which I have explored too.’
Patient comment, in the Healthwatch Dorset report.

The pink dots show the 93 Dorset dentists registered on the NHS website, highlighting the gap in provision in Purbeck, and the north west, mid and north east of the county.

How many see an NHS dentist?
Data from NHS England shows that fewer than half the adults in the South West have seen a dentist in the last two years. If they end up with a problem, chances are they will not be able to access NHS dental care. Healthwatch Dorset has recently published a report on the state of dental access in the county. The recent survey of Dorset’s 93 dental practices found that, at the end of 2022, none was taking new NHS patients.
So what is happening and how is care being prioritised?
Healthwatch Dorset manager Louise Bate explained what had caused her most concern about the report: ‘Last year when we did this questionnaire there were three dentists taking patients. This year, there are none. It’s getting worse. Even if the contracts are changed, there are no dentists.’
Of the 78 dental practices that responded to the Healthwatch survey, none was taking new NHS adult patients, 17 now only treat private patients and only 18 were accepting new NHS patients if they are children. Seven practices said they were accepting patients with additional needs, and 23 practices had waiting lists, half of which were more than 12 months long.

Dorset’s below average
Maps indicate that there are dentists in North Dorset, but they are not taking any NHS patients right now.
The South West Dental Reform Group is a network which sets the strategy for NHS dentistry in the west country, including Dorset. Membership includes regional and local staff. Their assessment of future needs in Dorset identified several significant issues for the future of dentistry. For example, by 2028, Dorset’s population will have increased by three per cent – or an additional 23,708 people. While the child population will have decreased by six per cent, older adults (65+) will have increased by 18 per cent, or 35,504 additional people.
So, in addition to finding dentists to serve more residents, there will also be a need to provide extra services to manage the complex dental needs of older people.
Louise identified a further issue. ‘Because of the way the dental contract is currently set up, dentists see the easiest people to manage – those needing basic check ups. That means it is much harder for people with complex needs to get an appointment.’
How many people can actually get to see a dentist? The SW Dental Reform Group reviewed the data and found that access to children’s dental services in the last year was 48.9% in below the average for England (53%) average. Access to adult NHS dentistry in Dorset is also below the national average at 45.6% (England average 47.1%). That’s a significant gap between those who should be able to see a dentist and those who don’t or cannot.

Testimonial from Healthwatch Dorset report

How is dental care funded?
Until April this year, NHS dentistry was commissioned by NHS England. From April, dentistry is under the control of the local Integrated Care System (ICS). Louise is encouraged by this: ‘I’m more positive now the ICS is taking over responsibility. There’s an opportunity to use local incentives. I’d like to see children prioritised; if we don’t, we are setting ourselves up for a generation of dental problems. I’d also like to see better access for vulnerable people.’
With local commissioning of dental services, there are also opportunities to design services to meet the needs of the population. Louise already has thoughts. ‘I’d like to see more joint working with the voluntary sector. For example, people access mental health services because their teeth are problematic. People are unable to eat properly, they become malnourished, and voluntary groups contact us for advice.’
Chief commissioning officer of the NHS Dorset Integrated Care Board, David Freeman says: ‘From 1st April we will have a much greater opportunity to work with local people, dentists and other specialists in our area to develop new and different ways of working. We’ve already started this work – from helping children and families with good dental hygiene to designing extra services to meet more complex dental needs, we are developing plans for improvements this year.’

Map shows dental clinics in Dorset that accept children as new NHS patients.
None said they were accepting adult patients, unless very elderly or had additional needs.

What can you do now?
If you have toothache and don’t have access to a dentist, Louise Bate advises the best course of action is to dial NHS 111 to discuss your needs. ‘And keep looking for appointments, because some NHS slots do come up.’
Clearly, the NHS will be busy working to improve access to dentistry this year. However, there has never been a better time to ensure we all practise good dental hygiene, stop smoking and reduce sugar intake to avoid tooth decay as much as possible.

Sources:
South West Dental Reform Group Report 2022-Dorset.
Healthwatch Dorset 2023: NHS Dental care in Dorset.

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