Following its annual survey's release, Healthwatch revealed widespread public confusion over NHS dental care rights and continued struggles to access an NHS dentist.

Healthwatch, an organisation dedicated to improving local care, polled 1,791 adults in England. The data revealed:

  • Sixty-eight per cent mistakenly believed they had the right to register with an NHS dentist, akin to registering with a GP.
  • Only 16 per cent knew this was false, while another 16 per cent were unsure.

This misunderstanding likely stems from the confusion caused by the introduction of the 2006 NHS dental contract, said Healthwatch.

Louise Ansari, chief executive of Healthwatch England, commented, “The difficulty of getting NHS dental treatment is one of the public’s biggest concerns about the healthcare system and a crisis that dental leaders estimate is denying 13m people access to NHS appointments. These findings underline the deplorable state of NHS dentistry.”

Gaps in access

Healthwatch England’s research highlights ongoing struggles in accessing NHS dental care:

  • Thirty-three per cent of people reported waiting longer than desired for an NHS dental appointment.
  • Sixteen per cent said they couldn’t find an NHS dentist willing to treat them, and 27 per cent of those resorted to private care.

Ash Green, chief executive of Healthwatch North Yorkshire, said, “Whilst we recognise that dental practices were given extra money to take on NHS patients, we’re still hearing how people are struggling to access NHS dental services, and the impact on their health and wellbeing is deeply concerning. Incremental changes are not enough – we need fundamental reform.”

In North Yorkshire, only 35 per cent of adults accessed NHS dental care in the past two years (as of 2022), a steep decline from 50 per cent in 2018. Rural areas such as Selby and Ryedale face severe shortages, with some of the worst dentist-to-patient ratios in the country.

The 2023 annual GP patient survey revealed that 29 per cent of patients in Humber and North Yorkshire (not including Craven) and 25 per cent of patients across West Yorkshire and Craven tried but could not get an NHS dental appointment in the last two years.

Health inequalities

Healthwatch explained that vulnerable groups face significant stress and financial strain.

According to the North Yorkshire Rural Commission, 85 per cent of North Yorkshire is classed as ‘super-sparse’ or very rural. This means most people live in smaller communities – making access to services, isolation and transport difficult for people.

It has been argued that rurality should be classed as a “health inequality” as it continues to be a barrier for many people, adding extra frustration and pain for many people.

In October 2024, Lee Pitcher, MP for South Yorkshire, told the House of Commons that he had heard “horror stories” about patients in “horrendous pain” who had resorted to DIY treatments.

One of the survey respondents told Healthwatch North Yorkshire, “I have pulled out four of my own teeth, and number five is getting to the stage where it’s going to come out. I don’t want to leave the house.”

Tooth extractions

According to the Office for Health Improvement and Disparities, there were 47,581 tooth extractions in under-19s in NHS hospitals in England in 2022/23. Key findings include:

  • Two-thirds of extractions resulted from a primary diagnosis of tooth decay, a 17 per cent increase from the previous year.
  • Yorkshire and the Humber reported 405 cases per 100,000 children – the highest in England.

Around one in eight parents nationally claim they have been able to sign up their child to an NHS dentist only if they agree to be a private patient at the surgery. Healthwatch said that this number, though small, is still worrying.

A spokesperson for Healthwatch England called this practice a clear breach of NHS rules. Louise added, “We have alerted NHS England and urged them to remind dentists that this is a breach of their NHS contract. Children who are aged under 18 and those under 19 who are in full-time education are eligible for free NHS dental treatment at practices with available NHS appointments for children.”

Public preferences for reforms

Healthwatch’s polling revealed strong public support for a GP-style NHS dental system:

  • Fifty-five per cent favoured permanent registration with a local NHS dentist.
  • Sixteen per cent preferred flexible registration near work or other convenient locations.
  • Only three per cent expressed a preference for private dentistry.
  • Twenty-seven per cent supported the status quo, which allows patients to seek appointments at any NHS dentist without guarantees of continuity.

Healthwatch said that a GP-style could address many shortcomings in the current system. It added that prioritising long-term solutions will be essential to ensure equitable and accessible dental care for all.

In the short term, the organisation has called for dental practices to assist in improving public awareness by explaining to patients how 'registration' works and if there are any obligations on attendance to stay on a regular list. This could help reduce conflicts between patients and practices if they are 'removed' as NHS dental patients.

A spokesperson for Healthwatch added, “We also urge them to learn any lessons from initiatives that have been tried to increase dental appointments in the short-term, such as the patient payment that came in on March 1, 2024.”

A spokesperson for NHS Humber and North Yorkshire Integrated Care Board (ICB) said, "Regrettably, the testimonies we hear from patients and organisations like Healthwatch are all too familiar and are a reflection of the long-standing issues in dentistry across the country that have been building well before ICB’s absorbed responsibility for commissioning local dental services.

"Across Yorkshire, ICBs and the dental profession have been united in calling for reforms to the NHS dental contract and we are hopeful the government will acknowledge this when it publishes its long-term plan in the spring. Findings and recommendations from reports, such as those shared by Healthwatch, are key in lobbying for change. We have a strong relationship with our local Healthwatch colleagues and meet with them regularly to address concerns.

"As an ICB, we understand the frustrations many people face when trying to book routine appointments, and we know that dentists are doing their best to offer as many NHS slots as possible to meet the high demand in Humber and North Yorkshire, but national reform is needed.

"We have already increased the rates paid to dentists and have introduced the national Golden Hello recruitment incentives but recruitment and retention of NHS dentists in the area remains a challenge. Alongside the national plans, we are working collaboratively with dental leaders and professional bodies and have made strides locally to improve paediatric dentistry training and recruitment, introduced a dental fellowship programme and are piloting a Centre for Dental Development to enhance training and development opportunities.

"Unfortunately, the ongoing difficulties with recruiting and retaining dental professionals are further limiting the ability of practices to accommodate all patients.

"We will, however, continue to work hard to increase provision where we can – particularly in our more disadvantaged communities where need is greatest. We can point to a number of areas where we've managed to boost activity using capacity from contracts that have been handed back, and where we've added additional resource for urgent appointments and other pilot schemes aimed at improving access.

"We are keen to see the government's long-term plan and are actively working with NHS England to share our local experiences with the aim of influencing national plans for dental reform."

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