Why NHS Dental Practices Are Struggling – And What’s Really Happening Behind the Scenes

NHS dentistry has long been a cornerstone of affordable healthcare, offering essential dental services to millions. However, behind the scenes, many NHS dental practices are grappling with serious financial and structural challenges that make it increasingly difficult to operate sustainably. From outdated contracts to recruitment struggles, these pressures are causing many practices to reduce their NHS commitments or move to private dentistry altogether.

Let’s explore the key reasons why NHS dental practices are struggling and how they attempt to cope with these challenges.

1. The Outdated and Rigid NHS Contract

One of the biggest barriers is the NHS dental contract, introduced in 2006, which operates on a Units of Dental Activity (UDA) system. This payment structure ties dentists’ income to the number of UDAs they deliver, but the system doesn’t account for the time, complexity, or materials required for different treatments.

For example:

• A simple filling might be worth 3 UDAs.

• A complex root canal involving several visits and specialist equipment is only worth 5 UDAs.

This creates a clear problem: dentists are underpaid for complex treatments and may find it financially unsustainable to provide them on the NHS.

2. Low UDA Rates and Rising Costs

The amount a practice is paid per UDA varies widely, with some practices receiving as little as £20–£30 per UDA. With the rising cost of materials, staff wages, and utilities, this makes it difficult to cover even basic expenses, let alone invest in improvements like new technology, staff training, or longer appointments.

At the same time, NHS funding for dentistry has stagnated or declined in real terms, which means that fewer patients can be treated and fewer UDAs are available for each practice.

3. High Patient Demand vs. Limited Capacity

Many NHS dental practices are overwhelmed by patient demand. Long waiting lists for NHS dental appointments are increasingly common, especially after the COVID-19 pandemic, which exacerbated access issues and created a backlog of untreated dental needs.

This demand, combined with limited appointment slots and funding, often leads to rushed care and shorter appointment times.

4. Recruitment and Retention Challenges

Burnout, dissatisfaction with the NHS contract, and better opportunities in private dentistry have led to a serious recruitment and retention problem in NHS dentistry. Many experienced dentists are reducing their NHS commitments or leaving the NHS entirely, while younger dentists often prefer to work privately, where they have more time per patient, better pay, and greater professional autonomy.

As a result, NHS practices often struggle to maintain a full dental team, leading to longer waiting times and reduced continuity of care for patients.

5. Limited Treatment Options and Patient Frustration

The NHS dental contract focuses on essential, clinically necessary treatments. While this ensures access to basic care, it also limits the range of treatments available. Advanced or cosmetic treatments like teeth whitening, dental implants, and Invisalign are typically not covered by the NHS, which can frustrate patients seeking a broader range of options.

This is challenging for dentists, too, as they often feel restricted by the system. They may want to provide more comprehensive, preventive care but are constrained by UDA quotas and limited resources.

6. Cutting Corners to Cope with Financial Pressures

With so many financial pressures, some NHS practices are forced to make tough decisions to stay afloat. Unfortunately, this sometimes means cutting corners:

• Rushing Appointments to Maximize UDAs: Dentists may reduce the time spent with each patient to see more people and meet their UDA quotas. A check-up that should take 20 minutes might be squeezed into just 10 minutes, leaving little time for preventive advice or patient concerns.

• Prioritising Simpler Treatments: Since NHS contracts don’t pay extra for complex procedures, some dentists focus on quicker, low-effort treatments to stay within budget. This can lead to “patch-up” dentistry instead of comprehensive, long-term solutions.

• Minimising Investment in Technology and Materials: With tight budgets, some NHS practices rely on older equipment and cheaper materials, which may impact the overall patient experience.

7. Delegating to Dental Therapists and Hygienists

To improve efficiency, some NHS practices delegate certain treatments—like fillings and scale-and-polishes—to dental therapists or hygienists. This can help reduce costs and improve access but also means patients might not always be seen by a dentist.

8. Offering Private Add-Ons to Stay Afloat

To balance the books, many NHS practices adopt a mixed NHS/private model, offering private treatments alongside NHS care. Private income can help fund essential investments, such as staff training, new equipment, and longer appointment times.

Common private add-ons include:

• White fillings instead of NHS amalgam fillings.

• Teeth whitening.

• Private hygiene appointments.

While this approach can improve patient choice, it also reflects the reality that NHS fees alone are often insufficient to sustain a practice.

9. The Administrative Burden

Running an NHS dental practice involves significant paperwork and bureaucracy, from managing UDA targets to submitting claims and adhering to NHS regulations. This administrative workload adds to the pressures faced by dentists and takes time away from patient care.

10. The COVID-19 Impact

The COVID-19 pandemic has left a lasting impact on NHS dentistry. Practices were forced to close or operate at reduced capacity for extended periods, which led to a backlog of untreated dental problems. Many practices are still struggling to catch up, adding further strain to an already stretched system.

Conclusion: Why Many Practices Are Moving to Private Dentistry

Given all these challenges, it’s not surprising that many practices are reducing their NHS commitments or switching to private dentistry entirely. Private dentistry allows practices to offer:

• Longer Appointments: More time for thorough examinations and personalized care.

• A Wider Range of Treatments: Including cosmetic options like teeth whitening and Invisalign.

• Better Work-Life Balance for Dentists: Reduced stress, less bureaucracy, and more professional autonomy.

While NHS dentistry remains a vital service, it’s clear that the current system is struggling to meet the needs of both patients and dental professionals. Without urgent reform—such as fairer contracts, increased funding, and a greater focus on prevention—NHS dentistry will continue to face serious challenges in the years ahead.