Reflections on the Dental Recovery Plan

12 April 2024

By Catherine Rutland, Clinical Director at Denplan

The beginning of 2024 saw the much-anticipated NHS Dental Recovery Plan published by the Department of Health and Social Care. For months prior, the question was whether this plan would finally mark a turning point for the sector and ensure that local communities have access to the dental care they need. During this time, both the Government and the Opposition committed to restoring access to dentistry as a key election pledge.

The reality of the situation, however, is that access to services has reached such a crisis point, that it was going to take a significant overhaul of the status quo to recover care. At Denplan, we have been reflecting on the impact of the recovery plan. While it provides some welcome initiatives, ultimately we believe that it does not go far enough to alleviate the challenges faced by dentists and patients

Changes to the dental contract remain superficial

The 2006 dental contract is almost universally criticised for its flawed structure, as partly evidenced by the expected underspend of the NHS dentistry budget by £400m this year.¹ Other critics have argued that paying for a set amount of dental activity (UDA) makes carrying out NHS work financially unsustainable - 74% of NHS dentists already do not enjoy working in the NHS.¹

While the plan commits to increasing the value of UDAs in areas where rates are lowest, it does not address the root cause of why dentists choose to leave the NHS, such as the inflexibility of the contract which dictates patient treatment. For example, many would like to prioritise the vulnerable or children within their contracts but it's too inflexible to allow them the choice.

We already know that 59% of NHS dentists say that contract reform would make the service more attractive to them as clinicians.² The Government has hinted that they will consult on potential contract improvements, but thus far they have been opposed to wholesale reform.

The plan risks leaving prevention behind

It is welcome to see that the plan offers support for new patients and attempts to restore access to services in areas that have been historically neglected. However, as a direct consequence, these initiatives raise a number of concerns around prevention treatment and implementation.

1. The new patient premium is to be implemented without an equal focus on the continuity of care for existing patients.

There is a risk that existing patients may have a harder time accessing routine preventative care as the premium does not address the fundamental capacity issue where NHS dentists are unable to meet the rising demand for care. This approach fails to shift the dial away from focusing on elective and emergency care in the long term, as patients remain unable to access services for routine care. The time-limited nature of the premium, ending in March 2025, also risks bringing new patients into a broken NHS dentistry model, with no certainty of how it may improve longer-term.

2. The plan to deploy mobile units to underserved areas lacks the detail necessary and raises questions about the practicalities of implementation.

While the plan iterates that these mobile units are a temporary solution while longer-term arrangements are set up, there is no further detail on the model for operationalising such a huge undertaking. Crucially, how are they to be staffed given the well-documented acute workforce crisis in the dental industry?

There is an obvious absence of staff retention considered in the plan

Perhaps the most critical issue the plan fails to address is that of retention. Initiatives like the provisional registration proposal to incentivise qualified overseas practitioners to then join the NHS focuses predominantly on growing the dentist workforce – although it remains unclear whether a faster access route would directly translate into more dentists carrying out NHS activity.

While growing the dentist workforce is important and necessary, there has been less consideration given to the equally important problem of how to prevent the people leaving NHS dentistry. In fact, there is only one mention of retention in the plan itself, acknowledging that retention is difficult in certain parts of the country.

Retention, however, is central to the success of any recovery plan. Short-term solutions are not enough to elevate services to a stable footing and without further action, it is likely that the dental recovery plan will remain just that – a plan without tangible progress. Further action should include considerations on:

The declining number of other members of the dental care team

One specific example of this is the decline in dental technicians. There has been an almost 32% decline in dental technicians in the last 15 years.³ Further decline across dental care providers will have a significant impact on the delivery of care – especially when the demand for services is at a record high.

How to better utilise the whole dental workforce

More consideration should be given to how the system can enable practices to make better use of the wider dental team – like dental therapists and hygienists – by allowing them to carry out a wider range of dental services. Early considerations of how this could be facilitated include allowing them to have NHS performance numbers or improving pension rights.

It is fundamental that the conversation shifts to how we can deliver patient care realistically within the current landscape the sector finds itself in.

Mixed and private dentistry can offer a solution to some of these issues, but it is ultimately only through joint working that we will be able to have a real impact on these complex challenges. There is no timelier reason for the sector – from private to mixed to NHS – to work together to ensure that the dental care needs of local populations are met.

Company News Visit The Core

Does the dental recovery plan deliver for the sector?