The dentist won't see you now

Rural areas see far less access to NHS dentistry - and recovery has stalled

The Labour government has raised tax a lot. Spending will soon be £152 billion a year higher than planned under the Conservatives - that’s 11% more every year. The top priority for all this extra tax and spend was supposedly to improve the NHS.

This post looks at whether the extra money has worked in one particular bit of the NHS: in dentistry.

The summary version is this:

• Less dental treatment is being done on the NHS than before the pandemic.

• The big geographical variations in access to NHS dentistry that already existed have got bigger - and show no signs of closing.

• The recovery that was happening after the pandemic has ground to a halt.

• And once you factor in a growing population, the picture looks even more stark, with less provision per head.

Let’s walk through that.

How much NHS dental work is being done?

Every month the NHS publishes information on how much NHS work each dental practice has done, and how many NHS patients they have seen. The unit of measurement of their output is the “Unit of Dental Activity” (UDA).

The more complicated and time-consuming a bit of work is, the more UDAs are awarded,¹ and the more the NHS pays the dentist.

So how much activity is happening where?

Here is a comparison (not per head) of the amount of NHS dental work over the last year (to March 2026) compared to the year to March 2019. I’ve aggregated the numbers to the district level.

As you can see, the map is mainly red - in most places there is a lot less activity happening now. That is particularly the case in the shires - the south west, Norfolk and so on.

These are point-to-point comparisons though.

The chart below shows what happened over time. To smooth out the choppy movements from month-to-month, the chart below shows a 12 month rolling total. As you can see, things fell off a cliff in the pandemic, and then recovered.

But that recovery has ground to a halt - at a lower level - about an eighth lower than pre-pandemic. And that is before you account for population growth.

Activity per head - and the growing gaps

The really striking thing is when you look at the variation between places. There were always gaps in provision, but those gaps have got bigger.

The chart below shows activity per head² in each Integrated Care Board (ICB) over time. Some places see more than twice as much NHS dentistry per head as others:

And below is the same data, but as an index value - how much it has changed since the pre-pandemic era. Overall, there is 16% less activity per head than pre-pandemic.

And the fanning out is even starker. While nowhere is delivering as much NHS dentistry per head as they were pre-pandemic, the growth in the gaps between places is enormous - London hasn’t changed much, but Somerset is seeing about 60% less activity per head, which is pretty mind-blowing. And while some places seem to be recovering a bit, others are flatlining or falling further.

If we turn that chart back into a map you can see the rural-urban split pretty clearly - urban areas are down a bit, but rural areas are down a lot, particularly in the south west:

Possible reasons

Why do we see these variations? I don’t think there is a definitive answer, but parts of it include:

• The funding formula: As well as different areas getting different total amounts from funding formulas, each dental practice also gets paid different amounts per UDA. These historic rates reflect the patient & treatment mix that practice had in 2005 - and they were sprung on dentists as a surprise back then. Over time rates are becoming less and less anchored to any reality. Where funding and UDA rates are lower, delivery is generally lower.

• Dentist demographics: Dentists generally qualify in cities and anecdotally younger dentists are less inclined to move to shire areas. Vacancy rates are much higher in shire areas.

• Choices of the local ICB. Different ICBs have put more or less priority on dentistry and been more or less innovative in encouraging NHS dentistry.

• Willingness and ability of the population to go elsewhere. To some extent there is more scope for NHS dentists to move to do more private work in places where people are more willing or able to pay themselves to get seen.

Policy

When I was responsible for this area as a minister I worked on a comprehensive set of proposals to try and fix this - some of which saw the light of day after I left, and other bits didn’t.

In so far as there has been a focus dentistry at all, Labour seem to have focussed on access to urgent appointments. In 2025 Labour promised to deliver 700,000 extra urgent dental appointments, funded from underspends. But data I got from the department shows they didn't deliver any meaningful increase, and now they have quietly abandoned the target.

Some more substantive things are happening: in December the government announced new payments for complex care pathways for people with serious problems (which have been hard to manage in the current system). There is a new requirement to deliver urgent appointments as standard, and support for preventative activity.

Nonetheless, dentists continue to press for a more fundamental overhaul. Responding to the reforms above, the British Dental Association said that “a decisive break from this target-based contract remains key, and these changes do not constitute a final destination for NHS dentistry in England” … “These are the biggest tweaks this failed contract has seen in its history” (a double edged comment) “but this cannot be the end of the road”.

The Oral Health Foundation said: ‘The proposed reforms acknowledge some of the pressures within NHS dentistry… but they stop short of the fundamental change the system requires.

The government is currently saying that, “We remain committed to delivering further, fundamental reform of the dental contract before the end of this Parliament.” We will see.

Conclusions

The data above shows that there is a lot less NHS dentistry happening than pre-pandemic - and even more so once you consider it per head. Variations between similar places have hugely increased.

Hopes that all these problems would simply be washed away by a wall of money under the new Labour government seem to have been dashed.

Money is important but so is reform: many dentists argue that the basic NHS dental contract is dysfunctional, and sets broad price bands that often don’t match the real cost of work. Escaping from the bureaucracy of the NHS is one big motivator for many dentists to go private.

And this is another great example of the incredible variations in performance within the NHS. People often present the NHS as a homogenous monolith, but in reality similar places see very different levels of service, and accountability for local underperformance is very weak. That needs to change - even if NHS reform is a bit like pulling teeth.

1

• Band 1: Check-ups, examinations, and simple scaling (worth 1 UDA).

• Band 2: Fillings, root canals, and extractions (worth 3 UDAs).

• Band 3: Complex laboratory treatments like crowns, dentures, and bridges (worth 12 UDAs)

2. Population statistics from ONS midyear ICB population statistics and for the prior year e.g. for the year to March 2019 the population is midyear 2018. Midyear 2025 is linear projection based on previous 6 years.