Fit for the future: A manifesto for 21st Century dentistry

The nation’s oral health is going back in time.

Deep inequalities are set to widen. Over 12 million people in England cannot access the care they need, with 7% so desperate they attempted some form of ‘DIY’ dentistry since lockdown.

Chronic underfunding and failure to reform the dysfunctional NHS dental contract in England has brought NHS dentistry to the brink of collapse.

Underfunded, overstretched, and working to a system which puts government targets ahead of patient care, many dedicated clinicians see no choice but to leave the NHS. This crisis in morale is causing an exodus from the workforce which threatens the very survival of this service.

Dentists and their teams, in NHS, mixed and private practice, on our high streets and in our hospitals need support.

It will take urgent action to end this crisis, and make dentistry fit for the future.

A venn diagram of the manifesto priorities: Fix the NHS contract, end the access crisis, value the workforce and double down on prevention.

1. Fix the NHS contract

It’s time to put an end to a system in England that puts government targets before patient care, and that’s fuelling the access and workforce crises.

The government must:

Commence immediate negotiations on a new NHS dental contract and commit to a firm deadline for rollout
Make a decisive break from the current failed contract, with a shift to a model that’s prevention-focused, patient-centred and rewards dentists for improving the health of the communities they serve
Take urgent short-term action to stabilise the service and keep practices sustainable before they can transition to a new system.

2. End the access crisis

Restore care to millions. Ensure NHS dentistry is available for all who need it, for the long term.

The government must:

End more than a decade of real-terms cuts to dental budgets, securing a long-term funding settlement for NHS dentistry which keeps pace with demand.
Ringfence and reinvest funds so money allocated to NHS dentistry is spent on NHS dentistry.
Stop filling the holes in budgets by increasing NHS charges. Patients shouldn’t have to pay more, simply so Ministers can pay less. Patient contributions should at least form a stable or declining proportion of the NHS dental budget.
Extend and simplify the system of exemptions from dental charges. Introduce real-time patient charge exemption checking, so patients aren’t unfairly fined for honest mistakes.
End the scandal of more than year-long waits for dental treatment in hospitals for children and adults with special needs by ensuring Community Dental Services have the resources they need.
Improve access and patient safety by including dentistry in the digital transformation of the NHS. Give dentists access to Summary Care Records and roll-out e-prescribing to NHS dentistry.
Invest in the next generation of dental technology, so that the NHS can benefit from the cost-savings and efficiencies of digital scanning and 3D printing of materials.
Improve access for vulnerable groups like care home residents and people experiencing homelessness with properly resourced dedicated provision.
Ensure dentistry has a voice in Integrated Care Systems, so the oral health needs of local communities are not overlooked.

3. Value the workforce

Halt the exodus and make the NHS a place where dentists and their teams want to work. Make dental teams a part of the NHS family, through tried-and-tested initiatives that recognise and reward commitment. Make sure all corners of dentistry have the talent they need.

The government must:

Recognise and reward dedication to the NHS, with commitment and late career retention payments already tried and tested in other parts of the UK.
Make the NHS a place dental students would choose to build a career – not a place where they are forced to serve their time after graduation.
Treat dental teams as members of the NHS family; from flu jabs to miscarriage leave and state-backed indemnity cover, our teams deserve the same support as our medical colleagues.
Commit to above-inflation pay uplifts across primary and secondary care, drawing a line under a 40% real-terms fall in incomes since 2010 with no parallel in the public sector.
Ensure NHS dentists have the support they need to cover the costs of the phase-down of dental amalgam.
Future-proof dentistry by committing to a credible, deliverable and fully funded plan to meet the workforce needs of NHS and private dentistry, in primary and secondary care.
Cut red tape and ensure the dental regulator upholds its duty to protect the public fairly and proportionately.
Ensure processes for registering dentists trained overseas are timely and fair, but do not compromise patient safety.

4. Double down on prevention

Oral disease is almost entirely avoidable. Investment in prevention can reduce oral health inequalities, foster a healthier future for our communities, and take unnecessary pressure off our health services, while saving the NHS millions in treatment costs.

The government must:

Set children up for a lifetime of good oral health by introducing an ambitious national prevention programme for England, including supervised toothbrushing in early years settings and schools, and targeted fluoride varnish applications.
Extend free school meals to every primary school child in England to fight the severe impact child hunger and poor nutrition are having on children’s dental health.
Prevent oral cancer by committing to the creation of a smokefree generation, and introduce ambitious measures to minimise uptake of both smoking and vaping.
Step up the fight against sugar. Introduce warning labels on the packaging of unhealthy products, including those full of ‘secret sugars’ such as sauces or condiments.
Extend the Soft Drinks Industry Levy to other products like confectionery, biscuits, milkshakes, yoghurts and cereals to force industry to reformulate sugary foods. Ensure Levy funds are ringfenced to improve children’s health and reduce inequalities.
End the hard sell, with a ban on displaying sugary products at kids’ eye level, the use of cartoon characters on packaging, and games in marketing, as well a mandatory guidelines for sugar content in baby food.

The nation’s oral health is going back in time.

Deep inequalities are set to widen. Over 12 million people in England cannot access the care they need, with 7% so desperate they attempted some form of ‘DIY’ dentistry since lockdown.

Chronic underfunding and failure to reform the dysfunctional NHS dental contract in England has brought NHS dentistry to the brink of collapse.

Dentists and their teams, in NHS, mixed and private practice, on our high streets and in our hospitals need support.

It will take urgent action to end this crisis, and make dentistry fit for the future.

1. Fix the NHS contract

It’s time to put an end to a system in England that puts government targets before patient care, and that’s fuelling the access and workforce crises.

The government must:

Commence immediate negotiations on a new NHS dental contract and commit to a firm deadline for rollout
Make a decisive break from the current failed contract, with a shift to a model that’s prevention-focused, patient-centred and rewards dentists for improving the health of the communities they serve
Take urgent short-term action to stabilise the service and keep practices sustainable before they can transition to a new system.

2. End the access crisis

Restore care to millions. Ensure NHS dentistry is available for all who need it, for the long term.

The government must:

End more than a decade of real-terms cuts to dental budgets, securing a long-term funding settlement for NHS dentistry which keeps pace with demand.
Ringfence and reinvest funds so money allocated to NHS dentistry is spent on NHS dentistry.
Stop filling the holes in budgets by increasing NHS charges. Patients shouldn’t have to pay more, simply so Ministers can pay less. Patient contributions should at least form a stable or declining proportion of the NHS dental budget.
Extend and simplify the system of exemptions from dental charges. Introduce real-time patient charge exemption checking, so patients aren’t unfairly fined for honest mistakes.
End the scandal of more than year-long waits for dental treatment in hospitals for children and adults with special needs by ensuring Community Dental Services have the resources they need.
Improve access and patient safety by including dentistry in the digital transformation of the NHS. Give dentists access to Summary Care Records and roll-out e-prescribing to NHS dentistry.
Invest in the next generation of dental technology, so that the NHS can benefit from the cost-savings and efficiencies of digital scanning and 3D printing of materials.
Improve access for vulnerable groups like care home residents and people experiencing homelessness with properly resourced dedicated provision.
Ensure dentistry has a voice in Integrated Care Systems, so the oral health needs of local communities are not overlooked.

3. Value the workforce

The government must:

Recognise and reward dedication to the NHS, with commitment and late career retention payments already tried and tested in other parts of the UK.
Make the NHS a place dental students would choose to build a career – not a place where they are forced to serve their time after graduation.
Treat dental teams as members of the NHS family; from flu jabs to miscarriage leave and state-backed indemnity cover, our teams deserve the same support as our medical colleagues.
Commit to above-inflation pay uplifts across primary and secondary care, drawing a line under a 40% real-terms fall in incomes since 2010 with no parallel in the public sector.
Ensure NHS dentists have the support they need to cover the costs of the phase-down of dental amalgam.
Future-proof dentistry by committing to a credible, deliverable and fully funded plan to meet the workforce needs of NHS and private dentistry, in primary and secondary care.
Cut red tape and ensure the dental regulator upholds its duty to protect the public fairly and proportionately.
Ensure processes for registering dentists trained overseas are timely and fair, but do not compromise patient safety.

4. Double down on prevention

The government must:

Set children up for a lifetime of good oral health by introducing an ambitious national prevention programme for England, including supervised toothbrushing in early years settings and schools, and targeted fluoride varnish applications.
Extend free school meals to every primary school child in England to fight the severe impact child hunger and poor nutrition are having on children’s dental health.
Prevent oral cancer by committing to the creation of a smokefree generation, and introduce ambitious measures to minimise uptake of both smoking and vaping.
Step up the fight against sugar. Introduce warning labels on the packaging of unhealthy products, including those full of ‘secret sugars’ such as sauces or condiments.
Extend the Soft Drinks Industry Levy to other products like confectionery, biscuits, milkshakes, yoghurts and cereals to force industry to reformulate sugary foods. Ensure Levy funds are ringfenced to improve children’s health and reduce inequalities.
End the hard sell, with a ban on displaying sugary products at kids’ eye level, the use of cartoon characters on packaging, and games in marketing, as well a mandatory guidelines for sugar content in baby food.