Analysis by the Nuffield Trust reveals a significant shift away from NHS dentistry across England, with more than one in 10 practices that previously offered NHS care no longer doing so. The withdrawal has been concentrated in specific regions, with Cornwall, Devon, and Northamptonshire experiencing some of the largest reductions. In Cornwall alone, more than a quarter of practices that once provided NHS treatment have ceased doing so. Somerset has seen particularly dramatic changes, with fewer than one in five dental practices now offering NHS services.
The underlying cause appears to be financial unsustainability for dental practitioners. Dentists report that NHS contracts operate at a loss, prompting many to hand back their agreements and transition to private practice models. Some practices continue NHS work but no longer accept new NHS patients due to the financial burden. Practitioners describe difficult decisions balancing staff employment and business viability against the commitment to provide NHS dental care.
The decline has contributed to access challenges for patients seeking NHS dental treatment. Current data indicates that NHS dental activity is 8% lower than pre-pandemic levels, while six in 10 adults have not visited an NHS dentist within two years. Among those who attempted to secure new appointments in the last two years, just 38% were successful, according to the NHS GP Patient Survey. For elderly and low-income patients, the shift toward private dentistry has created particular hardship.
Experts characterize the situation as a gradual transformation toward a two-tier system where access increasingly depends on ability to pay and geographic location. The changes have not affected all regions uniformly, with North West London, the Black Country, and North East London recording smaller declines in NHS practices. North East London was the only area to record an increase, with one additional practice offering NHS treatment compared with a decade prior.
The government has indicated plans to address the crisis through contract changes, expanded dentist training in underserved areas, and requirements for newly qualified dentists to practice in the NHS for a minimum of three years. Dental professionals and campaign groups have criticized the current situation, attributing it to policy decisions and inadequate funding levels over successive years.
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