A two-tier service emerges
New analysis from the Nuffield Trust, a health think tank, has found that almost 600 dental practices in England have withdrawn from NHS dentistry over the last decade. The report concludes that “NHS dental care is hard to find in England, if not impossible” and suggests the country is moving towards a two-tier system, where access to dentistry increasingly depends on what people can afford and where they live.
The figures, reported by the BBC and the Daily Mirror, show that more than one in ten dental practices that once offered NHS care no longer do so. The decline is particularly sharp in parts of the South West and East of England, with Cornwall, Devon, and Northamptonshire seeing some of the biggest reductions. In Cornwall, more than a quarter of practices that previously offered NHS treatment have stopped, while in Somerset fewer than one in five practices now offers NHS services.
Mark Dayan, policy analyst at the Nuffield Trust, said: “The retreat of NHS dentistry was never an announcement or a policy. There has been no closure programme for citizens to oppose and no single decision to reduce the service. The loss of universal care happened through practices deciding for themselves that NHS work is no longer worth doing.” He added that this has led to “the quiet transformation of dentistry into a two-tier service.”
The human cost
The report paints a stark picture of the impact on people who can no longer find an NHS dentist. Alan, an 83-year-old from Somerset, has given up trying to find an NHS dentist and has only one tooth remaining after the others “crumbled out over the years.” He joked that he has perfected a way of eating Brazil nuts, but the situation has affected what he can eat.
In Blackpool, retired shopkeeper Mike Wood, 84, has been trying to get an NHS dentist for 11 years. He and his wife have asked at eight or nine practices within travelling distance but have been unable to find one taking on new NHS patients. As a result, he has two cracked front teeth, several fallen-out fillings, no teeth left on the left side of his lower jaw, and gaps throughout his mouth. “My mouth's full of gaps and it can be painful. I can't eat properly on my right side and on my left it's difficult,” he told the Mirror. He relies on emergency extractions.
National surveys cited in the report indicate that six in ten adults in England have not seen an NHS dentist in the past two years. Of those who attempted to get a new appointment, only 38% were successful, according to a Nuffield Trust survey. NHS dental activity is 8% lower than it was before the Covid pandemic.
Why dentists are leaving the NHS
Dentists who have left the NHS describe a system that is financially untenable. Jim Sykes, a dentist in Hexham, handed back his NHS contract in October 2024 after asking to continue treating only children, a request that was refused. He said: “We were delivering care at a financial loss. The numbers in NHS dentistry don’t add up. I struggle to understand how anyone can make it work.” His practice was forced to pay back large sums to the NHS because it could not carry out the contracted units of dental activity (UDAs). Sykes also said that none of his friends from his graduating class in dentistry still works in the NHS.
Vivak Shah, who runs three practices in Northamptonshire, continues to offer NHS treatment but says it operates at a loss, and he no longer takes on new NHS patients. His practice also experiences the financial pressures of a system where complex patients are more expensive to treat.
The Nuffield report highlights that the number of registered NHS dentists in England has fallen from 6,262 in March 2017 to 5,654 by March 2026. Meanwhile, the total number of dental practices has risen – there are now more than 10,160 practices operating in the country, an increase of over 400 – but the share offering NHS general dental services has dropped from 64.6% to 55.6%. The overall number of NHS dental practices has fallen in every region except North East London, which saw an increase of one practice. The Black Country and North West London saw the smallest declines.
The report also highlights that some practices are reducing the proportion of NHS patients they see while continuing to offer some NHS care.
Where has the money gone?
The British Dental Association (BDA) claims that NHS dental funding has been subject to real-term cuts of around a large amount, which they calculate to be £1 billion per year over the last decade. The percentage of the NHS budget spent on dentistry fell from 3.3% in 2010 to 1.5% in 2024. The BDA's chair of the General Dental Practice Committee, Shiv Pabary, said the situation is “the direct result of choices made by successive governments.”
The Labour government increased the annual dental budget to £3.5 billion for 2024/25, but the BDA says fundamental contract reform requires an extra £1.5 billion a year to restore NHS dentistry as a universal service. Labour has promised to reform the “flawed” dental contract before the end of this parliament.
Mark Dayan said: “The decline started under previous governments but it certainly hasn’t been reversed. That’s not surprising because nothing the current government has done is of the scale that would be required.” In response, a Department of Health and Social Care spokesperson said: “We are changing the NHS dental contract to make NHS dentistry more sustainable and are training more dentists in areas where they are most needed.” The government also points to progress in overseeing 1.8 million extra courses of dental treatment between April and October 2025 compared with the corresponding period before the 2024 general election, and they have increased the number of emergency dental appointments by paying dentists more for them. They have also introduced supervised teeth brushing at schools in more deprived areas.
Regional variation
The dramatic regional differences are highlighted by the BBC report, which notes that reductions in NHS dental practices were smallest in North West London, the Black Country, and North East London. In these areas, the number of practices offering NHS work has remained relatively stable, with North East London actually seeing a small increase. Meanwhile, areas like Cornwall and Somerset have been hit hardest.
The Nuffield Trust's Mark Dayan puts the situation in context: “This is not a shortage of dentistry but a shortage of NHS dentistry.” The report concludes that dental capacity has not disappeared but has moved beyond the reach of anyone who cannot pay for it.
Perspectives
The British Dental Association
Shiv Pabary told the BBC that the situation is “the direct result of choices made by successive governments,” and the BDA has called for an extra £1.5bn a year to reverse the decline and make the contract sustainable.
The Department of Health and Social Care
The government says it is committed to improving access by changing the dental contract, training more dentists, and requiring newly qualified dentists to practice in the NHS for at least three years to ensure NHS services are available to more people.