NHS Dentists: South-West England

Anne Marie Morris Excerpts

Wednesday 24th May 2023 Westminster Hall

[Anne Marie Morris (Newton Abbot) (Con)]

Healthy teeth are a critical part of a healthy body; we cannot really separate one from the other. It has always surprised me that when the NHS was established, the concept of free at the point of delivery excluded dentistry, for which there has always been a charge. There is something about dentistry, because it is either too complex or too expensive, that has led it to be somewhat second class.

As the decades have gone by, Governments have recognised how important teeth are, and I am pleased to say that there is a much more enlightened view as to their inclusion. There has also been a recognition over the years of the importance of healthy teeth for children particularly, hence the free care for the under-18s. That is why it is particularly worrying that colleagues say—I have heard exactly the same comment—that although children need to be prioritised, they are not being prioritised as things stand. Indeed, on one of my more recent visits to one of my local practices, I came to understand that dentists cannot take on private patients and only child NHS patients; if they go for NHS, they have to do everybody. That is a fundamental piece that ought to be changed.

As colleagues have already said, covid has effectively exposed a pre-existing weakness in the system. There is a shortage of dentists. We have heard a lot—it is absolutely true—about the cap on training numbers and the challenge to which that has given rise. We have heard about how, year on year, more dentists are moving away from the NHS into private. Across the country, the NHS has lost 10% of its dental coverage.

In Devon, in my constituency, there are no NHS dental appointments. The situation is at least as bad in Devon as it is in Dorset. Indeed, on that same visit to the dental practice, I asked how long people would have to wait to get on the patient list—the answer was seven years. That strikes me as even worse than the position in Dorset. Our proportion of dentists, which appears to be accepted, is extraordinarily low. In Devon, there are 51 dentists for every 100,000 patients. That seems very low, but, believe me, it is actually quite good—many places are worse than that. If that is the starting point, it is the wrong starting point and needs to change.

Dental health is absolutely fundamental to the whole body. Reference has already been made to hospital admissions for children. As I understand it, certainly in my part of the country, most admissions for children between six and 10 are caused by the health of their teeth. It is not just that they happen to have a problem with their teeth that is spotted when they are in hospital.

What has to change? Clearly we need more recruitment. The cap has to go. I know that it costs £230,000 to train a dentist, but, frankly, that is good value for each dentist. We need better retention, and the contract, which has been referred to, is clearly one of the biggest reasons why we do not have the retention that we need. We need to broaden the profession. The Government have taken steps, such as the “Advancing Dental Care” review in 2017 and a dental education reform programme. But that is too slow. The ambition is right—more flexible entry, more apprenticeship, new centres of development and putting the training together as dentists get to the secondary stage of their training—but it is not enough. My hon. Friend the Member for Totnes (Anthony Mangnall) suggested that dental therapists should be better used, which is absolutely right. 

The trouble with the contract is, as we have heard, the challenge of how it is constructed. Dentists are not paid per patient, nor for all the work done; they are paid for the most complex work, and that decides the amount paid, which generally does not cover the value of the work they have done. The second problem is that when someone enters into the contract, if they do more work, they do not get paid for the extra, but if they do less they have to give a refund. Effectively, the challenge for dental practices—certainly, for the one I recently visited—is that they cannot use all their contracted hours because they cannot get the dentists to fulfil them.

There is work to be done. The Government absolutely need to deal with the backlog, the contract and the payments. They need to deal with the children issue and to allow individuals to treat children in the NHS, even if they cannot treat adults.