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By spring 2024, Neil McDonald had not been able to see an NHS dentist for four years. In “absolute agony” and on the verge of pulling out a second tooth, the 61-year-old Ipswich resident called the 111 medical helpline.
It referred him to a new state-funded service in the town in the east of England, one of the nation’s “dental deserts”, where a quarter of patients tried and failed to see a dentist between January and March last year, according to the latest NHS data.
At the University of Suffolk Dental CIC, local health and education leaders are working their way around a broken system that has left millions of NHS patients performing risky procedures on themselves.
Poor access to some of the most basic services is largely the result of the NHS dental contract system, according to dentists and health chiefs, which is forcing them into private practice at a time of severe staff shortages and long waiting lists.
Under NHS contract terms, dental practices are paid a set fee to deliver a certain number of “units of dental activity” (UDAs), or treatments, a year. The number of procedures for which dentists receive payment annually is capped.
Dentists complain the system has left them struggling to cover costs, and less willing to take on more patients with complex needs, with simpler dental work sometimes remunerated at the same rate as intricate treatment, such as root canal surgery.
But in Ipswich, Lorraine Mattis, chief executive of University of Suffolk Dental CIC, pointed to “innovative commissioning” of dental services by the Integrated Care Board, which manages healthcare resources at a local level.
Under its model, one of the first in operation in England, dental practices have a Personal Dental Services contract with the NHS, which allows some flexibility.
“We are commissioned to deliver sessions and appointments as opposed to units of dental activity,” said Mattis. “That allows us to see a patient, deal with the urgent issue and bring them back for ongoing care and support so anyone who leaves us is dentally fit.”
“We need more ICBs to be brave, courageous and challenge the status quo, especially in rural and coastal communities [where] this sort of commissioning works,” she added.
Suffolk university began enrolling undergraduates in its dental hygiene and dental therapy course in February last year, with students trained in and seeing patients in the same building in which the CIC operates.
Graduates of the three-year course — which received 709 applications for September 2025 for just 24 places — will be able to carry out many routine tasks performed by qualified dentists.
Professor Jenny Higham, university vice-chancellor, said: “A lot of the work that dentists do doesn’t necessarily need to be done by them and dental therapists could have a bigger role. We’ve got a limited workforce, and so the desire is there for everybody to be working at the top of their licence.
“I think it’s universally known that access to dentistry services has fallen off and the [UDA] contract hasn’t worked optimally,” she added. “We are very proud of what we do but it’s amazing how constraints around the practice make it more difficult than it should be.”
Health secretary Wes Streeting has vowed to renegotiate the contract, meeting dentists’ representatives in his first week in office last July.
However, details of what a reformed system might look like are yet to be published, though the sector hopes it will form a part of the government’s long-awaited 10-year plan for the health service.
Matthew Taylor, chief executive of the NHS Confederation, which represents health leaders, said poor oral hygiene practices, lack of investment and the nature of the UDA contract meant the “demand supply conundrum is difficult for policymakers to solve, especially when resources are very limited”.
“But there is a way forward, as this innovative model shows,” he added. “We look forward to seeing more in the government’s forthcoming NHS 10-year health plan.”
The Department of Health and Social Care said it was “reforming the dental contract to make NHS work more appealing to dentists” and “looking at a wide range of options”.
It added that it had introduced “a ‘golden hello’ scheme . . . to recruit dentists to areas with most need”.
McDonald, one of the CIC’s first patients, has now had more than a dozen appointments under the PDS scheme. “I have been so impressed,” he said. “Everybody, including the students, they’ve been happy. I haven’t seen any bad vibes in this place.”
Data visualisation by Amy Borrett
