Lack of NHS dental appointments widens health inequalities

A new survey of public attitudes to NHS dentistry shows that half of the adults in England find dental charges unfair amid escalating living costs. In Liverpool and many other areas, no dentists are taking on new NHS patients.
A close up photo of several dentist's tools, including dental probes and a mouth mirror, laid out next to each other.

A new survey of public attitudes to NHS dentistry shows half of adults in England find dental charges unfair amid escalating costs of livingHealthwatch England says NHS dentistry is in desperate need of reform ahead of new regional health bodies taking over control next year. 

Healthwatch England warns that health inequalities are widening as people in every part of the country are struggling to pay for dental care.

A representative poll of 2,026 adults based in England found nearly half (49%) of respondents felt NHS dental charges were unfair. 

What are people saying?

The poll, which looked at people’s experiences of NHS dentistry, including costs associated with dental care, found the following: 

  • 41% of respondents said they found it difficult to book an NHS dental appointment, whilst one in five (20%) couldn’t access all the treatments they needed. 
  • One in four (24%) respondents said they had to pay privately to get all the treatment they required. 
  • One in six (17%) reported they felt pressured to pay privately when they booked their dental appointment. Similar numbers (17%) said their NHS dentist didn’t explain the costs before starting their treatment. 
  • More than one in 10 (12%) reported that their NHS dentist charged more for the treatments than the advertised NHS charges. 
  • Almost a third (29%) said lack of access to dental care led to more serious problems, making them feel anxious. Others said lack of timely dental care made it hard to eat or  speak properly (16%); and made them avoid going out (14%). 

Widening health inequalities

The shortage of NHS appointments has hit people on low incomes hardest, meaning they are less likely to have dental treatment, compared with those on higher incomes. The poll suggests that people from social economic group (SEG) A are six times more likely to be able to pay for private dental care if they can’t find an NHS dentist to treat them than people from SEG E (48% and 8%, respectively). 

The new data also reveals a significant North-South divide when it comes to affordability of dental care. While one in five people (20%) living in the South said they can afford private dental care if they can’t find an NHS dentist, in the North, just seven per cent said they could afford private treatment. 

Overall, 38% of the respondents feel they are less likely to visit a dentist, despite clinical guidelines recommending regular dental check-ups to keep people’s mouths healthy. 

Fewer NHS dentists

The findings come as more than 2,000 dentists quit the NHS last year, according to new data obtained by the Association of Dental Groups under freedom of information laws, suggesting a growing trend towards private provision. 

Healthwatch England has repeatedly raised concerns over the last two years as the twin crisis of access and affordability has continued to grow. Between October 2021 and March 2022, the Healthwatch network heard from 4,808 people about their experiences of dental care, many of whom were struggling to access timely care. In Liverpool alone we heard from 1,123 people in this period about their struggles to access NHS dental care. 

Healthwatch is therefore making renewed calls on NHS England and the Department of Health and Social Care to put a reformed dental contract in place before formal responsibility for dental services passes to the 42 new Integrated Care Systems in April 2023. 

Louise Ansari, national director at Healthwatch England said:

“Access to NHS dentistry has been one of the most significant issues people have raised with us in the last two years. There is now a deepening crisis in dental care, leaving people struggling to get treatment or regular check-ups on the NHS. 

“The shortage of NHS appointments is creating a two-tier dental system, which widens inequalities and damages the health of the most disadvantaged communities. With millions of households bearing the brunt of the escalating living costs, private treatment is simply not an option and even NHS charges can be a challenge. This needs urgent attention if the Government is to achieve its levelling up plan and tackle health disparities. 

“We are once again calling on the Department of Health and Social Care and NHS England for greater ambition and urgency from NHS dental reform plans to create a fair and inclusive dental service. We strongly recommend that a new dental contract is in place before Integrated Care Systems take on formal responsibility for dentistry from next April.” 

No NHS dental appointments in Liverpool.

Healthwatch Liverpool Chief Officer, Sarah Thwaites, said:

“The numbers of people who contact us about their difficulty getting dental treatments has grown dramatically since the start of the pandemic -  1,921 people between April 2021 – March 2022. That's a 354% increase compared to the year before.

“People tell us that they have called many dentists but cannot find one taking new patients. There are currently no dentists open for new adult NHS patients locally, and only a few with a waiting list of many months to be taken on.

“Each day we must tell people who are in pain and discomfort that they are not likely to be seen before autumn at the earliest. This includes people who are losing teeth, or parts of teeth, that might otherwise have been saved. With so many people in the city living on very limited incomes many people just can’t afford private dental care.

“People in the most urgent need may get emergency treatment, such as antibiotics or a temporary filling but then can’t get a dentist to provide ongoing care. Some people have needed to access the Emergency Dental Service multiple times because they can’t find a dentist to take them on to deal with the underlying issue. 

“There are many people who have now not seen a dentist for years. This includes many children, disabled and older people who may be building up further problems through the lack of check-ups and preventative care.   

“We really need a long-term solution that gives people access to the NHS dental care they need”. 

What you've told us

Liverpool residents who've been in touch with us have said:

“I have spent 2 years on and off in pain looking for a dentist” 

“I have been trying to register myself and my little boy with a dentist for over a year now with no luck” 

I have tried many practices who have said that I may be treated if I pay privately, but I cannot afford this as I am on Universal Credit.”  

Please keep continuing to share your experiences of trying to access NHS dental treatment with us. Your continued feedback helps us to keep raising access to NHS dental treatment as an urgent priority with NHS England.

You should also notify NHS England about the issue, as it has a duty to provide routine and urgent dental care across the country.  Find out how to make a complaint here

About the poll

Yonder Data Solutions polled 2,026 adults (aged 18+) based in England in February 2022.

Key findings from this polling are available on the Healthwatch England website.

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