Dentists in Powys have issued a stark warning that NHS dentistry in the county is “on the brink of collapse,” citing chronic underfunding and inflexible performance targets that are straining practices to the limit.
Mohammed Malik, who runs Clifton Dental Practice in Newtown, said the current NHS contract framework in Wales is making it increasingly difficult for community-focused dental practices to remain financially viable.
Dr. Malik, who qualified in 2021, took over the predominantly NHS practice in 2024 alongside his lifelong friend, Dr. Usman Ahmed. While they remain committed to providing NHS care, he said the system itself is now working against that mission.
“The system isn’t failing because dentists are walking away,” Dr. Malik said. “It’s failing because the structure makes it almost impossible to keep going.”
Under Wales’ NHS dental contract, practices are funded through activity-based targets called Units of Dental Activity (UDAs). Dentists argue this model prioritizes hitting numerical targets over improving patient outcomes.
Dr. Malik explained that practices only need to meet 25% of their annual UDA target to secure contract funding. Beyond that, additional treatments generate little or no extra payment.
“Work beyond the minimum requirement is often effectively unpaid,” he said. “Success is measured by hitting figures, not by improving long-term oral health.”
Rising costs for staff, materials, and laboratory services mean that some NHS treatments are delivered at a loss, he added. Inconsistent communication with local health boards further compounds operational pressures, making it difficult for practices to plan and sustain services.
“Many of us chose to run NHS practices because we believe in public dentistry,” Dr. Malik said. “But goodwill alone can’t keep a practice open.”
Dental professionals across Powys are calling for increased transparency in how contracts operate, alongside meaningful reform of the funding model. Without structural change, Dr. Malik warned, NHS dentistry in the county risks failing entirely.
“We are not seeking to abandon the NHS,” he said. “We want it to succeed. But good intentions cannot compensate for structural flaws.”
In response, a Welsh Government spokesperson said that new contract arrangements, developed through negotiations with the British Dental Association (BDA) and the NHS, will take effect on April 1.
The reforms aim to replace the current “treadmill” model with a system that pays dentists for the time spent treating patients, placing a stronger emphasis on prevention and public health.
“We have consulted widely, listened to feedback, and worked with the profession to make improvements,” the spokesperson said. “From April 1, Wales will have a new dental contract with patient and preventative care at its heart.”
The government said it is “proud” of the new system, developed in partnership with the BDA, the NHS, and communities across Wales. Officials hope the reforms will ensure that NHS dentistry remains accessible and sustainable for patients and practitioners alike.