Dentists in England have returned more than £900 million to the government over the past two years after failing to deliver the full amount of National Health Service (NHS) dental care they were contracted to provide, according to analysis of NHS financial accounts by the BBC.
The returned funds represent roughly £1 for every £7 paid to dental practices during that period. The figures highlight ongoing difficulties patients face in accessing NHS dental services, despite record levels of funding allocated to the sector.
Under the NHS dental contract system, practices agree to deliver a set volume of treatments each year in exchange for monthly payments. If a practice delivers less than 96% of its contracted activity, the NHS can reclaim a portion of the funding the following year.
In the 2024–25 financial year alone, more than £450 million was returned. The previous year saw nearly £480 million clawed back. In both years, more than 40% of dental practices were required to repay funds, marking a significant increase compared with earlier years.
The growing gap between NHS funding and delivered services comes as many dentists increasingly prioritize private treatments, which often pay significantly more than NHS work.
The issue is expected to draw further scrutiny as the Competition and Markets Authority prepares to launch an investigation into the private dentistry market and the fees charged to patients.
For many patients, access to NHS dentistry remains a major challenge. Nikita Jenkins, 27, from Cornwall, said she had not seen an NHS dentist in 14 years. Unable to find appointments locally, she eventually paid for private treatment for her two daughters after being told waiting lists in her area stretched up to seven years.
“I tried every dentist in and around my area, but it was near impossible,” Jenkins said. “In the end we felt we had no choice but to go private to make sure our children received proper care.”
She added that the additional costs place extra strain on family finances. “Dentistry feels like a luxury rather than a necessity because it’s so difficult to access,” she said.
The British Dental Association (BDA) argues the problem stems from the current NHS dental contract, introduced 20 years ago. BDA chair Eddie Crouch said many dentists struggle to cover their costs when providing NHS services.
According to the union, private dentistry can pay roughly twice as much as NHS treatments for procedures such as examinations, fillings and extractions. For example, dentists may lose around £7 for each new patient examination under NHS rates because the reimbursement does not cover operating costs.
“Dentists are effectively losing money delivering NHS care,” Crouch said. “No healthcare professional can be expected to work under those conditions.”
While most returned funds result from practices failing to meet contract targets, a small portion is reclaimed after audits identify incorrect claims for treatments.
Patient advocacy group Healthwatch England says the figures reflect widespread concerns about access to dental care. Rebecca Curtayne, a representative for the organization, said many people report being unable to secure NHS appointments, while others find their local dentists have stopped offering NHS services entirely.
“The consequences fall hardest on those already facing financial difficulties,” Curtayne said. “The current dental contract is simply not fit for purpose.”
The government says it has taken steps to address the issue by increasing payments for NHS dental work and offering £20,000 incentives to attract dentists to underserved areas. Officials say these measures are helping increase the number of treatments provided.
The government is also planning broader reforms to the NHS dental contract before the end of the current parliamentary term in an effort to expand patient access.
Health and Social Care Minister Stephen Kinnock said progress was being made but acknowledged further action was needed.
“We know there is more to do to address the root causes of the problem,” he said.
An NHS England spokesperson added that clawback figures typically reflect data from the previous year and that any returned funds are reinvested into dental services.
“We are working closely with the government to introduce further reforms in the coming months,” the spokesperson said.