Dental student Amirali Ziaebrahimi explains why the government’s proposed healthcare changes risk deepening the crisis in dentistry.
The government’s recently announced NHS 10-Year Health Plan includes ambitious goals for dentistry: expanding neighbourhood health services, extending opening hours to 12-hour days, six days a week, and proposing mandatory NHS service commitments for newly qualified dentists.
At first glance, such measures seem designed to fix the chronic access crisis plaguing NHS dental services. Yet, without urgent reform of the underlying dental contract, this plan risks becoming a recipe for disaster.
The contract at the heart of the crisis
NHS dentistry is already in a fragile state. The current dental contract – introduced in 2006 – has long been criticised for its rigid activity targets and financial penalties, failing to reflect the time, skill, and complexity required to deliver quality patient care. The British Dental Association (BDA) has repeatedly warned that the contract drives clinicians away from the NHS, with reports showing over 40% of dentists reducing their NHS work or planning to leave entirely.
Imposing compulsory service on new graduates under this system is short-sighted. It fails to address why dentists are leaving in the first place and risks turning NHS dentistry into an increasingly undesirable career path. As human behaviour demonstrates time and again: force professionals into untenable working conditions, and they will find ways to leave.
Recently, care minister Stephen Kinnock defended the proposed three-year NHS tie-in for new graduates by stating: ‘On average, it costs the British taxpayer around £200,000 to educate and train a dentist. Yet we estimate around one third of the current workforce does no NHS work whatsoever. We don’t think this is right and I do think there’s an element of principle here. It is only fair that there is a return on that investment.’
While Mr Kinnock is quick to cite the £200,000 cost of training dentists and the statistic that around 30% of dentists do no NHS work post-foundation training, several important details remain conspicuously absent. He doesn’t clarify the age range of the dentists surveyed, who conducted this survey, or what proportion of those so-called non-NHS dentists actually work in mixed practices – still delivering NHS care alongside private work. The reality is that many of the 70% who stay in practice likely contribute significantly to the NHS, even if not exclusively.
Moreover, there’s a crucial point that seems overlooked: as dental students, we begin providing patient care quite early in our training. A significant portion of our studies is spent delivering treatment under supervision, contributing to patient services without any financial compensation. We don’t get paid for this work, nor do we complain. What does Mr Kinnock have to say about the value of that contribution?
Rather than resorting to blanket tie-ins, the government should seek to understand the complexities behind why dentists choose to leave or stay, and address those root causes. Only then can NHS dentistry become a career path that new graduates willingly and enthusiastically commit to.
A pipeline under threat
This plan could have profound consequences for the future of the profession. Dentistry is already witnessing falling morale among students and young graduates. The prospect of being tied into an overstretched, underfunded NHS for three years, while grappling with significant student debt, may deter talented applicants – particularly those from minority backgrounds who already face barriers to higher education.
Alarmingly, there’s no mention in the plan of addressing the financial burden new dentists face. The government often cites the £200,000 cost of training each dental student, yet remains silent on practical measures like student loan forgiveness, tax relief or fair remuneration during the crucial early years of practice – which are often the most professionally and financially stressful.
Also, it’s important to remember that this period is not only pivotal for career development but also for personal milestones such as building relationships, marriage, or buying a home. How is a newly-qualified graduate expected to achieve any of this under such conditions?
Risk of two-tier dentistry
One of the gravest risks lies in fuelling the growth of a two-tier dental system. If NHS dentistry becomes increasingly unattractive, private dental schools may proliferate, potentially excluding students who can’t self-fund or secure corporate sponsorships. The result would be an elitist profession, disconnected from the communities it serves and dominated by corporate providers able to absorb the costs and logistical demands of expanded service hours.
Moreover, while neighbourhood health hubs may offer long-term benefits for integrated care, they don’t address the immediate crisis: patients in pain who cannot access a dentist. Nor does the plan explain who will staff practices operating 12 hours a day, six days a week, under the current contract’s constraints.
Remembering NHS dentistry at its best
At its peak, NHS dentistry rewarded clinicians fairly, allowed time to deliver patient-centred care, and offered professionals the freedom to balance NHS and private work – fostering clinical excellence. Without bold contract reform, we risk losing this balance entirely.
Tying young dentists to a failing system won’t stop experienced clinicians from leaving. True reform must make NHS dentistry a place where professionals choose to stay – a career path offering respect, fair compensation, and sustainable working conditions.
As a profession committed to public health, we must continue to advocate for a reformed NHS dental contract that values both patients and practitioners. Otherwise, the next decade may cement a crisis we can ill afford.
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