Key Summary
- The number of practices without an NHS contract, largely private or specialist providers, has increased by almost 1,000.
- The South West and East of England have seen particularly steep declines, highlighting persistent regional inequalities in access.
- The authors warn this was creating a two-tier service, with the access depending on what people can afford to pay and where they live.
Around 600 dental practices in England have stopped providing general NHS dentistry services since 2017, as more practices move towards private care, claims Nuffield Trust.
The authors of the study warn this was creating a two-tier service, with the access depending on what people can afford to pay and where they live.
The analysis shows the proportion of dental practices offering general NHS dentistry has fallen from around 65% in 2017 to around 56% in 2026.
Over the same period, the number of practices holding an NHS general dental contract has fallen by around 600 – equivalent to around one in ten NHS dental practices.
The number of practices without an NHS contract, largely private or specialist providers, has increased by almost 1,000.
The decline has been almost universal across England, with the number of NHS dental practices falling in 41 of the country's 42 integrated care boards.
However, the South West and East of England have seen particularly steep declines, highlighting persistent regional inequalities in access.
The analysis suggests the trend has accelerated since the Covid-19 pandemic, as growing pressures within the NHS dental contract have continued to push practices away from NHS work.
The authors argue that the reforms introduced in April do not address the underlying incentives driving practices away from NHS dentistry.
As per the reforms, urgent dental care has been made a contractual requirement and payments for some complex treatments have been increased.
The authors warn that this trend may help explain the poor results from the GP Patient Survey, which showed that half of adults have not sought an NHS dental appointment in the past two years.
Among those who did not try, one in four said it was because they did not believe they would be able to get an appointment. Of those who attempted to get a new appointment, just 38% were successful.
The Nuffield Trust says the success of the government's promised fundamental contract reform should be judged by whether it succeeds in bringing practices back into NHS dentistry and reverse the long-term decline in access.
Paying practices to care for a population, based on local need rather than the number of individual treatments they complete, would create stronger incentives for dentists and help restore access based on need, not ability to pay.
A quiet transformation
Nuffield Trust Policy analyst Mark Dayan said: "The retreat of NHS dentistry was never an announcement or a policy. There has been no closure programme for people to oppose.
"But it amounts to the quiet transformation of dentistry into a two-tier service over the last decade, where access increasingly depends on what people can afford to pay and where they happen to live.
“As the government delivers the contract reform it has promised, it will face a stark choice. Either it makes NHS work attractive enough to turn this trend around and bring back enough practices to cover everyone, or it will need to give up on the promise of a universal service and prioritise those who need preventive care most, or do not have the money to pay privately.
“If the government tries to dodge this decision, the gradual drift away from NHS treatment will mean we have abandoned the health service's promise of comprehensive care for those in need, with some parts of the country hit much harder than others.”
Lessons for pharmacy owners: Akomolafe
Baba Akomolafe comments on the Nuffield Trust's analysis. Baba Akomolafe
Commenting on the findings, Baba Akomolafe, founder of Christchurch Pharmacy, said: "What I find particularly interesting about the Nuffield Trust’s analysis is the narrative: “The NHS has lost around 600 dental practices.”
"When around 600 dental practices stop providing NHS dentistry, it is rightly recognised as a loss of NHS capacity.
"Yet more than 1,000 community pharmacies have disappeared from the network over the past decade, but the narrative is much more often about pharmacies closing as businesses rather than the NHS losing valuable frontline infrastructure and patient access.
"That distinction should concern us pharmacy owners.
"Community pharmacy leaders are doing their level best to challenge government nationally, but perhaps this report should also be a catalyst for grassroots pharmacy owners to think differently.
"Alongside the NHS 10-Year Plan, perhaps we need to start developing our own 'Private 10-Year Plan'.
"Not because we want to walk away from the NHS, but because we cannot build the future of our businesses on the assumption that NHS funding and policy will always sustain the infrastructure we have today.
"If the NHS doesn’t recognise what it is losing, pharmacy owners may eventually have no choice but to recognise it for themselves."
