For 20 years, NHS dentistry in the UK has been collapsing. What began in 2006 with the overhaul of how dentists are paid and contracted has spiralled into a full-blown access to dental care crisis. One that disproportionately harms the poor, the vulnerable and those with the greatest dental needs.
The cause of this crisis, is the Units of Dental Activity (UDA) system, introduced under the Tony Blair Labour government. It was supposed to simplify payments and contain costs, instead it created financial incentives that reward easy, low-need treatments while penalising dentists for taking on complex treatment cases. The result has been widespread dentist withdrawal from the NHS, and a dramatic drop in access to dental care for those who cannot afford private treatment.
In England in 2024, only about 40% of adults had seen an NHS dentist in the previous two years, down from over 50% in 2006. This means millions more people have routine or urgent dental needs going without treatment. (1)
An estimated 13 million adults now are going without treatment in NHS dentistry, with more than 5.6 million adults in recent years failing to get an appointment at all, and a similar number not even attempting to seek treatment because they think it’s futile. (2)
For many, there simply is no NHS dentist to go to. Among people without a regular dentist, up to 97% of them were unable to access NHS dental care even after trying, forcing many to pay for private treatment or go without. (3)
One dangerous consequence of this shambles has been people resorting to unsafe alternatives, with people attempting DIY dental work on themselves, because NHS appointments either don’t exist or are so scarce. (4)
Children are also suffering. Almost half of children in some parts of the UK have not seen an NHS dentist in a full year, a dramatic reversal from earlier decades. (5)
This isn’t a minor access problem but a systemic failure. The contractual model that was introduced has made many dentists reluctant or unable to take on NHS patients. Practices close their books to new NHS patient registrations, and in some regions NHS dental care has effectively ceased to exist for much of the local population. (6)
Two decades on from the UDA reforms, the promise that everyone needing a dentist would be able to find one under the NHS has vanished. Instead, dentistry has become a postcode lottery and a two-tier reality, where those with money get care and those without often go untreated.
