Source · Select Committees · Public Accounts Committee
Recommendation 5
5
Accepted
Publish analysis of actual NHS dental care costs, reflecting treatment complexity and community deprivation impacts.
Conclusion
DHSC and NHSE have not undertaken the analysis needed to understand the actual cost of delivering NHS dental care, without which any efforts at reform will fail to address fundamental issues around the affordability of NHS work. The discrepancy between what a dentist can earn delivering NHS work and private work is a fundamental issue for improving access. The current NHS dental contract, and its reliance on Units of Dental Activity (UDA) rates that were set nearly two decades ago, is unfit for purpose. Recent attempts to address disparities in what practices can earn for delivering NHS work by increasing the minimum UDA value first to £23 and then to £28, and to better reflect the different costs of treatments of greater complexity, have failed to deliver any identifiable improvements. We agree with DHSC when it says that fiddling around with the contract fails to address the real problem. In April 2023, there were 34,520 dentists registered to provide dentistry in England, but only 24,193 of these provided some NHS dental care in 2023–24. Without proper remuneration it is likely that even more will move exclusively to the private sector. However, it does not appear that NHSE and DHSC yet have a sense of what level of funding would provide a realistic incentive for dentists to prioritise NHS work. Until there is a clear and evidence–based proposal for remuneration that reflects the true costs of dentistry, that issue is unlikely to be resolved. recommendation DHSC and NHSE should commit in their Treasury Minute response to conducting and publishing analysis of the actual costs of providing NHS dental care as part of any future work on reforms to NHS dentistry, reflecting the full range of complexities of treatments that patients might need. This should include an explanation of how the current structure of payments to dentists, in terms of the range and complexity of treatment, has different impacts depending on the deprivation of the community served.
Government Response Summary
The government agrees to conduct and publish analysis of the actual costs of NHS dental care, engaging with the BDA on this work which is expected to be published in due course. They also note interim changes to UDA payments to incentivize more complex treatments.
Government Response
Accepted
HM Government
Accepted
The government agrees with the Committee’s recommendation. and engaging with the BDA on this work, which the government expects will be published in due course. The government is working to reform the dental system, and in the interim have made vital changes to how dentists are paid within the current UDA system, for example, through fairer payment for more complex band 2 treatments, in turn incentivising access for patients with a need for higher volume or more complex treatment within band 2. The government recognises that different communities will have different needs and that there is a link between deprivation and higher need for dental care. The national contract provides for the breadth of treatments that could be needed by different populations and it also enables flexible commissioning so that ICBs can commission tailored dental programmes and initiatives to meet the specific needs of their local population. ICBs are responsible for commissioning NHS dentistry to meet the needs of the local populations, as well as undertaking oral health needs assessments to identify areas of need.