NHS dentistry explained
The King’s Fund explains more about NHS dentistry in England.
What is NHS dentistry?
NHS dentistry provides treatment that is clinically necessary to keep mouths, teeth and gums healthy and free of pain and includes primary, community, secondary and tertiary dental services. In 2021/2022 the NHS contribution to dentistry was about £2.3 billion.
How is NHS primary care dentistry organised?
Primary dental services are one of the four pillars of the primary care system in England, along with general practice, primary ophthalmic services (eye health) and community pharmacy. These services use a ‘contractor’ model of care, which means that almost all NHS primary care services are delivered by independent providers contracted to the NHS.
There are around 11,000 independent dental provider practices in England, private businesses that provide a mix of both NHS and private dental care. About three-quarters of these hold contracts to provide NHS services. These practices might be dentists working as individuals or in partnerships or small businesses, although there are also a small number of large corporate dental providers. Dental providers who have a contract to provide NHS funded dental services can also offer private treatment to their patients. All dental practices must be registered with the Care Quality Commission.
There is no national registration system in dentistry like there is in general practice. People do not need to be registered with a dentist to receive NHS care and should be able to go to any dental practice that holds an NHS contract for treatment, without any geographical or boundary restrictions. Dental practices can choose whether they provide NHS treatment to new patients depending on whether they have capacity under the terms of their contract (see below).
Once a patient is accepted for an assessment of their treatment needs the practice cannot refuse to complete the course of treatment. Once the treatment is completed, the dental practice does not have ongoing responsibility for their dental care, though some NHS treatments, such as fillings, crowns and inlays, are covered by a 12-month guarantee. Dental practices have patients they regard as ‘regular attenders’ for the purposes of planning recall appointments. Dental practitioners can prescribe any items listed in the dental practitioners’ formulary, and can issue both NHS and private prescriptions.
Community dental services provide dental care for patients (adults and children) with more specialist needs. This might include people who need services such as general anaesthetics or sedation, orthodontics, or adults and children with particular needs such as physical or learning disabilities, medical conditions, people who are housebound and people experiencing homelessness. Community dental services are provided in a range of settings including mobile clinics, people’s own homes or care homes, hospitals and specialist health centres.
Most secondary care dentistry is provided by NHS hospitals, including the 10 NHS specialist dental hospitals in England. It includes services such as complex oral surgery, oral and maxillofacial pathology, dental and maxillofacial radiology. Secondary and tertiary care dental providers have an important role in providing dentistry training and may also provide emergency primary care dentistry.
