Access to NHS Dentistry

Alex McIntyre Excerpts

Thursday 22nd May 2025 Commons Chamber

[Alex McIntyre (Gloucester) (Lab)]

I thank my hon. Friend the Member for Great Grimsby and Cleethorpes (Melanie Onn) for securing this important debate. I also thank the dentists, hygienists, dental nurses and practice staff in my constituency who do so much to look after my constituents.

The reality is that the dentistry system we inherited from the previous Government is broken, and we need to fix it. Time and again when I am knocking on doors in Gloucester, I hear that patients cannot get the dentist appointments they need, that we have people pulling their own teeth out at home, and that there are children with teeth rotting in their mouths.

We need more NHS dentists in Gloucester. This week, I have launched a campaign to get a new dental practice in Gloucester city to deliver for my constituents, and I wrote to my local ICB earlier this week about it. We need to see this new practice as soon as possible, so I would welcome a meeting with the relevant Minister to discuss my campaign to deliver a new dental practice for my constituents.

I recognise that my ICB and this Government have made fantastic progress on urgent dental care in Gloucestershire. We have another 11,000 urgent dental appointments in my constituency and the wider area, which is already delivering for my constituents who are most in need. But what we really need are regular check-up appointments so that people can be seen more regularly. I welcome reform of the dental contract and the consultation with local dentists, and I encourage all dentists and dental practices in my constituency to get involved with it so that we can deliver a better dentistry system than the one left behind a year ago by the Conservative party.

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[Dr Danny Chambers (Winchester) (LD)]

I thank the hon. Member for Great Grimsby and Cleethorpes (Melanie Onn) for securing this really important debate. Before I was elected, I drove around Winchester, the Meon valley and the beautiful New Forest treating horses as a veterinary surgeon, and a key part of that role is providing regular dental treatment. Horses do not like going to the dentist any more than humans do, but they need to have their teeth brushed every six months—at least every year—or they get ulcers in their mouths and they can get infected tooth roots. When we have to remove a tooth with a root that is three inches long—especially on a hot day like today—we work up a sweat and it takes a long time, but it is really painful for the horse, even though we use painkillers and nerve blocks. Often, all of that would have been avoidable had they had regular dental treatment, and it costs the owner a lot more money. It is exactly the same with human medicine.

There is cross-party agreement, with no one disputing that prevention is better than cure, and when it comes to dental care in the NHS we are failing at even the most basic level of public health. I am not going to go through all the stats that hon. Members have repeated about the numbers of children needing general anaesthetics for dental care.

[Alex McIntyre]

Will the hon. Gentleman welcome the Government’s partnership with Colgate on tooth- brushing in schools so that we can tackle prevention with children and make sure they are not going into hospital with tooth decay because they are learning how to brush their teeth and doing so properly?

[Dr Chambers]

I absolutely welcome that fantastic initiative.

I visited two dental practices in Winchester, and both told me exactly the same thing: they want to do more NHS work, and they want to be there for their communities, but because of the current NHS dental contract they simply cannot make it financially viable. They are effectively subsidising their NHS patients with income from private work. The British Dental Association estimates that private dentistry in England cross-subsidises NHS care to the tune of £332 million a year, which is due to rise to £425 million if NHS practices are not offered any help with the tens of thousands in additional staff costs brought in by the increase in national insurance. With the NHS work they do perform, they do not have time for the education—the proactive, holistic healthcare— that they want to do. Instead, they have to get people through in a quick turnaround. I say this clearly: dentists are not the problem. They are doing their best within a contract that is outdated and damaging.

I also want to speak to something that is often overlooked in this conversation: oral health is not just about teeth. I know that my dentist colleagues, as in veterinary practice, routinely identify serious conditions such as oral cancers and squamous cell carcinomas during routine dental checks. Those cancers are often aggressive but spotted early, they can be treated. We also know that infections in the mouth can lead to things such as endocarditis, which is not a trivial condition, and there is good evidence that periodontitis can contribute to the onset of dementia. How many cancers are we missing? How many heart problems are we not avoiding by not having routine dental checks?

I will sum up now as I know that we are pushed for time. The Liberal Democrats will continue to fight tooth and nail for an NHS that includes dentistry. I managed to avoid making any jokes about equine dentistry, and Members will be glad to hear that straight from the horse’s mouth. We do not want NHS dentistry to be an afterthought; it has to be a core part of a truly universal, holistic health service. Everyone deserves access to routine dental care. Many Members have said that they live in areas that are dental deserts, where NHS dentists are rarer than hen’s teeth. It is clear that we have cross-party consensus. Let us get the dental contract reformed and let us make this Parliament the last one during which anyone has to extract their own teeth.

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[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I congratulate the hon. Member for Great Grimsby and Cleethorpes (Melanie Onn) on securing this debate. Dentistry is important. Dentists do not just deal with our teeth; they deal with our mouth and gums, they identify physical diseases that include cancer and they prevent sepsis. Last month, I visited The Dental Design Studio in Sleaford to celebrate its 20th anniversary of great dentistry and I met some fabulous, committed professionals. Somewhat unexpectedly, given the venue, I was asked to help judge a cake competition. Members and my dentist will be pleased to know that I brushed my teeth very well afterwards.

Access to NHS dentistry has been a problem for a very long time. When I moved house in 2001, there was no NHS dentist available and I travelled two hours to Redcar to see the wonderful dentist Mr Dixon for many years until he retired. After that, there was no dentist at all. Are we therefore short of dentists? No, we are not. The Conservative Government increased the number of new trainee places and the number of new dentists, and although the population increased, there are still more per capita than in 2010. As the Minister for Care has said,

“The issue is not the number of dentists…but the paucity of dentists who are doing NHS work.”—[Official Report, 25 March 2025; Vol. 764, c. 766.]

I encourage the Minister for Secondary Care to consider more dental places, because we see that one in 15 of the youngsters who want to become a dentist is turned away and, as such, they go overseas to train or train to do something else. Will she commit to a dental school not just in Norwich, but in other underserved areas, such as Lincoln?

The main problem, as many have identified, is the 2006 contract with the UDA bands for procedures, and there are several issues with that. First, the amounts vary between practices based on historical volume data; secondly, there is a disincentive to treat new or high-need patients; and thirdly, the UDA simply do not cover all the costs. The Conservatives improved that a little bit, ironing out some of the bizarre UDA contract terms and setting a new, higher floor for minimum UDAs. Yet there is much more to do, as we have heard today, to reform it completely. How are the Government getting on with that? Will the Minister give us an update, please? As the Public Accounts Committee notes,

“NHSE and DHSC do not yet know what that reform might look like or to what timescales it can be delivered”,

beyond a vague assertion that some reform is imminent.

[Alex McIntyre]

Will the hon. Lady give way on that point?

[Dr Johnson]

I will not because there is not much time at all.

I met Eddie Crouch from the BDA recently, who talked about the national insurance costs. Before today’s announced pay rise, dental practices were facing a 9.5% increase in staff costs, again pushing more of them further to private practice. Will the Minister ask the Chancellor to exempt NHS dentists from the national insurance contribution rise? There has also been discussion about compelling dentists to do a proportion of their work in the NHS, either by compelling dentists who are newly trained or by incentivising with the use of student loan repayments. Have the Government considered that?

We have many overseas trained dentists—some are British students who were trained overseas, some are foreign nationals—but the overseas registration exam has 2,000 people on its waiting list. Somewhat bizarrely, those who pass can work in the private sector, but not in the NHS without supervision. That seems somewhat incoherent. Does the Government have confidence in the exam or not? It is illogical to allow a person to practise as a private dentist but not in the NHS. It is also a clear disincentive to NHS practice. What good discussions have the Government had with the General Dental Council about this issue?

My right hon. Friend the Member for Herne Bay and Sandwich (Sir Roger Gale) has repeatedly raised the issue of Ukrainian dentists. There are 200 Ukrainians dentists in the UK. Why not assess them and allow them to work? It is better for them and for us.

Dentists form part of a wider team of hygienists, nurses, technicians and therapists. What are the Government doing to help people in each of those roles practise at the top of their skill range to provide greater dental care? What are the Government doing to support rural areas since they cancelled the mobile dental vans? What are they doing to ensure they deliver the 700,000 promised appointments a year, since they have delivered hardly any of them so far?