A Nuffield Trust analysis highlights widening inequalities in UK dental care as fewer practices provide NHS services, making access increasingly difficult.
England’s dental care system is showing a growing divide, with NHS access becoming harder for patients who cannot afford private treatment.
A new Nuffield Trust analysis found that the share of dental practices offering NHS general dentistry fell from 64.6% in 2017 to 55.6% in 2026, with around 600 practices leaving NHS care. (1✔ ✔Trusted Source
The great extraction: the changing state of NHS general dental services in England
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NHS Dentistry Is Becoming a Two-Tier Service
The Nuffield Trust says England is seeing a continued decline in dental practices providing NHS dental care. Its latest analysis found that nearly 600 practices have stopped offering NHS general dentistry over the past decade, raising concerns about a growing two-tier dental system.
For patients, this can mean a difficult choice: wait for an NHS dentist or pay privately for faster treatment. The problem is especially serious for people who cannot afford private dental care, potentially widening oral health inequality.
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Why Are Patients Struggling to Find NHS Dental Care?
Access to NHS dentistry varies widely across England. Nuffield Trust data shows that in June 2025, only 40% of adults had seen an NHS dentist within the recommended two-year period, compared with 50% before the pandemic. (2✔ ✔Trusted Source
NHS dental services
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The shortage is not simply about the number of dentists. Many dentists provide both NHS and private treatment, while concerns about the NHS dental contract, workload, and funding can influence how much NHS work practices undertake.
The House of Commons Library has also highlighted the uneven distribution of dentists and the emergence of areas described as “dental deserts.”
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What Is Driving the NHS Dentistry Crisis?
A major issue is the way NHS dental services are funded. Dentists are paid through a system based on Units of Dental Activity (UDAs). Critics argue that this model does not fully reflect the complexity of patients’ needs and can make it difficult to provide comprehensive NHS care.
Funding pressures are another concern. The Nuffield Trust reported that spending on dentistry in England was 31% lower in real terms than in 2009/10 in its 2025 submission. It has called for major NHS dental contract reform and better targeting of services toward people who cannot afford private treatment (3✔ ✔Trusted Source
Fixing NHS dentistry: Nuffield Trust submission to the Public Accounts Committee
The government has introduced changes to NHS dentistry payments and quality measures in 2026, including reforms aimed at improving access and supporting preventive care. However, dental organizations say wider reform is still needed. (4✔ ✔Trusted Source
NHS dentistry: quality and payment reforms contractual guidance
A Patient’s Perspective: When Dental Care Depends on Your Wallet
For many patients, the issue is no longer simply finding a dentist; it is finding one who accepts NHS patients. Those who can afford private dentistry may have more options, while others may delay routine check-ups or treatment.
That delay matters because regular dental visits can help detect tooth decay, gum disease, and other oral health problems early.
Nuffield Trust data shows that emergency hospital admissions for dental decay reached 2,528 in 2023/24, highlighting the potential consequences when preventive dental care is difficult to access. (2✔ ✔Trusted Source
NHS dental services
If access continues to depend on availability and affordability, the gap between NHS and private dental care could become even wider.
And when getting a dental appointment starts feeling harder than getting a tooth pulled, something clearly needs fixing.
References:
- The great extraction: the changing state of NHS general dental services in England – (https://www.nuffieldtrust.org.uk/news-item/the-great-extraction-the-changing-state-of-nhs-general-dental-services-in-england)
- NHS dental services – (https://www.nuffieldtrust.org.uk/resource/nhs-dental-services)
- Fixing NHS dentistry: Nuffield Trust submission to the Public Accounts Committee – (https://www.nuffieldtrust.org.uk/sites/default/files/2025-04/Dentistry%20submission.pdf)
- NHS dentistry: quality and payment reforms contractual guidance – (https://www.england.nhs.uk/long-read/nhs-dentistry-quality-payment-reforms-contractual-guidance/)
Source-Medindia