Almost a third of people in England now use private dentistry, with a sharp rise in the number of poorer households forced to pay for fillings and extractions.
Shortages of NHS care mean the proportion of people using private dental services rose from 22% in 2023 to 32% at the end of last year, the health service’s patient watchdog found.
Reliance on paid treatment is so significant that dental care is becoming an expensive “single tier” (private only) service for more and more people, warns Healthwatch England.
He is concerned that the percentage of people who describe themselves as having financial difficulties and who have turned to private dentistry has almost doubled in recent years, from 14% to 27%.
Those who do so will receive a “double penalty,” the watchdog added. This is because dentists charge much more for private work than for the NHS, for example £64 for a check-up that costs just £27.40 on the NHS. And they may also lose out because many low-income patients, as well as all pregnant women and new mothers, miss out on the free NHS dental care they are entitled to because they cannot find a dentist who will treat them as health service patients.
“Our findings are a warning that for some people there is only one level of dental care – private,” said Rebecca Curtayne, acting head of policy, public affairs and research at Healthwatch England. “It is the most vulnerable people in our society who are bearing the brunt of the current shortage of dental appointments on the NHS.
“Too many low-income people are forced into private care that they struggle to afford, or go without treatment. The system is failing those who need it most.”
Healthwatch’s findings are based on a representative survey of 2,593 adults it conducted last October and November to inform its annual report on the patient experience in healthcare, which it will publish later this week.
According to Curtayne, ministers should address the access crisis by giving everyone the right to see an NHS dentist in the same way they have the right to be on a GP’s list. Healthwatch, the NHS patients’ legal ombudsman, is being abolished as part of Wes Streeting’s controversial reorganization of the NHS in England.
The big shift towards private dental care showed that NHS dentistry now “exists in name only for many people”, the Patients’ Association said.
“This report is further damning evidence about the state of NHS dentistry and this double penalty for low-income people demonstrates a systemic failure with real human consequences,” said Rachel Power, the association’s chief executive.
“It’s not just about the cost of dentistry. The lack of affordable dental care harms physical health, leaves people in ongoing, sometimes agonizing pain, and can take a heavy toll on mental and emotional well-being.”
Power added: “Healthwatch’s warning that we are sleepwalking towards an expensive, single-tier system is something we should all take seriously. While getting dental care simply means paying for it privately, the NHS dental service exists in name only for many people.”
The Competition and Markets Authority last week launched an investigation into the UK’s £8.4bn private dental market “to make sure it is working well for UK consumers”.
Explaining their decision, the competition watchdog’s chief executive, Sarah Cardell, said: “Going to the dentist is an important part of health and wellbeing. However, we are concerned that many may have concerns about costs, availability, treatment options and what they are entitled to. For some, resorting to private dentistry is an option, but for many it is a necessity.”
The CMA’s estimate of the number of people using private dental care in the UK (one in five) is substantially lower than Healthwatch’s 32% in England.
Its review will look at access to private dentistry, competition within the sector and the “significant” price increases that surgeries have imposed in recent years. For example, the cost of an initial consultation increased by 23% to £80 and a check-up by 14% to £55 between 2022 and 2024.
Dentists blame ministers for inaccessible NHS dental care. They say the NHS pays them so little to do certain types of work that they do it at a loss and have to subsidize them to the tune of £400 million a year just to cover the costs of those treatments.
The British Dental Association (BDA), which represents dentists, says this “funding shortfall… is inevitably putting some pressure on private prices. The government has a responsibility to adequately fund NHS care to prevent people being forced into private treatment.”
Responding to the announcement of the CMA investigation last week, Eddie Crouch, chairman of the BDA, said: “Those who have been left without options, who have felt forced to go private, are there entirely because of decisions made by the Treasury.”
The BBC revealed last week that dentists in England were doing so little work in the NHS that they had given back £936 million over the last two years of money allocated to them to pay them to carry out procedures.
A Department of Health and Social Care spokesperson said: “As this report shows, this Government inherited an NHS dentistry service that had been left to rot for more than a decade. “We firmly believe that everyone should be able to receive dental care, not just those who can afford it.
“We have taken immediate action to address this, providing 1.8 million more treatments in the first seven months of this year, meaning more children and the disadvantaged will benefit more. We are also reforming the dental contract to treat more patients and focus more on prevention. We are determined to end the two-tier service and make dental care accessible to everyone.”
