Breaking up "Big Dentistry"
How to double the dental workforce, tackle dental deserts and make everyone smile.
England is now so short of dentists that fewer than half of us can see a dentist at the right time. Many people have given up trying. The problems are now so bad that the NHS spends £50 million a year extracting rotten teeth from children. That is tragic on so many levels.
According to the NHS, adults should see a dentist every other year, while children should see one every year. But rather than 44 million adults receiving a dental check-up over the past two years, only 18 million saw a dentist - and only half of England’s 12 million children did so.
Things are getting worse as well: the number of dentists fell last year, and more than 7 million fewer people saw a dentist after the pandemic than before.
Some people won’t see a dentist unless they’re in extreme pain, and others go private. But this doesn’t explain why 87% in North Kesteven or 78% in King’s Lynn haven’t seen an NHS dentist recently. Much more likely is that no local dentist will see them - and have given up looking.
How did we get here?
NHS dentistry is different from NHS healthcare in two ways.
First, most people have to pay. Current charges start at £26 for an examination and polish, up to £307 for complex procedures like crowns or dentures.
Second, the private sector provides most NHS dentistry. Individual dentists and practices sign NHS contracts and the NHS pays them for their work. Unlike GPs, they can sell patients private treatment, like teeth whitening.
With no constraints on where they work, we have “dental deserts”, where it is impossible to find an NHS dentist because there aren’t any. Dentists have an incentive to move to affluent areas where it’s easier to upsell private treatment.
Finally, when the coalition government liberalised university places, medical courses - including dentistry - were excluded, constraining numbers and leaving Britain short of doctors and dentists.
The Government’s new dental plan starts to tackle some of these challenges by raising dentist fees, rewarding them for seeing people overdue for an appointment and offering bonuses for dentists moving to underserved areas.
It also pledges to “bring forward legislation early this year to enable dental care professionals to work to their full scope of practice.” Here’s where Onward’s proposals come in.
What should be done?
Thankfully, few of us need to see a dentist—check-ups, polishes, and fillings can all be performed by dental therapists, who are trained and licensed to do this.
These professionals can’t run their own practices or work alone. That’s why we need to liberalise dentistry to allow more people to receive dental care.
Everyone should, as a matter of course, see dental therapists for routine appointments. Dental therapists would refer patients to dentists as and when necessary - just like a GP refers people to a specialist for more complicated cases.
This is not dumbing down or a reduction in quality. Dental therapists are highly trained and skilled. They have a three-year degree in dentistry. They can do this job.
This would immediately increase the size of the workforce, as it would allow dental therapists to work on their own, running their own practices.
A dentist currently costs the government £65,700 to train. In contrast, it costs £33,870 to train a dental therapist. We can therefore train roughly twice as many dental therapists as we can dentists for the same budget.
All dentistry students would start a three-year university course to become dental therapists. They can choose to extend by two years to become fully qualified dentists if they wish, or they can start work and see patients two years earlier than at present.
Doubling the workforce over time is the best and only way to ensure access for all and to cut waiting lists permanently. Better dental health for all would be something to smile about.
You can read more about Tim Leunig’s dental proposals in his short research note, Smiles All Round, published by the think tank Onward.
Tim is Onward’s part-time Chief Economist. He served as a senior UK government advisor for a decade, supporting two Chancellors and six other cabinet ministers. He invented the UK’s furlough scheme.