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An analysis by the Financial Times found that NHS dentists in England had to pay back £147 million in government funding last year after failing to meet their treatment targets.
The sector said the underspending was the result of a “broken” NHS dental contracting system that forced dentists into private practices at a time of severe staff shortages and long waiting lists for appointments.
Under the terms of the NHS contract, dentists are paid a fixed income for providing a certain number of Units of Dental Activity (UDAs) or treatments each year. The number of treatments for which dentists receive annual compensation is limited.
Dentists said the system had left them struggling to cover their costs because simpler dental work was sometimes paid at the same rate as more complex treatments. This has been an incentive to admit more patients with complex needs, they said.
Practices are typically required to repay government funds if they fail to achieve 96 percent of their contracted UDA target. But last year the threshold was temporarily lowered to 90 percent to reflect the financial pressures dentists face.
“Underspending is not a reflection of a lack of demand for NHS dentistry – but the result of struggling practices failing to meet their penalty targets,” said British Dental Association chairman Eddie Crouch.
“Practices on the same high street receive different levels of remuneration and the BDA emphasizes that underspending is highest where UDA rates are lowest,” he added.
In 2022-23, dentists paid back £147 million in payments to the government after thousands of practices failed to meet their treatment targets, a comparable figure to previous years.
The FT analysis of data from the NHS Business Services Authority, a non-departmental part of the Department of Health and Social Care, examined General Dental Services (GDS) contracts – the arrangement used by four out of five practices.
In Somerset, repayments were more than three times higher than the England average of 5.5 per cent, with 17 per cent of funds repaid in 2022-2023.
Across the South West, the proportion or money repaid increased from 7 per cent in 2018-19 to 13 per cent in 2022-23.
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Practices also receive different amounts for the same procedure, leading to further regional differences in treatment. The analysis found that dentists in parts of the South West were paid a quarter less per treatment session than in the best-funded area of North East London.
The House of Commons Health and Social Care Committee has described the UDA contracting system as “not fit for purpose” and called for “urgent reform” to boost recruitment and retention in NHS dental services.
Many practices have reported that they have been unable to meet their targets due to recruitment issues as more dentists leave the NHS and move into the private sector.
Dr. Jenna Murgatroyd, chair of the local dental board for Cornwall and the Isles of Scilly, said her own practice was 1,000 UDAs short of its target, partly because it lost two dentists to private dentists last year.
Dentists working in both private and healthcare settings are now spending less time on NHS treatments. Data from NHS Digital showed the average hours spent treating NHS patients in England fell by almost a tenth, from 27.3 hours per week in 2018-19 to 24.8 hours in 2022-23.
“We have seen a rise in dentists being forced to leave the NHS to work privately over the last year and it would take a complete overhaul of the contract for morale to change,” Murgatroyd said.
“We are penalized for taking on new patients because they take more time and yet we are paid virtually the same amount of money for care,” she said.
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The Ministry of Health and Human Services said practices were already accepting new patients as a result of the “Dental Recovery Plan,” which is expected to create up to 2.5 million more appointments this year.
The plan includes offering dentists £20,000 worth of “Golden Hellos” for working in underserved areas and introducing mobile dental vans to rural and coastal areas where access is more difficult.
An NHS spokesman said it had announced new support for practices this year to meet contractual obligations and improve delivery.