Dentistry in Decay: A&Es swamped by thousands of dental patients unable to get an appointment at their local NHS practice

Tens of thousands of people are turning up at the UK’s overstretched A&Es each year with toothache and other dental complaints, we can exclusively reveal.

By Michael Holmes
Monday, 23rd November 2020, 6:00 am

Critics have blamed the growing trend on rocketing fees for NHS dentistry and continued difficulty accessing appointments, particularly in England – even before the first coronavirus wave brought dental treatment to a standstill.

The British Dental Association (BDA), which represents dentists, has called on the Government to “stop treating our patients like a cash cow”.

Health chiefs have urged people with urgent tooth problems to seek treatment at emergency dental services instead of A&Es.

Sign up to our public interest bulletins - get the latest news on the Coronavirus

A file image of two dentists carrying out a procedure on a patient during the pandemic (Picture: Leon Neal/Getty)

More than 77,000 people turned up at the UK’s A&E departments and minor injury services in 2019/20 with dental problems, costing the NHS an estimated £13m, the figures obtained by JPIMedia Investigations show.

And with not all NHS bodies responding to our Freedom of Information requests, health experts say they fear the real cost will be higher.

Common complaints included toothache, cavities and gum disease.

The BDA said in almost all cases, patients were unlikely to get anything more than pain relief and would be referred to a dentist, meaning this route offered people little help while lumbering the NHS with extra costs.

The Dentistry in Decay logo

Dave Cottam, below, chairman of its General Dental Practice committee, said: “It’s no surprise patients were turning up at A&E departments in droves. Millions have struggled to secure an NHS dental appointment, and those that do find themselves clobbered with inflation-busting hikes in charges.

“Covid has simply upped the ante. When ministers treat dentistry as a Cinderella service the impact is felt across the NHS.

"Sadly, a decade of cuts is pushing patients to overstretched A&E medics and GPs who are neither trained nor equipped to treat them.

“We will see no progress until the Government stops treating our patients like a cash cow and provides adequate funding.”

Dentistry is a devolved matter. In England, dental treatment fees have seen nearly a decade of inflation-busting hikes.

A fee rise planned for April was postponed because of the coronavirus pandemic, and the Department of Health and Social Care says ministers are now considering whether and when to lift this freeze.

Meanwhile, the amount invested into dentistry each year by the Government has fallen by a fifth – nearly £500m – in real terms since 2010.

The Department of Health and Social Care said: “Dental charges help towards the running costs of the NHS, but we carefully consider them every year and continue to offer people on low-incomes free treatment through exemptions and the NHS low-income scheme.”

It said dentists have been able to remain open during the second national lockdown, and those practices holding NHS contracts have continued to be paid in full throughout the pandemic.

In England, almost 64,000 people suffering dental problems turned to A&E departments and minor injury units in 2019/20, figures released by hospital trusts under the Freedom of Information Act show.

A spokesman for NHS England disputed the claim that people were struggling to get dental appointments, saying: “Nearly 25,000 dentists are offering NHS care – the highest number on record – and during the first wave of the pandemic, over 600 urgent dental centres were set up so patients could access the care they needed.

“Dental practices are open and are understandably prioritising urgent care alongside recalling patients to complete routine care.”

Writer's 105-mile trip to see dentist as woman is left in pain

People from across Lancashire have told of their difficulty getting access to timely, affordable, and local treatment.

Travel writer Carol Kubicki, 60, faces a 105-mile round trip to get her teeth seen to by an NHS dentist. She said: “It’s a day out!”

Carol, who lived in Preston for almost 30 years before moving to Salford 12 years ago and Morecambe last year, said she’s been on the waiting list in the seaside town since 2019.

She had “three or four” different NHS dentists during her decades in Preston but was forced to keep switching as each began turning away NHS patients to go private.

“Getting an NHS dentist was always what we [she and her partner] wanted to do,” she said.

“Then they would stop and we would have to go on the list for another one.”

Carol was able to find a dentist after moving to Salford, but not when she shifted to Westgate in Morecambe – leaving her with a lengthy trip for any dental work.

She said: “However you get there it’s an extra cost but it’s still cheaper than going private.”

Fiona Taylor, from Blackpool, said she hasn’t been able to find a dentist taking NHS patients for years – with private care too expensive for her.

She said: “I’m now in a position where I need so much work doing to my teeth that I simply can’t afford it. I work and am entitled to no financial help, yet if I was at home and unemployed I’d get it all free.

“So now I have no choice but to stay in pain most of the time.”

Fiona said she has a number of broken molars, which makes eating tough and gives her recurring abscesses.

“I’m getting to a point where I just want them all ripped out and be free of them,” she added.

“I’m in so much pain when I eat because I can’t chew properly.

"It’s hell and it’s unfair that there isn’t more help for those who may well work but may not have the disposable money to pay for dental work straightaway.

"It’s physical and mental torture.”

A Preston mum, who asked not to be named, said appointments for her three children, aged 12, seven, and five, have been cancelled several times during the pandemic.

The seven-year-old’s mouth is “completely decayed” and has even been to hospital to be seen.

“She is not in pain but if she opens her mouth you see there’s something going on,” mum said.

Her five-year-old, a boy, was given antibiotics over the phone after his mouth swelled, but he hasn’t been seen by a dentist because of the pandemic.

His mum said: “Dentists need to be checking their teeth because otherwise you don’t know what’s happening.”

The use of antibiotics went up during the pandemic, with dentists unable to see some patients but still wanting to provide help.

Patients abandon vital NHS dental treatments because they 'cannot afford rising fees'

People are abandoning vital NHS dental treatments because they cannot afford the rising fees, dentists have warned.

Six million bills of £100 or more have been handed to UK patients in the past five years, totalling more than £1.3bn, JPIMedia Investigations can exclusively reveal.

While annual dental fee increases of five per cent have become the norm in England in recent years, last year the cost of many common treatments saw inflation-busting hikes across Wales, Scotland and Northern Ireland as well.

Governments across the UK have said there is help available for people unable to afford dental fees.

President of the Oral Health Foundation, Dr Ben Atkins, said he has had “quite a few patients” fail to show up for treatment or even disappear halfway through a course of appointments.

He said: “They will book in for a treatment and then not turn up because they don’t have the money for it.”

Dr Atkins said help was out there for patients who do not qualify for free treatment, but he suspected people did not know where to find this.

While NHS dental treatment is free for children and people on low incomes across the UK, for those who have to pay the cost can be in the hundreds.

In England, patients have had to pay Band 3 bills some 4.6m times since 2015/16, totalling £1.1bn.

But 120,000 fewer people opted to undergo the costliest treatments in 2019/20, compared with five years ago – a 13 per cent drop.

The decrease is partly down to the pandemic as dental practices were closed and routine treatment was paused from March 25 to limit the spread of the coronavirus.

Patients could be facing higher charges next time they visit their dentist too.

Fees in England were due to rise in April but were frozen because of the coronavirus pandemic.

In late October, the Department of Health and Social Care said ministers were considering whether and when any uplift should be applied.

'More help could stop dentists leaving the NHS'

The NHS in England should follow the example of Scotland and invest in retention schemes to reward dentists who remain in the NHS, according to the British Dental Association.

The number of independent practitioners providing NHS treatments has increased north of the border by 35 per cent since 2007.

But NHS England hasn’t invested any money into retention or golden handshake schemes since 2013, when it was set up to take over from the NHS Commissioning Board.

The British Dental Association (BDA) said Scottish dentists with five years’ service are rewarded for treating NHS patients through quarterly ‘commitment payments’ scrapped in England in 2006.

It also criticised the “failed” contract system in England and Wales, which was brought in the same year and sees dentists paid per course of treatment. In Scotland and Northern Ireland, they are still paid for each individual treatment.

Dave Cottam, chairman of the BDA’s General Dental Practice Committee, said: “England offers nothing to recognise and reward commitment to NHS dentistry. Restoring some of the approaches still active in Scotland could help throw this service a lifeline.”

Dr Shalini Kanagasingam, a senior clinical lecturer at the University of Central Lancashire, which has its own dental clinic, said more dentists would stick with the NHS if they were given more support.

She said: “I know a lot of NHS dentists and there’s a lot of satisfaction in delivering that care within the NHS.

“But I think we are not really getting the support that we need to deliver some procedures.

"If you do the math, I wonder how general dentists actually do carry out the treatment and cover the costs.”

When asked why it doesn’t offer golden handshake or retention schemes, NHS England said there were more dentists doing more NHS work last year than a decade ago.

It said patients were also more satisfied, with 92 per cent able to get an appointment, according to a survey of 771,000 people.

A spokesman said: “Nearly 25,000 dentists are offering NHS care, the highest on record, and there are 3,000 more dentists offering NHS care compared to 2009.

“This means more than nine out of 10 people needing a dental appointment are able to get one when they ask for one.”

Recruitment market has 'taken a beating' during the Covid crisis

The dentistry recruitment market has “taken a beating” throughout the pandemic, with the number of vacancies plummeting by 60 per cent, according to a leading recruiter.

Malcolm Barker, whose firm BMR Dental works across the UK, said dentists were routinely interviewing at four or five different surgeries – some of which were offering £5,000 to £30,000 golden handshakes out of their own pocket – before Covid arrived on our shores, with demand for dentists far outstripping supply.

But he said most practices have now “put a hold on recruitment”.

“This has been a combination of practices closing, restrictions in practice, and a reduction in targets that have been put in place by the NHS, while guaranteeing payment of NHS contracts,” he said.

Prior to the pandemic, scores of job adverts across the country remained unanswered for years, with coastal and rural areas said to be the worst hit.

Mr Barker, whose firm has 20 years’ experience, said: “No longer could you place an advert and expect a response.

“I don’t think there’s one reason why. It’s smaller pieces building up to the big picture.”

Heavy investment from private equity firms had led to an explosion of new practices, with NHS red-tape and restrictions on overseas recruits also playing a role, Mr Barker said.

“The initial uncertainty of the economy caused dentists to stay put and it never really recovered from that,” he added.

“There’s such a demand, salaries are going up to a level we have never experienced before.”

Practices are paid a set amount by the Government to treat NHS patients, with dentists increasingly being given a bigger share – taking their pay packets up to around £60,000 a year even when newly qualified, he said.

Mr Barker said he had never placed any recruits into Blackpool, describing it as “one of the more difficult locations to recruit for”.

He said: “We do have vacancies in Blackpool, we just don’t get applications.

“We placed one locum for a short period and that was a dentist from outside the area on £500 per day.

“Practices are having to go to extremes to keep things ticking over.

“On a permanent basis we are not getting any interest.

“I think it’s just down to the simple fact there are no dentists in the area.”

NHS England said there were more dentists doing more NHS work last year than a decade ago.

It said patients were also more satisfied, with 92 per cent able to get an appointment, according to a survey of 771,000 people.