New analysis shows that hundreds of dental practices across England have withdrawn from NHS dentistry over the past decade, accelerating the shift toward a two-tier service in which access increasingly depends on where patients live and what they can afford. The Nuffield Trust, which examined the data, found that nearly 600 practices that once offered NHS care no longer do so, with the sharpest falls recorded in the South West and East of England. More than one in ten practices that previously treated NHS patients have stopped, leaving some communities with virtually no option for an NHS appointment.
NHS dental activity is now 8% lower than it was before the Covid-19 pandemic. According to the NHS GP Patient Survey, six in ten adults have not seen an NHS dentist in two years, and of those who tried to book a new appointment in that period, only 38% succeeded. Cornwall has been hit particularly hard: more than a quarter of practices there that once provided NHS treatment have ended that work. Devon, Northamptonshire and Somerset have also seen significant reductions, with fewer than one in five practices in Somerset now offering NHS services.
Patients describe the struggle in personal terms. Alan, an 83-year-old from Somerset, said he has given up trying to find an NHS dentist and now has only one tooth left after the others crumbled over the years. He has adapted what he eats, joking that he has perfected a way of eating Brazil nuts. Vivak Shah, who runs three dental practices in Northamptonshire, still offers NHS treatment but said it operates at a loss and he no longer takes on new NHS patients. He warned that if more practices stop providing NHS care, patients could be left in pain or end up in hospital emergency departments.
Some dentists have already made the decision to walk away. Jim Sykes, a dentist in Hexham, handed back his NHS contract in 2024. He described it as a difficult emotional decision, driven by sustained financial losses, and said none of his former classmates still works in NHS dentistry. “There has been a real breakdown in trust for me,” he said, adding that even a new government offer would not easily persuade him to return to the NHS contract system.
Mark Dayan, head of public affairs at the Nuffield Trust, said the repeated handing back of contracts over a decade amounts to “the quiet transformation of dentistry into a two-tier service.” Shiv Pabary, chair of the British Dental Association’s General Dental Practice Committee, blamed “choices made by successive governments” and urged ministers to fix and fund NHS dentistry before more dentists reduce their NHS work or leave entirely.
The government says it is changing the dental contract, training more dentists in underserved areas, and will require newly qualified dentists to work in the NHS for at least three years. The campaign group 38 Degrees described the crisis as “shameful,” saying people are being forced to pay unaffordable fees or suffer pain and complications from being denied vital NHS care. Overall, the number of dental practices in England has risen over the decade, but as Dayan noted, “This is not a shortage of dentistry but a shortage of NHS dentistry.”