Dentists barred English NHS patients over skipped checkups in pandemic

People queueing to register at a dentistry practice in Bristol last week. Photograph: Simon Chapman/LNP

Patients across England who failed to visit their dentists since the beginning of the Covid-19 pandemic have been systematically barred by some clinics from getting NHS treatment.

Dental practices across the country informed patients they could no longer get NHS treatment, citing non-attendance over a period of two years or more that included lockdown.

The Observer has established that many of these patients were not given any written warning and now face potential future treatment costs of thousands of pounds.

The decision to “de-list” some NHS patients comes as the government faces growing anger over the state of dental care in the country, with many patients resorting to “DIY dentistry” out of desperation. Ministers last week launched a recovery plan, with £20,000 bonuses for dentists in areas with the poorest access to NHS care.

PM Rishi Sunak has repeatedly cited the £3bn annual budget in England for NHS dentistry, but it has fallen in real terms by more than £500m in a decade. It also includes dental charges paid by NHS patients worth almost £747m in 2022/23, according to the latest accounts of the Department of Health and Social Care.

This weekend, responding to the Observer’s findings, Healthwatch England, the health and social care champion, said it wanted reforms to allow patients to register with a dental clinic in the same way as a GP surgery. Chris McCann, its director of campaigns, said: “It’s not uncommon for people to think that they are ‘registered’ with a dental practice only to discover that they have been ‘de-listed’ when they go to make an appointment.

“People want to sign up with a local NHS dentist in the same way as they register with a GP, knowing they’ll be there for them in the long term.” Under the current system, there is no official NHS dental registration scheme in England and practices can choose whether to provide NHS treatment on an individual basis.

Sylvia Suddes, 59, a copy editor from Huddersfield, said she contacted her dental practice after the pandemic in the autumn of 2021 and was told she could no longer get NHS treatment because of non-attendance. She has not seen a dentist since before lockdown. “None of my neighbours have got a NHS dentist,” she said. “When they have a serious problem they call NHS 111.”

When Boris Johnson announced a lockdown in March 2020 to prevent the spread of coronavirus, routine dental care was suspended. Dentists were allowed to resume in June, but infection control meant clinics were only able to see a fraction of their usual patients. The British Dental Association (BDA) said in the year from March 2020 about 28m courses of NHS treatment were missed in England.

Many people were anxious about appointments and some who have been “de-listed” said they were never contacted after lockdown. Trevor Maggs, 64, a writer, and his partner Gillian, 64, who live near Penzance in Cornwall, were told last week that NHS treatment at their local practice was no longer available because of non-attendance. They had been patients there since 2012.

“They haven’t refused to treat us, but have refused to treat us as NHS patients,” Maggs said. “We’ve got modest savings and spending thousands of pounds to have our teeth fixed is a bit galling.”

Maggs said his last appointment had been in early 2020 before lockdown. He said: “We are both still very cautious about Covid infections having had it quite badly very early in the first wave and at least once since.”

Lizzie Dunthorne, 32, a communications manager who lives in the Cotswolds, called to book a post-Covid dental appointment in August 2021. She was informed she had been could not have NHS care because she had not visited the clinic in Kidlington in Oxfordshire since late 2019. She was not given prior written notification. Dunthorne was unable to find another NHS practice and paid £90 for a private appointment. “They told me two fillings needed redoing at £220 each,” she said. “I haven’t booked to go back.”

In Scotland, patients must be given three months’ notice by a dental practice if it intends to remove them from a register. The rules do not apply in England, which allowed practices to “de-list” some NHS patients after the pandemic as they faced a backlog in care and the prospect of better returns from private practice.

There is now scant chance in many areas of finding NHS treatment, as seen last week in Bristol, where hundreds of people queued outside the St Pauls Dental Practice in the hope of registering.

Shawn Charlwood, chair of the BDA’s general dental practice committee, said hundreds of practices were cross-subsidising their NHS activity with private work. “Many dedicated colleagues are just looking for the exit,” he said. “The cash offered to dentistry doesn’t even begin to reverse a decade of savage cuts.”

The BDA does not have figures on patients in England who have been told they are no longer eligible for NHS care at specific clinics, but says practices faced “clear limits on patient throughput” after the pandemic.

The BDA says more than 12 million adults in England have unmet need for NHS dentistry, more than one in four of the adult population. An online survey of 500 UK dentists by the BDA last month found more than eight out of 10 had treated patients who had performed “DIY dentistry”.

NHS dentistry was founded in 1948, with clinics typically operating independently, providing both NHS and private treatment. Dental charges for NHS patients were first introduced in 1951 and by 2006 covered more than 400 items.

The BDA has called for a “decisive break” from the current dental contract for dentists, which was introduced in 2006 and pays providers an annual sum for delivering an agreed number of courses of treatment. MPs have said the contract is not fit for purpose. The government said last week it was developing further proposals for dental contract reform.

The Department of Health and Social Care said: “Our new dental recovery plan sets out how we will make access to dentistry faster, simpler and fairer. The plan – backed by £200m of government funding – will create an additional 2.5m dental appointments for patients over the next 12 months.”

“The government already invests more than £3 billion each year to support NHS dentistry and we are starting to see progress. Last year, 1.7 million more adults and around 800,000 more children saw an NHS dentist compared to 2022.”

A Commons’ health select committee report published in July recommended the government require patients to be registered with an NHS dentist. The government has said it has no plans to introduce official patient registration for dental services, because the current model allows “greater choice and flexibility for patients”.

An NHS England spokesperson said: “The NHS plan for dentistry will make it easier for patients to get an appointment by supporting dentists to take on new patients and helping practices set up shop in areas where there aren’t enough NHS appointments.”

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