Many people ask us questions about the NHS dental care system. Why do we pay? How much should we pay? And how do we find NHS dentists, there seems to be so few? Many of these questions can be answered by explaining how the NHS dental system works. Toothpick co-founder and dentist in residence, Sandeep, tries to outline it simply, and explain what you should expect to pay.
Background, and patient cash contribution
Since the NHS was founded in 1948 the overriding principle was that it would be free to patients. So why do we pay each time we go to an NHS dentist? The answer is that there are certain exceptions; primarily dental, optical and prescriptions. For dental, patients make a major cash contribution to the cost of the treatment or visit. This is similar to the cash contribution for NHS prescriptions and has to do with the size of the national budget available for NHS dentistry.
Treatment is free for children (under 18), expectant mothers and those on certain government benefits. Since April 2006 all practices in England were automatically switched to new NHS dental charges by NHS England or face closure , meaning that the patient contribution to the costs would be fixed according to three ‘bands’ with different types of treatment (ranging from simple to complex).
Government funding, and ‘not accepting new NHS patients’
NHS dentistry is a small sector within the NHS, worth around £3.5Bn per year The funding for NHS dentistry is fixed and unlikely to increase in the coming 5 years (although many people, including us at Toothpick, are campaigning for this to be reviewed). 30 million people saw an NHS dentist in the last 2 years, representing less than half of the UK population. Dentists offers a limited set of dental treatments on the NHS and those that are not covered are available on a private basis. The amount of NHS dentistry a practice can do is agreed annually with the local payor of NHS dental services.
Once a dental practice has completed its annual limit then it will only be able to offer dentistry on a private basis – which is why you will sometimes find dentists saying they are not accepting new NHS patients. The new contract that came out in 2006 was intended to limit the amount of government spending on NHS dentistry, as previous contracts had no limit, which is still the case eg in Scotland.
Patient costs – the NHS dental charges ‘bands’
The contribution fee for paying patients is fixed into three fixed prices, which cover certain treatments. The cheapest dentist is band 1 and costs £18.50 and covers the basics eg initial examination, X rays and scaling and polishing when clinically necessary. Band 2 covers the most common dental treatments things like fillings and costs £50.50 – and importantly also covers everything in band 1 in the same charge. Band 3 is the most expensive at £219, covering everything in Band 1 and Band 2, as well as complex treatments like dentures and crowns. If you come back within two months, you are entitled to the treatments within the band you have paid for. Full details can be found in our infographic on 2014 NHS dental charges.Common treatments not covered include tooth coloured fillings or crowns on the back teeth and cosmetic treatment eg teeth whitening
So why do patients have to pay?
Although no formal information is available from NHS England, it is likely that the NHS dentistry budget which only serves around half of the population is already very stretched and access very limited. GP access is free for all patients and is relatively unlimited, which is why we typically don’t see any access problems there. NHS dental patients however are limited with the number of visits, the amount of treatment choice along with access to finding a new NHS dentist. Another change that came about with the new system in 2006 was that patients no longer need to register with a dentist. This means patients are free to see any NHS dentist with availability and, conversely, there are no obligations for the practice to providing an NHS dental appointment even if you have been to the practice before.
What can you do to keep dental costs down?
There are several things you can do to keep costs down, including:
- Asking for NHS treatment specifically, understanding what is available on the NHS, and completing treatments in that fixed priced band.
- Taking advantage of free dental care if you’re pregnant, up to 9 months after you baby is born, when your children are under 18, and if you are receiving certain benefits
- Comparing prices with those of private dentists, which are not always that much more expensive.
- Use Toothpick to find an NHS dentist near you – bearing in mind that even though there may not be any appointments available at your local dentist, there could well be appointments a little bit further away, at less busy practices. Because there is no formal dentist registration process, you’re free to move around to wherever a dentist can see you
- If you can’t find an NHS appointment anywhere near you, consider taking out a dental insurance plan to go private (typically around £12-20/month) or stay tuned for our Toothpick VIP programme launching soon, which will give you an immediate 20% discount off any private treatment
The future for NHS dentistry
For the last three years, NHS England have been trying to test a new contract that puts more focus on preventing dental problems rather than just curing them. The need for a new contract is widely accepted as necessary. The issue that we face however is that when an NHS dentist spends more time with each patient (covering prevention as well as treatment), the fewer people they can see – and so NHS access reduces. This would have a profound reduced access for the millions of NHS dental patients . There are no clear timelines of replacing the existing contract and the impact this will have on NHS dental costs.
Because of these uncertainties we encourage all patients to consider all options in your local area – if you can’t find an NHS dentist, don’t hold off. Avoiding dental treatment, and regular check-ups, can have profound effects for both your health and costs down the line. Consider dental insurance, dental discount plans and compare prices – we frequently publish private dentists on Toothpick whose examinations costs a little more than an NHS examinations, but enables more time to be spent with each patient.
If you have further questions, email us at email@example.com.