NHS dentistry in crisis as 600 practices quit in a decade, creating 'dental deserts'

In the past decade, nearly 600 dental practices across England have stopped accepting NHS patients, reshaping the landscape of who can afford to see a dentist and where. The withdrawal has been uneven and brutal in some places. Cornwall has lost more than a quarter of its NHS-providing practices. Devon and Northamptonshire have seen similarly steep declines. Somerset now has fewer than one in five practices offering NHS treatment at all. The result is what researchers and policymakers have begun calling dental deserts—regions where finding an NHS appointment has become nearly impossible, and where access to care increasingly depends on ability to pay rather than need.

The scale of the shift is stark. More than one in ten dental practices that once offered NHS care no longer do so. Six in ten adults have not seen an NHS dentist in two years. Of those who tried to book a new appointment in the past two years, only 38 percent succeeded. Meanwhile, overall dental activity through the NHS sits 8 percent below pre-pandemic levels. The Nuffield Trust, which conducted the analysis, found that this is not a story of dentistry disappearing—overall practice numbers have actually risen in England over the decade. What has vanished is NHS dentistry specifically. The private sector has grown while the public system has contracted, creating a widening gap between those who can pay and those who cannot.

The reason practices are leaving is economic. Dentists say NHS contracts are loss-making. Vivak Shah runs three practices in Northamptonshire and continues to offer NHS treatment, but he no longer accepts new NHS patients. Each year, he says, the practice struggles to decide whether to continue. The private side of his business cannot indefinitely cover the losses from NHS work. Jim Sykes, a dentist in Hexham, handed back his NHS contract in 2024 after concluding the work was running at such a loss that he had to think of his staff. When he asked if he could continue treating children under NHS terms while dropping adults, he was told it was all or nothing. He chose nothing. Sykes says that of his graduating class in dentistry, none still work in the NHS. His peers have gone private, retired, or moved into teaching—any path that avoids NHS dentistry altogether.

The human cost is visible in individual stories. Alan, 83, lives in Somerset and has given up trying to find an NHS dentist. He has only one tooth left after the others crumbled away over years without proper care. He has adapted his diet, though he jokes about having perfected a technique for eating Brazil nuts with a single tooth. His situation is not unusual. Dentists warn that when practices stop providing NHS treatment, patients are left in pain or forced to seek help in hospital accident and emergency departments—a far more expensive and inappropriate place to treat dental problems. The British Dental Association's chair, Shiv Pabary, describes the situation as the direct result of choices made by successive governments. Unless ministers fund NHS dentistry properly, he warns, more dentists will reduce or abandon their NHS work.

The decline has not been uniform across England. North West London, the Black Country, and North East London have seen smaller reductions. North East London is the only region to record an increase, gaining one additional NHS-providing practice over the decade. Every other region has seen the number fall. Mark Dayan, head of public affairs at the Nuffield Trust, frames the shift as a quiet transformation. One practice handing back its contract in one town attracts little attention. Repeated across the country for a decade, it amounts to the systematic creation of a two-tier system. Access to dental care increasingly depends on what people can afford and where they live.

The government has pledged to address the crisis. It says it is changing the dental contract, training more dentists in areas of greatest need, and will require newly qualified dentists to work in the NHS for a minimum of three years. But dentists remain skeptical. Sykes says there has been a real breakdown in trust. Even if a new government offer came, he would be nervous about entering a new NHS contract. The sector is waiting to see whether the promised changes will actually make NHS dentistry viable again, or whether the two-tier system will continue its quiet expansion.