'I work in NHS dental desert - I feel guilty but I'm quitting to go private'
A dentist in one of Britain's worst 'dental deserts' has told of his guilt at quitting the NHS to go private.
Dr Tim Hodges says the perverse NHS payment contract - which means dentists make a loss treating the most in-need patients - meant he was effectively doing NHS work 'for free' so will now do more lucrative private work instead. It is the latest in a series of Mirror special reports for the Dentists for All campaign from Devon - which NHS data suggests is one of Britain's worst dental deserts. There is a hidden oral health crisis that sees many families locked out of NHS care for years and children losing teeth having never seen a dentist.
Today we report claims that the pressure to 'churn' through NHS patients could be contributing to high suicide rates among dentists. Tim, 42, is a local lad who grew up near Axminster in a big NHS family. Both his parents were local GPs and he is one of five siblings - three are now doctors and two are dentists.
'I feel a huge amount of guilt,' he admitted. 'My NHS work was breaking even. I don't want to say it felt like charity work, but basically it was doing it for nothing. The private side was propping it up which wasn't really fair on the private patients.'
The NHS system includes two types of dentists; Associate dentists, who are essentially self-employed, have their own patient lists and pay a rent to the practice business to use the premises, support staff and materials. Then there is the owner, or partner in ownership, of the practice business.
Dr Tim Hodges has been a partner at Axminster Dental Practice since 2011 when it saw mostly NHS patients and he became the sole owner in 2024. The NHS contract pays the practice for each Unit of Dental Activity - known as a UDA.
A check-up is worth one UDA while a filling is worth three. Axminster Dental Practice, owned by Dr Hodges, was receiving £30 from the NHS per UDA, and of that, an associate dentist would be paid £13.65. Dr Hodges said: 'You're not talking very different pay from a tradesman and you start to think, is £80,000 worth of debt from university worth it for that level of salary?
'My issue was that we have three associate dentists at the practice. They were happy but they would have eventually gone to private practice where they could earn more money, unless I could pay them more.'
Dr Hodges added: 'The NHS side literally broke even and made nothing so sadly it had to go. All of our adult NHS patients, we told them we couldn't see them on the NHS any more. This is a practice I did work experience at when I was 15. I did my foundation training here after I qualified as a dentist.
"Having grown up in the area with mum and dad being well known local GPs, I never really had to build up my reputation because they had done it for me. I just tried not to disappoint them. But my main feeling about it all is guilt. But it was just unviable. If you actually follow the NHS contract to the letter, and look after your patients as you're meant to, it's not really workable.'
The NHS dentistry payment contract has been deemed 'not fit for purpose' by Parliament's Health and Social Care Committee. MPs on the committee will question dentistry minister Stephen Kinnock on the crisis on Wednesday.
Labour 's 2024 General Election manifesto pledged fundamental reform of the NHS contract which currently means dentists get paid the same for a patient having three fillings as 20. Dr Hodges said: 'It disincentivises treating the patient who needs more care, which is just madness. Then over the years when they haven't increased the rates despite inflation then it's just become totally unmanageable.'
Despite stopping seeing adult patients on the NHS, such is the demand in Devon, Dr Hodges still has 1,200 patients on his waiting list to become private patients. Dr Hodges still sees his remaining child patients but has closed the list.
READ MORE: Dentist being fined £150K by NHS for keeping patients' teeth too healthy
He said: 'When you compare the NHS contract now to what you can earn privately, the gap is just vast. But it's not just that. It's actually having the freedom to look after the patient as well as you can rather than churning through them like you're on a treadmill.
'You can book that patient in for a long enough time to care for them properly. And also for your own personal wellbeing. There's actually a quite high suicide rate among dentists and I think a lot of that is due to the pressures that come with having to churn through patients.'
UK research in 2020 suggested that around 10% of dentists had recently considered suicide.
Dr Hodges warns that children not getting regular dental check-ups risks life-long health harms. He said: 'You're going to have kids with no teeth basically. And with young kids fortunately it might not make a big difference but once they hit teenage years it's a real worry.
'Fortunately I've not come across it much but it's almost more of a worry that I've not come across it because it's known that the government only funds dentistry for 50% of the population. So if everyone wanted to see an NHS dentist only half the population could. We're in a scenario where those that really need NHS care don't get it and it is pretty upsetting really.'
Emergency measures announced by the Government on Tuesday will attempt to begin to change a situation where dentists are disincentivised from treating the patients who need care most.
The interim measures include a new time-limited 'care pathway' for higher needs patients so dentists get paid more for clinically complex cases. Other proposals going out to consultation include paying dentists extra for a special course of treatment for patients with severe gum disease or with at least five teeth with tooth decay. There will also be more money for denture modifications.
Last week's Ten Year Health Plan sparked fears that proper reform will be kicked into the long grass until after the next General Election. It only said that by 2035 a new dental contract would be at the heart of a "transformed" NHS system. And there is uncertainty as to what extent the Treasury will fund radical reform.
The British Dental Association has labelled the contract 'absurd' and calculates that a typical practice loses over £40 producing a set of dentures £7 on a new patient exam.
BDA Chair Eddie Crouch said: "Savage cuts mean many dentists aren't just working for free, they're delivering NHS care at a loss. No health professional should be expected to work on this basis, and no business can stay afloat. If NHS dentistry is going to have a future we need real reform and sustainable funding."
Health Minister Stephen Kinnock said: 'We inherited a broken NHS dental system that is in crisis. We have already started fixing this, rolling out 700,000 urgent and emergency appointments and bringing in supervising toothbrushing for 3 to 5 year olds in the most deprived areas of the country.
"But to get us to a place where patients feel NHS dentistry is reliable again, we have to tackle the problems in the system at their root. These reforms will bring common sense into the system again, attracting more NHS dentists, treating those with the greatest need first and changing the system to make it work.
"This is essential to our Plan for Change - building an NHS fit for the future and making sure poor oral health doesn't hold people back from getting into work and staying healthy.'
Dentists for All campaign
Save NHS Dentistry petition
Sign our petition to save NHS dentistry and make it fit for the 21st century
Our 3 demands
Everyone should have access to an NHS dentist
More than 12 million people were unable to access NHS dental care last year – more than 1 in 4 adults in England. At the same time 90% of dental practices are no longer accepting new NHS adult patients. Data from the House of Commons Library showed 40% of children didn't have their recommended annual check-up last year.
Restore funding for dental services and recruit more NHS dentists
The UK spends the smallest proportion of its heath budget on dental care of any European nation. Government spending on dental services in England was cut by a quarter in real terms between 2010 and 2020. The number of NHS dentists is down by more than 500 to 24,151 since the pandemic.
Change the contracts
A Parliamentary report by the Health Select Committee has branded the current NHS dentists' contracts as 'not fit for purpose' and described the state of the service as "unacceptable in the 21st century". The system effectively sets quotas on the maximum number of NHS patients a dentist can see as it caps the number of procedures they can perform each year. Dentists also get paid the same for delivering three or 20 fillings, often leaving them out of pocket. The system should be changed so it enables dentists to treat on the basis of patient need.
Have you had to resort to drastic measures because you couldn't access an NHS dentist? Are you a parent struggling to get an appointment for a child? Email martin.bagot@mirror.co.uk or call 0800 282591
The interim measures will now form part of a six-week public consultation on the future of the NHS dental system.
Jason Wong, Chief Dental Officer for England, said: 'Far too many patients are waiting too long to see a dentist, and while steps have been taken to turn this around, there is still further to go. That is why I'm urging the public to take part in this consultation and give their views on our plans, so we can strengthen this vital part of the NHS.'
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