Fears Norfolk and Waveney £18.3m dental underspend could go elsewhere

Jeffrey Sherer, at the Dental Design Studio, told the BBC some practices could provide more NHS treatment

An underspend of £18.3m ring-fenced for dentistry in Norfolk and Waveney could be spent elsewhere due to a lack of dentists, the NHS says.

The amount is more than a quarter of the area's £65.5m budget for dentistry.

Eddie Crouch, chair of the British Dental Association (BDA), warned that the money was being used to plug "black holes" in other healthcare budgets.

The area's Integrated Care Board (ICB) said it was investing "as much of the dental budget" as it could.

Norfolk and Waveney has been described by people in the sector as a "dental desert".

The Association of Dental Groups said there were 38 NHS dentists for every 100,000 people in the area in May 2022, one of the lowest rates in England.

One patient told the BBC how he resorted to pulling out two of his own teeth - and another said he had paid privately for treatment in Spain.

Norfolk and Waveney's underspend in dentistry is the largest for any ICB area in the east of England

Mr Crouch added: "In areas of the country where the ICBs have been more radical and actually used the funding [for dentistry], we've seen a reduction in the number of people phoning 111 for emergency care."

In November, NHS England told ICBs they could divert unspent money to pay for other healthcare, like drugs and hospital operations.

A spokesperson said: "NHS England has ringfenced dental allocations and on behalf of patients we are supporting dental contractors to deliver on their commitments in full, so this money is spent. However, if dental contractors underdeliver on their commitments this results in an underspend.

"The Dental Recovery Plan will support practices to deliver on their obligations and increase access for patients."

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Jeffrey Sherer, the clinical director of the Dental Design Studio, which has six practices in the area, said: "In some of our practices, we have capacity to do more, but because we're only commissioned for a certain amount of NHS treatment, that's the only amount we can provide."

After taking over a practice in North Walsham, he said 3,000 people asked in the space of 24 hours whether it was taking on additional NHS patients.

There are no surgeries in Norfolk and Waveney taking on new adult NHS patients.

Dr Kristina Nadizadeh made the decision to only see private patients

The number of NHS dentists in Norfolk and Waveney reduced by 85, to 372, between 2014-15 and 2022-23, with the trend continuing in 2023-24.

The BDA believes staff will be incentivised if the NHS increases what it pays dentists for each examination.

In Norfolk and Waveney, these are being increased to a minimum of £30, which the ICB said was higher than the £28 recommended in the government's recently published dental recovery plan.

However, Mr Sherer pointed out these payments were on average higher in Yorkshire and added: "Most dentists are self-employed and will want to go where they are getting paid the most for delivering treatment."

Private dentist Dr Kristina Nadizadeh said she would never work in the NHS, adding: "It is too much stress for too little money."

Stephen Ward said he lost his NHS dentist when the practice went private

Mr Ward, who pulled out two of his teeth, said the NHS needed to pay dentists more

Stephen Ward said he pulled out two of his teeth - another two fell out - and four were broken. He took painkillers but said it still felt "excruciating and eating hurt".

Mr Ward said he wanted to become a new patient at the North Walsham practice and said he had not had an NHS dentist for four years. He receives universal credit.

"Even when you're in desperate pain on the NHS, it seems impossible [to be treated]... it's going back to the dark ages," he said.

"I called round every dentist I could find the number for in Norfolk, and some in Suffolk, and got nowhere."

Pauline and Peter Dunkley see a dentist in Spain every year on holiday

Peter, 64, and Pauline Dunkley, 63, from Watton, said they lost their NHS dentists after the Covid-19 lockdowns.

Mr Dunkley had a tooth removed and a filling while on holiday in Vélez-Málaga, Spain. Ms Dunkley also had a filling.

"Maybe I wouldn't have had the need for my tooth to be removed if I'd have had treatment on the NHS," said Mr Dunkley.

'Encouraging dentists'

Norfolk county councillors have written to the health secretary to outline concerns regarding the national pay contract for dentists.

The government said its dental recovery plan would include "a new marketing campaign to help everyone who needs one to find a dentist".

It said up to 240 dentists across England would be offered £20,000 to work for three years in under-served areas.

A spokesperson for NHS Norfolk and Waveney ICB said: "The ICB is committed to improving patient access to high quality NHS dental care.

"We are investing as much of the dental budget as we can to support delivery of dental services and improve patient access to services.

"We don't have the level of NHS provided dental services we need in Norfolk and Waveney, and we have been working hard since we took over responsibility for the commissioning of NHS dentistry on 1 April 2023 to increase availability of NHS dental care.

"We are working to build relationships with dental practices to provide support and encourage them to work with the NHS contract. We have uplifted the amount we pay dentists to provide NHS care to a minimum of £30 per Unit of Dental Activity (UDA) to make our rates more attractive and encourage more dentists to come and work in our area."