In August 2024, a surprising set of statistics was released by NHS Business Services Authority (NHSBSA). Instead of confirming a continuation of the downward trend reported by Nuffield and others last year, the figures indicated that in 2023-24, NHS dentistry in England experienced a small but significant rise on the previous year.
Although it may be too early to celebrate this, the increase in UDAs, and NHS courses of treatment (COTs), as well as an increase in dentists offering NHS treatment is interesting, and worth monitoring to consider the impact on the overall dental market.
The statistics
There were 24,300 dentists who performed NHS dental activity in 2023/24, a slight increase of 0.4 per cent compared to 2022/23. This is 500 more than in 2021-22. With a possible caseload of 2000 per individual dentist, this small increase could represent potential dental care for 1m patients. With the addition of a further 400 dentists with NHS activity, numbers could equal those of 2019-20.
The story continues with 34m NHS COTs delivered, representing a 4.3 per cent increase in the previous year. COTs increased for both adult and child patients, by 2.2 per cent to 23m, and 9 per cent to 11.2m respectively.
Income from NHS treatment also increased last year. In 2023-24, the total patient revenue was £774m, 2.7 per cent more than in 2022-23. Although at 72m the total value of UDAs is still 9.1 per cent lower than the 79.7m total in 2019/20, the figure has increased by 3.4 per cent since 2022/23.
Why is this surprising?
In 2021-22, 2000 dentists left the NHS, potentially affecting 4m patients. Filling this gap has not been an easy task, and there has followed a recruitment and retention crisis in many regions of the UK.
Low morale, resulting in dentists choosing to leave NHS practice, was reported by the BDA as recently as June 2024. The report cited heavy workloads, rises in practice costs, continuing problems with recruitment and retention, and fear of complaints among the reasons dentists were choosing to leave.
Why are NHS numbers now increasing?
The dental profession, like many others, has begun to embrace different ways of working to make treatment more accessible. Improvements in communications through digital technology, as well as the introduction of telephone and online appointments have been shown to enhance patient engagement. Empowering multidisciplinary team members to deliver certain treatments has been identified as a factor in improving provision figures in the medical arena, and it may be that a similar strategy is already working to relieve pressure in NHS dental practices.
Although increases in NHS dental treatment will be encouraging for many, numbers are not increasing equally across England and seem to be dependent on the commissioning strategies in each region, as well as other variables. The overall average percentage of adults accessing NHS dental care in England over the last two years was 40.3 per cent, but this extended to 55.7 per cent in the South Yorkshire Integrated Care Board (ICB). It was as low as 29 per cent in Cambridgeshire and Peterborough ICB.
Children fared better across England, with an average of 55.4 per cent, but had a similarly wide regional variance. In South Yorkshire ICB, 63.6 per cent were seen by a dentist and in the lowest – this time Somerset ICB – 42.8 per cent of children received NHS dental treatment.
The dental market
Exclusively NHS practices can be highly profitable, and achieve strong multiples in some regions of England. In fact, there is emerging evidence that the NHS contract can be a key driver for practice growth. Profitability trends between NHS and private practices already show similarities, with the latest interim goodwill report produced by Dental Elite showing the average mixed practice sold to an independent operator for nearly 100k more than other income compositions. This could further change in favour of the NHS market as investment in services increase.
Fully private practices still achieve a higher gross income, but an increase in NHS activity could potentially affect figures. Some private practices are also reporting the slow appearance of more white space so it could be that mixed practices are now falling back more on NHS activity. Further still, changes in the recognition of UDAs may be making it easier than it was to achieve a higher volume of UDAs which may be inflating the appearance of volume of NHS delivered.
Dental Elite has monitored market trends for 14 years, using the specialist team’s collective experience to directly benefit clients through its bespoke services. Whether you are looking to buy, sell or enhance your practice before going to market, Dental Elite’s team of experts will guide you every step of the way.
There is still a lot of work to do to recover pre-pandemic levels of NHS dentistry, let alone returning to numbers reported in 2013. However, the latest statistics suggest that predictions of the total demise of NHS dentistry in England may yet be premature.
References available on request.
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