The UK dental sector is facing a transformative – but potentially destabilising – period. In England, the abolition of NHS England as a standalone entity marks a fundamental shift in health governance.
In Wales, a sweeping reform of the NHS’s General Dental Services (GDS) contract is triggering strong feelings within the profession. These moves, although emerging from different political and organisational contexts, could reshape the future of publicly funded dentistry across England and Wales.
England: Reform through Consolidation?
In a bid to streamline the healthcare system and cut bureaucratic overhead, the UK Government has moved to dismantle NHS England, integrating its functions into the Department of Health and Social Care (DHSC). This decision is framed as a cost-saving, efficiency-driven reform, with plans for a 50% reduction in staff across NHS England and associated integrated care boards.
While the intention is to reduce duplication and redirect funds to frontline services, sector leaders are sounding alarm bells. The British Dental Association (BDA) warns that such cuts could irreparably harm dental public health – a field already stretched thin. Over the past decade, the number of dental public health consultants in England has fallen from six to just two. Any further reduction, experts argue, would threaten essential services including oral health surveillance, epidemiological research, and targeted preventive programmes.
Moreover, analysts caution that centralising control under DHSC risks the emergence of new internal silos, effectively replacing one bureaucracy with another – without necessarily solving the structural challenges that plague NHS dental services. The concern is that reform on paper could amount to stagnation in practice.
Wales: A Radical Overhaul of NHS Dentistry
Meanwhile, in Wales, the government is taking a different – yet equally radical – approach. A wide-ranging consultation proposes fundamental changes to the way NHS general dental services are delivered and paid for.
The key proposals include:
- Introducing a centralised Dental Access Portal to manage patient allocation, with the effect being that dentally fit patients can be treated in a number of different practices.
- Extending recall intervals for low-risk patients to 18–24 months.
- Moving to a banded, need-based payment model for dentists.
- Centralising fee collection and modestly increasing patient charges.
The Welsh Government has positioned the reform as a way to modernise dentistry and improve access in under-served areas. However, feedback from the profession has raised concerns from practice owners, clinicians and patients alike.
Central to these concerns are the compromise of clinical autonomy, disrupt continuity of care, and threaten practice viability – especially in rural areas already facing recruitment challenges. There is particular concern that under the centralised model, patients may lose their regular dentist and instead be routed to any available practitioner, undermining trust and long-term oral health management.
In some areas, like Pembrokeshire, where access to NHS dentistry is already critically low, clinicians have warned that the reforms could “destroy” NHS dental services altogether.
A BDA Cymru survey found that:
- 64% of dentists would consider going fully private.
- 73% plan to reduce NHS work if the proposals proceed.
- 72% would refuse to participate in the reformed system in the form currently proposed.
Cross-Border Consequences
Although healthcare is a devolved matter, developments in one nation often ripple into others. The abolition of NHS England will have no direct legal implications for NHS Wales, but the broader context – particularly on waiting lists and access – could influence cross-border treatment arrangements. With Labour proposing NHS cross-border treatment rights between England and Wales, capacity constraints in either system may increasingly affect the other.
Additionally, policymakers in England will be closely observing Wales’s contract experiment. The Welsh reforms could either provide a template for overdue contract modernisation in England or serve as a cautionary tale if uptake collapses and NHS provision deteriorates.
Sector Outlook: Reform or Fragmentation?
Both England and Wales are pursuing reforms rooted in long-standing criticisms of NHS dentistry: inadequate funding, outdated contracts, and inequitable access. Yet, without parallel investment, careful consultation, and robust planning, these reforms risk further destabilising the sector.
For England, success will depend on whether DHSC can effectively preserve and empower dental public health infrastructure amid sweeping consolidation. For Wales,
the key question is whether its reforms can deliver on access and quality without prompting mass withdrawal by practitioners.
In both nations, a unified message is emerging from the profession: reform is overdue – but without the right level of consultation, safeguards and investment, the cure may be worse than the disease.
