Cruel choices, pain and anger in the town where people are desperate for a dentist

21 Jan 2024

The NHS is 'at its most perilous point in its 75-year history' and Greater Manchester residents are suffering the fallout, Helena Vesty reports

One mum’s teeth are ‘crumbling and falling out’ leaving her ‘crying daily’. Another says her children ‘haven’t seen a dentist in years’ amid the ‘impossibility of paying for a family of four to see a private dentist’. And one person who said that they are questioning ‘choosing between food or dental care’ as their NHS dental practice is going fully private.

All people in Greater Manchester who have pleaded for help as NHS dentistry in England is in crisis. Getting hold of an NHS dentist has become increasingly difficult, funding continues to be squeezed, and rising inequalities in oral health mean poorer people suffer. 

These cases, which have been anonymised, have been brought to the attention of Stockport’s MP who says that receiving pleas for dental help has become ‘typical’. The desperate emails and calls to MP Navendu Mishra come as NHS dentistry in England is ‘at its most perilous point in its 75-year history’, according to independent health thinktank, the Nuffield Trust.

One Stockport woman has been trying and failing to get a dentist for the last eight years, since her eldest child was born. She developed dental issues during pregnancy and described her teeth as ‘crumbling and falling out, and then leaving great big holes that are open for infections’.

She wrote to her MP, saying: “I have tried to contact so many dentists to see if they will accept me as an NHS patient and help me, but I have had absolutely no luck.

“I either get ignored or get told they simply cannot help me. I am in pain every single day of my life. 

“I am becoming extremely depressed as the appearance of my teeth is just disgusting... I am lost in what to do. If I ring NHS 111 for emergency dental treatment, I get told to ring numbers that either no longer work, or I am just told they can only offer a temporary fix, which isn’t curing the problem, only prolonging it. 

“I am in constant agony, and I cry daily due to the pain I am in, but nobody seems to want to listen.”

Relying on emergency care because of the difficulties getting an NHS dentist

A fellow mum has also become part of the Stockport MP's caseload as her children have been without a dentist for four years. She told Mr Mishra: “Since moving to Stockport, we have been unable to register with a dentist due to every dentist being at full NHS patient capacity. 

“We have been on numerous waiting lists during this time and every three months I put my postcode into NHS services’ ‘Find a Dentist’ and I spend one of my days off starting at the top of the list and work my way down calling every dentist on the list to ask if they have availability to register with their practice.

“We still don't have a dentist.”

The woman says she is regularly referred to seek emergency care – but that’s not what her family needs. 

“Most dentist practices advise me to call the ‘community helpline’ on 0333 332 3800, however this is for emergency care. We don't need emergency care, we need a regular dentist and should be able to access NHS services,” she continued. 

“The most worrying aspect is that most dentist practices I speak to explain they have availability to see us as private patients, more often than not, on the same day but they just don't have availability to see us as NHS patients.

“I'm sure you will join me in my frustrations and will understand the impossibility in paying for four people to see a private dentist, considering our jobs.”

'Do I choose food or dental care?'

Some people have found themselves unable to access NHS dental care because their practice went fully private, and would no longer be providing NHS services. MP Navendu Mishra describes the email below as ‘typical’.

“I have received a letter from my dentist as they're going fully private. I can't afford their low income £20 a month scheme. Do I choose food or dental care?” asked one constituent.

“[Dentists taking on NHS patients in Stockport are] practically non- existent. I have been ringing around all week and even looked as far as Manchester and there's just absolutely nothing.”

In the last month, the Manchester Evening News has reported on waiting lists of 4,000 and queues out the door for an NHS dentist, and the story of one Cheadle resident having to pay £900 in private treatment after being thrown off her NHS practice's register because she did not have an appointment during the pandemic

'Near-terminal decline'

In December 2023, the Nuffield Trust issued a report on the state of NHS dentistry, saying: “NHS-funded dental services in England are in near-terminal decline: nearly six million fewer courses of NHS dental treatment were provided last year than in the pre-pandemic year; funding in 2021/22 was over £500m lower in real terms than in 2014/15; and there are widespread problems in accessing a dentist.” 

The report added that the government has promised a dental recovery plan, but further decline could well happen.

“The wholesale closure of routine dentistry for several weeks during the pandemic exacerbated many problems in NHS dentistry,” said the report. “But these problems have deep roots in a series of poor policy choices, and a general approach which may be charitably described as ‘muddling through’ over several decades…

“There are widespread problems in accessing a dentist – something that is particularly marked for people from black and Asian ethnic groups. 

“Full, universal access to NHS dentistry has probably gone for good, and a drift to the private sector has been taking place for years. But with bold policy-making it may be possible to prevent further decline.”

In the last month, the Manchester Evening News has reported on waiting lists of 4,000 and queues out the door for an NHS dentist, and the story of one Cheadle resident having to pay £900 in private treatment after being thrown off her NHS practice's register because she did not have an appointment during the pandemic – despite government rules that patients should stay away unless they needed emergency treatment. 

But apart from railing against the government, the MP fears there is little he can do to solve the chaos in dentistry, saying that this ‘bold policy-making’ is nowhere on the horizon. Navendu Mishra said: “12 million people in England – that’s more than one in four of our adult population – were not able to get an NHS dentist appointment last year. 

“We are seeing more and more people presenting at A&E with problems such as tooth decay because they haven’t been able to see a dentist, with 365 people in Stockport attending Stockport NHS Foundation Trust because of dental decay last year.

“The government is not doing enough to address this public health crisis. As well as raising these issues and representing the experiences of my constituents in the House of Commons on several occasions, I have met with the British Dental Association and sent a survey to every dentist in Stockport constituency to gain a better understanding of the problems plaguing NHS dentistry. All respondents cited years of government underfunding as the key driver of the crisis unfolding today.

“This means that, whilst I am committed to holding the government to account about the crisis in NHS dentistry, there are frustratingly few practical solutions that I can provide to people in my constituency to get them the care they need. We need urgent change at the national level to rescue NHS dentistry.”

What do the government and the NHS say?

A Department of Health and Social Care spokesperson responded to complaints about the state of dentistry by saying: “Dentistry should be accessible and available to all who need it and we want every adult and child who needs an NHS dentist to get one regardless of where in England they live.

“The government has taken significant steps to help people get an appointment with an NHS dentist and to receive the treatment they need: 1.7 million more adults and about 800,000 more children saw an NHS dentist last year compared with the previous year, but there is more to do, and the government is working on a dentistry plan with NHS England to make further improvements.

“We invest more than £3 billion each year to deliver NHS dentistry, and we have already introduced reforms designed to incentivise practices to deliver more dental care - including increasing the amount of money that practices receive for high-need patients and allowing dentists to carry out more than their usual contracted NHS work."

Ben Squires, director of primary care for NHS Greater Manchester said: "We are working with local dentists to help practices take on more NHS patients, seeing an extra 69, 000 patients since April. We also have an access plus scheme across Greater Manchester to help people who have received urgent dental care, but who require further care and treatment from an NHS dental practice.

“We ask that people attend all booked appointments and cancel ahead of time where possible so that other people who need appointments can get them. Over 14, 000 people did not attend their new patient appointments locally since April this year meaning other people who needed an appointment did not get one.

"If people are worried about the costs of travelling to their appointment and the treatment received, they may be able to reclaim these costs. Information is available on the NHS website.

“If someone is not registered with an NHS dentist or has a dental emergency and their regular dentist is closed, they can call the Greater Manchester Urgent Dental Care Service on 0333 332 3800 from 8am to 10pm every day including weekends and bank holidays."

By Helena Vesty, NHS, social care and patients reporter, Manchester Evening News, 20 Jan 2024