The NHS Dental System Isn't Broken. It's Been Breaking for Years.

On a Tuesday morning in Harpenden, a man walked into a private dental clinic in pain. Not discomfort. Pain. The kind that keeps you up at night, the kind you can't think around.

He hadn't chosen to go private. He'd tried to find an NHS dentist. There weren't any taking new patients. So he sat down in the chair, got the treatment he needed, and then faced a bill he could barely afford.

Dr Dan Shaffer, the dentist who treated him, described that moment on BBC Radio the same day. He wasn't telling the story to score political points. He was telling it because it had happened that morning, and because he knows it's happening in clinics like his across the country, every single day.

This is the reality of the collapse of NHS dentistry. Not in a government report. In a waiting room.

And now, with the Competition and Markets Authority (CMA) actively looking into why private dental fees are rising, the conversation is finally going public. The question is whether it's asking the right question.

The numbers behind why dentists are leaving

The cost of running a dental practice has gone up by around 30% in recent years. Staffing, energy, materials, laboratory fees: none of it has stood still. The NHS contract values largely have.

The result is a margin that has quietly become unworkable. Five years ago, the cost of delivering dental services used up around 65p of every pound an NHS practice earned, leaving 35p to actually run a business. Today that has shifted to roughly 75p in costs, leaving just 25p.

There is no business in the world that absorbs that kind of shift and carries on unchanged. Dentistry is no different.

The model that held it together has stopped working

For years, the system held together, just about, because of an arrangement that was always uncomfortable but rarely spoken about openly. Private income was used to pay for NHS care. Dentists effectively asked their paying patients to cover the shortfall created by government underfunding.

Dr Shaffer called it plainly: "a ridiculous state of affairs." He's right. It was. And now it's over.

Practices across the UK are handing back their NHS contracts in significant numbers. Not as protest. Not as leverage. Because delivering the service is costing them money, and there is a limit to how long any business, however committed its owner, can keep absorbing a loss.

The trap that makes it so hard to fix

What makes this particularly hard to solve at practice level is that NHS dentists have almost no room to move. The number of patients they can treat is fixed by government-set Units of Dental Activity. They cannot see more NHS patients. They cannot charge more for NHS appointments. When costs go up, the only real choices are: absorb the loss, hand back the contract, or go fully private.

More and more are choosing the last two.

The system was designed over 50 years ago, for a country and a cost base that no longer exist. It hasn't been meaningfully updated since.

The CMA is looking at the wrong end of the problem

The CMA investigation into rising private fees is understandable from a consumer point of view. But here is what it risks missing: private fees are rising because NHS dentistry has failed.

When practices can no longer afford to run NHS contracts, they go private. When they go private, they have to charge more to cover running costs that have risen 30% in a few years. The regulator is looking at the symptom. The real problem is elsewhere.

What would it actually take to fix this?

Dentists themselves are unambiguous: it's not a case of tweaking things at the edges; it needs a real overhaul. The money given to NHS dentists to deliver their contracts would need to roughly double to make them workable again and keep enough dentists in the system.

That is no minor adjustment. That is a serious rethink.

Until that happens, the trend is obvious. More contracts handed back. Fewer NHS appointments available. More patients in pain, turning up at private practices they can't afford, because there is nowhere else to go.

The question that lingers

That man who came into Dr Shaffer's clinic on a Tuesday morning, he's not a one-off. He's a preview of what follows.

The NHS dental system, as it currently stands, is not fit for purpose. That's not a political opinion. It's the conclusion of the dentists living inside it every single day.

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🎙️ Dr Dan Shaffer spoke about all of this on BBC Radio: the rising costs, the broken model, and what it means for patients and practitioners. Listen here: "BBC Radio: Why Private Dental Fees Are Rising – Dr Dan Shaffer on NHS and Private Dentistry"