"We should tear the whole thing up": Minehead MP calls for NHS dental reform
Rachel Gilmour MP has called crisis "outrageous"
More Minehead residents could be able to see an NHS dentist in the coming years if the efforts of their local MP prove successful.
Somerset is largely regarded as a ‘dental desert’, with large proportions of the population being unable to see an NHS dentist and very few surgeries taking on patients or offering appointments on the NHS.
The Tiverton and Minehead constituency has the worst level of NHS dental treatment delivery in England, according to statistics published by the House of Commons’ public accounts committee.
Local MP Rachel Gilmour (who serves on the committee) has been pushing the government to allow local surgeries to take on more NHS work, arguing it is essential to improve local health and in doing so drive forward the regeneration of west Somerset.
Dentists are not directly employed by the NHS, with each practice having a contract with the health service for the number of patients it is expected to treat each year.
Since 2006, NHS dentists have been paid on the basis of units of dental activity (UDA) carried out, rather than according to the complexity of cases or the specific needs of patients.
This system – introduced by then-Labour health secretary Patricia Hewitt – has been widely criticised, with NHS Somerset claiming it “discourages the treatment of high-need patients”.
There have also been reports of dentists waiting months to be paid for their NHS work, leading many to take on more private work to keep their practices financially solvent.
While access to NHS dentists has been declining for many years, the Brexit deal “made the UK less attractive for overseas professionals” (according to NHS health bosses) and the coronavirus pandemic created huge backlogs in treatment – with some dentists refusing to take on new NHS patients after the lockdowns ended.
Mrs Gilmour was in Minehead on February 21 to meet with Salma Moulana and her husband Sha, who have run the Ponsford 59 Dental Practice for the last three years.
Mrs Moulana said that it was important that the NHS allowed her to carry out detailed work to stabilise patients who had long-term issues, many of whom had not seen a dentist for many years.
She said: “Once the patients are stabilised, it’s not the same issue again and again. It’s only when you have a huge backlog, where I have a lot of patients and everyone needs every single tooth working, that’s where the system doesn’t work.
“When we came here, the state of play was not very good, for various reasons. We fixed it – it took us three years, but now today I can tell you 90 per cent of our patients who have been regular from their side are so stabilised that we don’t have to worry about emergencies from them.
“When we starting seeing patients, all of their neighbours would come back to register – many of them are so happy.
“People have commented that they never had that kind of treatment in other NHS practices, so they’re very pleased with that.”
Emergency dental appointments (e.g. someone who broke their tooth on a piece of food) are usually allocated via the NHS 111, with patients being directed to their nearest urgent treatment facility whenever appointments open up.
Mrs Gilmour said that people had been driving up to five hours to access emergency dental treatment, stating: “It is outrageous. We should just tear the whole thing up and find a system that works.
“I met the CEO of the British Dental Association when I first got elected and I’ve been in continual correspondence with him.
“There hasn’t been enough consultation with dentists. There hasn’t been an analysis of what workforce they need.”
It can take around five years to train as a dentist – meaning that simply training more British-born people will not ease the pressure on the NHS over the current parliament.
Mrs Moulana trained in India and took two years for her to book and pass the exams needed for her to enter the UK – a delay largely caused by the backlog of applications at the Home Office.
She said that the current NHS contracts system made it hard to recruit and retain staff, with the payment system essentially penalising dentists for looking after patients’ properly.
She explained: “When I start taking new patients, the workload will obviously increase, so then that means I need to work more or I need a larger workforce.
“With the NHS, it is the same contract on the same terms every year, which we can’t really fulfill.
“If we don’t fulfill the target, they penalise you – they can tell that ‘you haven’t seen enough patients, you haven’t done enough work’ – but that is because we have done everything to stabilise people.”
Mr Moulana said Minehead’s relative isolation and limited transport links made it difficult to recruit and retain staff on top of the challenges with the NHS contract – coupled with the fact that NHS dentists have to be paid the same whether they work in a city or a rural area.
He said: “If you have kids and you’re moving from London, you need a grammar school. You also need a good commute, like a proper railway station.
“If our dentist is off sick and I need to bring someone in – let’s say, from Bristol – you call up the agency to secure a locum, and you’re paying them the higher rate.
“People don’t want to commute to Minehead because you don’t have a railway station here – they have to take small roads. So people don’t move here.”
The Ponsford 59 practice currently has a contract of 9,500 UDAs a year – a figure which is not easy to increase without complex and lengthy negotiations with the Department for Health and Social Care (DHSC).
Mrs Moulana: “We need more UDAs so that we can see new patients and stabilise them.
“There are some practices with contracts for over 16,000 or 20,000 UDAs a year – 9,500 is actually very small.
“I think it has never been reviewed to acknowledge that this population needs more – for the last 20 years, to my knowledge, it’s just been the same.”
The practice registered an interest in August 2024 to increase its allocated UDAs, allowing it to see an extra 12 patients a week on the NHS.
Mrs Gilmour said she had escalated this twice with health ministers, believing it would make a huge difference to the town.
She said: “Whether it’s social mobility, the number of GPs, academic achievement, the number of people with diabetes, dementia or Alzheimer’s disease, Minehead ranks lowest.
“Can you imagine the difference that 12 dental appointments a week will make to this community, which we know is struggling at so many other levels?”
Professor Chris Whitty, the acting permanent secretary to the DHSC, has made a public promise to meet Mrs Gilmour in person to discuss Minehead’s dental woes.
Addressing a meeting of the public accounts committee on February 13, he said: “Attracting people to NHS posts in coastal, rural and remote areas that is an issue across the whole of the board.
“Dentistry is probably the most extreme, but it is not the only issue. All around the coastal strip, there has been a serious problem with attracting people: doctors, nurses, dentists and other health and social care workers.
“I am extraordinarily keen to talk about how we improve areas of low productivity.”
Mrs Gilmour said that she would continue to push the case for Minehead to ministers and civil servants – and warned the government not to simply focus on improving the parts of the NHS which could secure a second term in office.
She said: “I’m going to see Chris Whitty and I’m going to talk about dentists, but I’m going to use it as an opportunity to talk about health services as a whole.
“The committee can give the government a clear steer, but as we know, it’s all about the Treasury – there will only be one government department.”One thing I would say about the NHS is: you should criticise it at your peril, you know, be careful what you wish for.
“Under the Conservatives, I fear they were going towards privatisation. I’m confident this Labour government is genuinely committed to reform and change before investment.”But instead of focusing on primary care – which is the real issue, because that’s where you do preventative medicine – Keir Starmer is focusing on the waiting list because as a politician, he knows that’s going to win him more votes.
“The politics should come out of things like the NHS – you’re setting yourself up to fail if you are using a national institution as a political football.”
Sukeina Kassam, NHS Somerset’s director of primary care, presented an update on effort to improve access to NHS dentists when Somerset Council’s adults and health scrutiny committee met in Taunton on Thursday morning (February 27).
She said in her written report: “The dental profession is dissatisfied with the existing contract model, prompting many dental practitioners to reduce their NHS commitments or transition entirely to private practice.
“While the national government has introduced initiatives such as the dental recruitment incentive scheme, their impact remains limited, particularly in Somerset, where recruitment efforts have yet to yield tangible results.
“Despite the considerable challenges, NHS Somerset has made efforts to address the crisis through a series of targeted initiatives aimed at expanding service provision, supporting the dental workforce, and promoting preventative oral health care.
“Measures such as the procurement of new dental practices, financial incentives for NHS dental providers, and community-based outreach programmes reflect a commitment to tackling the issue at a local level.”