Addressing the NHS Dentistry Crisis: Could Overseas Dentists Be the Solution?

1. The scale of the crisis

The NHS dentistry system in the UK has reached a critical point. As of March 2024:

• Over 21% of NHS general dentist positions were unfilled—amounting to nearly 500,000 days of lost appointments The LancetBritish Dental Assocation+11British Dental Assocation+11Wingate Benefit Solutions+11.

• The NHS England workforce data recorded 2,749 full-time dentist vacancies, forming 87% of the total 3,160 open dentist roles, many vacant for over 180 days Dentistry+2Nature+2Dental Tribune International+2.

• Around 4.5 million people in England alone cannot access NHS dental care The Times+3The Guardian+3The Times+3.

• Only 40% of adults have seen an NHS dentist in the past two years, down from nearly 49% before COVID-19 British Dental Assocation+9The Guardian+9The Times+9.

• A staggering 97% of new patient attempts to access NHS dentistry fail The Sun+3British Dental Assocation+3British Dental Assocation+3.

Many people in dental pain resort to private clinics, emergency treatment, or even DIY dentistry—stories of individuals pulling their own teeth are heartbreaking reminders of the crisis The GuardianThe Times.

In short: too few NHS dentists, long waits, and widespread patient suffering.

2. Why is the crisis happening?

A. Dentist workforce shift and low NHS take-up

• Many dentists have reduced NHS work or left for private practice due to better pay and working conditions GOV.UK+15Nature+15The Times+15.

• In 2023–24, NHS England had 24,335 dentists, but this is still 1.5% below 2019 levels GOV.UK.

• Two‑thirds of UK dentists work part-time (≤ 30 hrs/week), and only 42% spend at least 75% of their time on NHS care General Dental Council.

B. Systemic barriers under the NHS contract

• The UDA (Units of Dental Activity) system pays for bulk procedures, not complexity, discouraging practitioners from treating complex cases Financial Times.

• Dental practices say NHS work often loses them money, while private work offers better financial returns Dentistry+1The Guardian+1.

• Attempts at reform, including a £20,000 “golden hello,” mobile vans, and a £88 million “new‑patient premium,” failed to deliver meaningful improvements—patient access actually dropped by 3% after these measures Financial Times+2The Guardian+2GOV.UK+2.

C. Recruitment and training constraints

• UK training places for dentists have been capped for over a decade at around 1,100 per year the-probe.co.uk+3The Times+3The Sun+3.

• Brexit and COVID reduced intake of internationally qualified dentists (IQDs): in 2019, 28% of the dental register were IQDs; by 2020 that had dropped sharply Nature.

• The ORE (Overseas Registration Exam) backlog is severe: 6,000 overseas graduates await placement, but only ~600 exam slots exist annually. The system is described by one dentist as being as hard to get into as a Taylor Swift concert The Guardian.

3. The idea: overseas dentists to the rescue?

Given the crisis, one potential solution is better integration of internationally trained dentists to fill NHS roles.

Pros:

1. Fast access to talent
   Thousands of fully qualified dentists from countries like India, Egypt, and Albania are ready to work NatureThe Guardian.

2. Hope for underserved areas
   A model in Ipswich shows how targeted NHS contracts and local qualified staff, including trainees and overseas-qualified providers, can improve care in “dental deserts” Financial Times.

3. Better initial NHS exposure
   New “provisional registration” rules could allow overseas dentists to work under supervision in high‑street NHS practices before full registration, helping them adapt quicker GOV.UK.

Cons and challenges:

1. Exam bottlenecks
   The ORE backlog means many cannot get exam slots. Those who do often take lower-skilled jobs while waiting The GuardianNature.

2. Regulatory and legislative delays
   Provisional registration needs new laws and guidance. The current system allows supervised training or teaching roles only—not full NHS practice GOV.UK.

3. Retention vs recruitment
   Overseas dentists may join, but if contract issues persist, they could quickly shift to private roles—just like UK‑trained dentists NatureGOV.UK.

4. What other solutions exist?

Recruiting overseas dentists is only one part of the broader strategy. Experts suggest a multi-pronged approach:

1. Reform the NHS contract

• The UDA system should be redesigned to reward prevention, complex cases, and quality care Financial Times.

• The PAC report and British Dental Association emphasize: “rip the contract up and start again”. A few small tweaks won’t work Dentistry.

2. Boost UK training

• Expand university dentistry places to replace the 1,100‑cap that’s been static for over a decade The TimesNature.

• Encourage more clinical roles for dental therapists, hygienists, and graduates—especially in underserved communities The Guardian+14Financial Times+14Nature+14.

3. Improve NHS recruitment methods

• Empower Integrated Care Boards (ICBs) to spend dental budgets effectively, and enable creative local commissioning Dentistry+3Nature+3GOV.UK+3.

• Expand the PDS model trialed in Ipswich: session‑based rather than UDA‑based contracts allow more flexible and preventive care The Guardian+4Financial Times+4Dental Tribune International+4.

4. Make ORE and provisional pathways smoother

• Increase the number of ORE sittings, add more exam centres, and streamline bureaucracy to clear the 6,000‑dentist backlog The Guardian+1Nature+1.

• Roll out provisional registration swiftly, letting overseas graduates begin supervised NHS work under mentorship and regulated standards GOV.UK+1GOV.UK+1.

5. Could overseas dentists help? The verdict.

Overseas dentists could be a valuable resource — but only if the system aligns to support them:

Thus, plugging the gap with overseas talent is only sustainable when combined with contract reform, training expansion, better recruitment, and streamlined registration.

6. Conclusion & call to action

The NHS dentistry crisis is not just a problem—it’s a challenge that impacts millions of people and carries public health risks. Overseas-trained dentists offer a ready pool of talent, but without fixing the systemic issues, they risk being underused—or underpaid.

To make this work:

1. Reform the UDA-based contract, making NHS dentistry financially viable and clinically rewarding.

2. Clear ORE backlogs and introduce supervised provisional pathways for overseas dentists.

3. Expand UK dental training and support roles for therapists and hygienists.

4. Use local commissioning and flexible models (like PDS) to reach underserved areas.

If all these pieces come together, the NHS could finally begin to close the access gap—and bring relief to millions.

Let us hope NHS England, Integrated Care Boards, the GDC, Parliament, and the Department of Health collaborate quickly and decisively. Because until they do, the NHS dentistry system will continue to groan under inadequate funding, broken contracts, and untapped potential—letting patients and dentists alike fall by the wayside.

✅ Sources