NHS dentistry: a system failing by design
BMJ 2026 ; 393 doi: https://doi.org/10.1136/bmj-2026-100078 (Published 29 June 2026) Cite this as: BMJ 2026;393:e100078 In their article about NHS dentistry, McColl and colleagues describe a system in managed decline. 1 The 2006 contract was flawed by design: a “unit of dental activity” model rewarding throughput over prevention and volume over complexity. The disconnection between clinical judgment and financial reward was always likely to drive attrition among the most conscientious practitioners. That practices are returning £900m of NHS funding—not owing to lack of demand but to financial unsustainability—is not a market failure. It is a policy failure, two decades in the making. The underuse of the wider dental team is equally inexcusable. Therapists, hygienists, and nurses with extended duties represent a substantial workforce that the current model systematically fails to use. The barriers...
