• dental resource allocation;
  • general practice;
  • health services’ needs and demand;
  • manpower

The National Health Service (NHS) in England provides a comprehensive dental service funded largely from taxation but supplemented by co-payments.


This paper provides a historical overview of NHS dental services and some personal reflections on the main challenges over the next five years.


A narrative review of the literature and some subjective observations and comments.


In 2006 there was a radical change to NHS dental sservices in England; central budgets were capped and general dental practitioners. Dentists who were previously paid on a fee-for-item basis moved to a new contract that required them to hit activity targets to maintain their historical income. This contract was unpopular with dentists and has been criticized for not improving access or quality. A new dental contract has been promised based on capitation. Against this background significant issues have to be addressed including: a rapidly growing gap in between demand and resources and a need to make substantial cost savings across the whole of the NHS; a significant decline in dental need; inequalities in utilisation of dental services; and provision of treatments of doubtful effectiveness.


The NHS dental healthcare system faces significant challenges and consideration needs to be given to the consequences of a focus on need rather than demand. Logically this would require a needs-based resource allocation formula and a needs-based approach to service and workforce planning. A move to a needs-led service is a political decision with associated political risks.