This week an event at the Medical School of the University of East Anglia launched its bid to create the first dental school for East Anglia. The aim is to counter chronic shortages of dentists in Norfolk and the region. An audience of medics, press and politicians heard presentations from the minister, Andrea Leadsom, the chief executive of the Norwich and Norfolk Hospital Trust, Leslie Dwyer, and the MP for Broadland, Jerome Mayhew. This follows endorsement of the plans by the shadow chancellor, Rachel Reeves, on a visit last month.
Norfolk: a dental desert
Norfolk has been described as a ‘dental desert’. Across England, there are just over two dental practices per 10,000 population. In most of Norfolk, and East and Mid Suffolk the figure is less than two thirds of that. A very high proportion of people in the county are not registered with an NHS dentist, and so far in 2024 only five dentists have taken on any new patients. Barely one child in three has seen a dentist in the last year, and in most of Norfolk over a quarter of 5-year-olds have visible tooth decay.
More than just teeth
Regular dental checkups are important, not only to avoid untreated tooth decay and pain, but to prevent a wide range of other problems in the mouth, throat and digestive system. Some of these are life-threatening, and many are expensive to treat. Last year, the hard-pressed A&E department of Norwich & Norfolk Hospital saw 500 patients with dental problems, almost all of which would have been avoided if those patients had had regular dental checkups.
There are five broad issues: providing emergency treatment, supply of dentists, divided responsibility for broader oral health, funding of NHS dentistry, and the business model for running a practice.
Emergencies
In 2023, responsibility for delivering NHS dental services in Norfolk and North Suffolk was delegated to the Norfolk and Waveney Integrated Care System (ICS). In an attempt to deal with the most urgent problems, they have set up an Urgent Treatment Service. This will provide emergency treatment for people referred by NHS 111, in 27 locations across Norfolk and Waveney. But this only deals with one of the issues.
Dentist supply
There is general agreement that there is a shortage of dentists in Norfolk. But the precise scale is unknown, since the last survey was conducted seven years ago.
We clearly need more dentists, but at present, anyone wanting to train has to go to London or Birmingham. When they qualify, they don’t come back to Norfolk. UEA’s experience in other fields is that people who train here, tend to stay here. So UEA is preparing a bid to the government to set up the new dental school. If successful they expect to take their first intake of students in September 2026. Vice Chancellor Professor David Maguire said:
We welcome the Government’s plan to increase the number of undergraduate dental training places. In considering the establishment of new dental schools in underserved areas, we are asking the Government to allocate the new dentistry undergraduate places to East Anglia, where a new dental school can have the greatest impact.
Divided responsibilities
Good oral health contributes to overall good health, and reduces the costs to the rest of the NHS. Dentists are commissioned by the ICS to provide checkups and treatment where necessary. But it is the responsibility of local councils to promote good oral health and prevent problems, particularly among children. However councils’ public health grant, which provides funding for this service among others, has been reduced by a quarter in real terms per head since 2015/16.
Funding
The funding of NHS dentistry is complex. Many dentists argue that the current system, set up in 2006, does not pay enough to run a viable business, and they are required to see an unreasonable number of patients. As a result, many dentists have given up NHS work.
Last year, £2.2m of the region’s funding allocation for NHS dental treatments in the region was returned to the Department of Health because there were no dentists available, or willing, to do the work. Ironically, this is close to the predicted costs of setting up and running the proposed 160-place dental school in Norwich.
Business model
Setting up a new dentist practice is difficult and risky. Last year the ICS invited bids to set up a new dental practice in Fakenham. Although this is the largest town in North Norfolk, the nearest NHS dentist is currently over 17 miles away.
Nobody bid. This is not surprising. Starting a new dental practice is risky. Most dentists are private businesses. To set up a new NHS practice in Fakenham you need premises, with planning approval for business use, and funding for equipment and facilities. This takes time and a substantial outlay before you can begin to bid for the contract, and your bid may not be successful, or the ICS may not allocate you enough patient treatments to cover your costs.
Repair or prevent?
As in so many areas of health, we are concentrating resources on the most expensive part of the system: paying to fix things which could have been prevented long ago. Much of the demand for urgent and expensive hospital treatment arises because people are not seeing a dentist regularly. And in turn, dentists are spending time on complex treatments which could be avoided by better oral health. But local councils and schools do not have the resources and time to promote that. At every stage, early intervention is the cheapest solution, but we face a huge backlog of problems. A new dental school in Norwich will help, but not for a few years. And we need action by government to make the whole system work better.
