Around one in ten NHS dental practices in England have stopped providing general NHS dentistry since 2017, according to analysis by the Nuffield Trust.

The think-tank found the number of practices holding an NHS general dental contract fell from about 6,260 in March 2017 to around 5,650 in March 2026 – a loss of at least 600.

Over the same period, the proportion of dental practices offering general NHS care dropped from around 65% to 56%, while the number without an NHS contract – largely private or specialist providers – increased by almost 1,000.

According to the analysis, the decline in practices providing general NHS dentistry was evident in 41 of England’s 42 integrated care board areas, with particularly steep reductions in the South West and East of England.

The Nuffield Trust said the shift away from NHS dentistry appeared to have accelerated since the Covid-19 pandemic and linked the trend to pressures associated with the NHS dental contract.

While reforms introduced in April have made urgent dental care a contractual requirement and also increased payments for some complex treatments, the think-tank said the changes did not address the underlying incentives driving practices away from NHS work.

The findings come amid evidence of increasing difficulty faced by the public in accessing NHS dental care. The latest GP Patient Survey found half of adults had not sought an NHS dental appointment in the previous two years.

Among those who had not tried, one in four said they did not believe they would be able to get an appointment. Of those who attempted to secure a new appointment, 38% were successful.

Nuffield Trust policy analyst Mark Dayan said: ‘The retreat of NHS dentistry was never an announcement or a policy. There has been no closure programme for people to oppose.

‘But it amounts to the quiet transformation of dentistry into a two-tier service over the last decade, where access increasingly depends on what people can afford to pay and where they happen to live.’

The Nuffield Trust said the government’s planned reform of the dental contract should be judged on whether it reverses the decline in practices providing NHS care and improves access.

It argued that funding dental practices based on local need, rather than the number of treatments completed, could give dentists stronger incentives and improve access.

Mr Dayan added: ‘Either it makes NHS work attractive enough to turn this trend around and bring back enough practices to cover everyone, or it will need to give up on the promise of a universal service and prioritise those who need preventive care most, or do not have the money to pay privately.'

Neil Carmichael, executive chair of the Association of Dental Groups, said: 'We should focus on the continued problems in recruiting dentists and other dental care professionals. The ADG is working to increase dental surgery exam capacity numbers, and the GDC is gearing up to deliver on its promises. ‘Dental Deserts’ will remain until there are enough dentists to practice in parts of the UK.

'We do also need to perfect the existing NHS contract and show support for it. Constantly undermining NHS dentistry is not helpful. We see variations across regions which point to the need for more resources. There are four different NHS contracts: England, Scotland, Wales and Northern Ireland, but the one common problem is a lack of dentists.'