Recent headlines say that £900 million meant for NHS dentistry has been returned to the government over the past two years.
For many people, this is confusing.
If it is so hard to get an NHS dentist appointment, how can so much money go unused?
The answer lies in how NHS dentistry in England works.
What is a “clawback”?
NHS dental practices work under contracts with the NHS. These contracts set a target for how much treatment a practice must provide each year.
Dentists measure this work using Units of Dental Activity (UDAs). This system has been in place since 2006.
If a practice delivers less than about 96% of its yearly target, the NHS can take back some of the money. This is called “clawback.”
Recent figures suggest:
- About £480 million was returned in 2023–24.
- About £450 million was returned in 2024–25.
Together, that is around £900 million returned to the government over two years.
Why these figures matter
The numbers highlight a clear problem.
Across the country, many people say they cannot find an NHS dentist. Others face long waits for appointments.
Yet at the same time, hundreds of millions of pounds set aside for NHS dentistry have gone unused.
“This shows the system is not working as it should.
“When people hear that hundreds of millions of pounds are being returned while they cannot find an NHS dentist, it naturally raises questions.
“The money is there, but the system does not always allow it to turn into care for patients. That is why so many people are struggling to get the treatment they need.”
Dr Rachael England, Head of Policy and Advocacy
Why is this happening?
There is no single reason. Several problems in the current system are contributing to the situation.
The NHS dental contract
Some complex treatments count for the same amount of activity as much simpler ones, even though they take far more time to complete.
The cost of providing care
Dentists say some NHS payments do not fully cover the cost of treatment, which can make it difficult for practices to provide certain services.
Workforce shortages
Many practices struggle to recruit dentists, which means they cannot always deliver all the NHS treatment they are contracted to provide.
Limited flexibility
Practices cannot easily increase the amount of NHS care they provide, even when there is strong patient demand.
What this means for patients
For patients, the result is simple: it becomes harder to get care.
When check-ups are delayed or missed, dental problems are more likely to worsen before treatment. This can lead to:
“The impact can be serious.
“When people cannot get routine dental care, small problems can become much worse. Tooth decay, gum disease and infections can all get worse without early treatment.
“Dental professionals can also spot early signs of serious conditions such as mouth cancer. When routine visits are harder to get, those early chances to find disease can be lost.”
Karen Coates RDN Cert OHE, Oral Health Content Specialist
A system under strain
The £900 million clawback figure does not mean people do not want NHS dental care.
It also does not mean dentists do not want to provide it. In many cases, dentists say the current system makes it difficult for them to offer the level of NHS care patients need.
Demand for NHS dentistry remains high, but the way the system works does not always translate funding into treatment.
The current dental contract is nearly 20 years old. Since then, patient needs have changed, and pressure on the dental workforce has grown.
Many people now believe the system needs reform to better support dentists in delivering care and help patients get the treatment they need.
Where the clawback money should go
The Oral Health Foundation believes money set aside for NHS dentistry should be used for dentistry.
That means putting clawed-back money back into services that help patients get care, especially those who struggle most to access it.
“This money should go back into frontline care and prevention.
“If funding is being returned while patients are struggling to get care, it should be put back into improving access to dentistry.
“That should include prevention programmes, flexible NHS commissioning to reach communities with the greatest need, and support for trusted charities that can provide care directly in local areas.”
Dr Rachael England, Head of Policy and Advocacy
This could include:
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Prevention programmes that stop problems before they start.
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Flexible NHS services for groups with high levels of unmet need.
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Community dental projects.
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Charities such as Dentaid, which can bring dental care into local communities.
Using the money this way could help reach people who are missing out on care now, while bigger changes to NHS dentistry are being worked on.
Looking ahead
NHS dentistry is still an essential service. For many people, it is the only affordable way to get dental care.
The £900 million clawback story has exposed serious problems in the system.
Fixing them will mean making it easier for practices to provide care, placing more emphasis on prevention, and ensuring patients can get the treatment they need.
Until that happens, too many people will continue to struggle to get NHS dental care.