Why Is a Dentist Being Punished for Keeping Patients Healthy? The Baffling NHS Dental Dilemma
Rob Mew, an NHS dentist in Exmouth, Devon, is facing an astonishing predicament: he’s been asked to repay £150,000—not because he over-treated his patients, but because they required less dental work. His “crime”?
Helping people stay healthy and avoiding unnecessary procedures. This paradox exposes a fundamental flaw in the NHS dental system—one where prevention is punished rather than praised.
Behind the scenes, a troubling question looms: does the NHS prioritize hitting treatment targets over genuinely caring for patients?
Serving a Community in Crisis
Every Thursday, Rob opens the doors of Fairfield House Dental Surgery, one of the rare clinics still accepting NHS patients in an area infamous for “dental deserts.” Families bring in children who’ve often never seen a dentist, some suffering from severe decay so bad it demands hospital visits for extractions.
“We’re treating toddlers with tooth decay so severe they need to be hospitalized,” Rob explains. “We have kids showing up after years without checkups—one 17-year-old needed 28 fillings.”
The emotional weight is heavy. Parents feel guilt, and staff are deeply affected by the scenes they witness. One dental nurse recently took a day off, overwhelmed by how much the cases mirrored struggles in her own family.
Committed Despite the Cost
Fairfield House has served the community for over 100 years. Rob became a partner in 2012 and assumed full leadership in 2017, determined to keep NHS care alive in an area with dwindling access.
Switching to private care would have been far more profitable, but Rob clings to the NHS ideal: health care for everyone, from childhood through old age.
Yet that dedication is backfiring.
The £150,000 Clawback: When Prevention Hurts Your Practice
Despite expanding its NHS patient list to nearly 19,000, Fairfield House was hit with a massive £150,000 repayment demand by NHS England. The cause? Failure to meet a government-set number of Units of Dental Activity (UDAs)—a flawed metric that pays dentists the same regardless of the complexity or volume of care.
Rob’s patients are healthier because of better prevention—annual checkups instead of repeated treatments—but fewer treatments mean fewer UDAs, leading to financial penalties.
The current system rewards volume over outcomes: whether a dentist fills one cavity or twenty, they receive the same UDA payment, often forcing NHS-focused practices into the red.
Demand Outpaces Supply in Dental Care “Deserts”
With NHS dentistry shrinking, desperate patients flood the few remaining practices. Rob fields five to ten calls daily from people seeking help—some traveling hundreds of miles just for an appointment.
“The NHS funds enough dentistry for barely half the population,” Rob notes. “Exmouth’s growing housing hasn’t come with funding increases. It’s a crisis.”
Stories like a family with three children never having seen a dentist, or a 14-year-old needing multiple crowns to save her teeth, highlight the urgent need. Fairfield House is even fundraising £30,000 for a new dental chair—proof that goodwill can’t cover systemic shortfalls.
A Broken System Exposed
The British Dental Association (BDA) and parliamentary committees have repeatedly slammed the NHS dental contract as outdated and counterproductive. Clinics lose money on new patient exams and dentures, pushing many to abandon NHS care for private practice.
The government’s Ten-Year Health Plan pledges reform by 2035, with promises of increased emergency appointments and reserved slots for urgent care. Yet, critics warn this is far too slow for a system on the brink.
Devon: England’s Dental Crisis Epicenter
Data reveals Devon as one of the toughest places to get NHS dental care. Only 72% of former NHS patients here manage to secure a new appointment—well below the national average. New patient acceptance rates are abysmally low, with only 14% succeeding.
Nationally, 12 million people went without NHS dental care last year, 90% of practices refuse new adult patients, and 40% of children missed their yearly checkups. Meanwhile, public dental spending has shrunk by 25% over a decade, and the number of NHS dentists has dropped sharply post-pandemic.
The System Is on Life Support
Eddie Crouch, BDA Chair, warns bluntly:
“This service is on life support. Without urgent, meaningful reform, NHS dentistry as we know it may cease to exist.”
The Department of Health claims to be addressing these issues, but for dentists like Rob and the millions they serve, meaningful change can’t come soon enough.
Conclusion: A Human Crisis, Not Just Numbers
The NHS dental crisis is more than budget lines and statistics—it’s a human tragedy unfolding daily. Children facing extensive decay, dentists penalized for prevention, and millions without access to essential care—all symptoms of a broken system.
Devon’s “dental desert” status is a microcosm of a nationwide failure: funding cuts, flawed contracts, and dentist shortages have collided to create a perfect storm.
Without urgent reform, the NHS risks losing the principle it was founded on—accessible, universal care. For Rob Mew and many like him, the question isn’t just how to survive financially, but how to keep hope alive for a healthier future.