Kent and Medway NHS Dentist Crisis Leaves Patients Behind

New NHS figures show Swale and Ashford doing better, Canterbury falling badly behind for adults, Thanet flashing red for children — and a dental system still built around contracts, not patients.

A child in Thanet shouldn’t need postcode luck to get their teeth checked.

An adult in Canterbury shouldn’t have to discover, after the pain starts, that NHS dentistry isn’t quite the public service many people still imagine it to be.

And a family in Tonbridge & Malling shouldn’t have to learn the hard way that a dental practice can exist on a map while NHS access remains somewhere between difficult, doubtful and don’t-hold-your-breath.

But that is where the latest dental data leads.

Across 12 Kent and Medway local authority areas, the figures show not one simple NHS dentistry crisis, but several local ones. In some places, more residents are getting through the NHS door. In others, adults are falling away. In Thanet, children are the warning light. In Tonbridge & Malling, both adult and child access look weak.

This is not a story about teeth alone.

It is a story about geography, money, old contracts, missing waiting lists and a public service that increasingly seems to ask the same question: can you afford another way in?

The official NHSBSA figures count adults as having been seen if they received NHS dental care in the previous 24 months. Children are counted if they were seen in the previous 12 months. Across England in 2024/25, 40% of adults and 57% of children met those tests.

That sounds dry.

It isn’t.

Because when you translate it into ordinary life, it means this: if you didn’t receive NHS dental care during that period, you weren’t counted as getting access, however many times you rang, searched, waited, gave up, went private, or decided the toothache would have to wait.

The Commons Library report helps explain why that matters. NHS dentistry in England does not work like GP registration. Patients are not guaranteed future access to the same dentist once a course of treatment is over. Primary care dentists are independent businesses and can provide a mix of NHS and private care. To provide NHS care, they need a contract with the NHS.

That is the first trapdoor under public understanding.

People talk about my dentist.

The system talks about activity.

Let’s start with adults.

Swale comes out best in this 12-area Kent and Medway extract, with 44.3% of adults seen by an NHS dentist in the previous two years. Thanet follows on 43.6%. Ashford is at 41.9%, Gravesham at 41.0%, and Folkestone & Hythe just above the England line at 40.1%.

That doesn’t mean everything is rosy in Swale, Thanet, Ashford, Gravesham or Folkestone & Hythe. It means they’re doing better than the national adult benchmark on this particular measure.

Then comes the other Kent.

Dartford is just below England at 39.9%. Medway is at 37.2%. Dover is 36.5%. Maidstone is 33.3%. Sevenoaks is 32.3%. Tonbridge & Malling is 31.5%.

Canterbury is bottom, with just 30.2% of adults seen by an NHS dentist in the previous 24 months.

Almost seven in ten adults in Canterbury were not counted as having seen an NHS dentist over a two-year period.

Not a bad week.

Not a difficult winter.

Two years.

That is the figure which should make NHS Kent and Medway, MPs, councillors and anyone tempted to call this recovery pause for breath.

The Commons Library report says that, in 2023, the Commons Health and Social Care Committee warned of a “crisis of access” in NHS dentistry, with unequal access across regions, ethnic groups and socioeconomic groups. It also cites the Nuffield Trust’s conclusion that “universal dental care has likely gone for good.”

That sentence is doing a lot of work.

Because if universal dental care has likely gone, then Canterbury’s adult figure is not just a local embarrassment. It is a local expression of a national retreat.

Now look at children, and the map changes.

Swale is again strongest, with 61.8% of children seen in the previous year. Ashford is close behind at 60.7%. Medway is above England at 58.2%. Folkestone & Hythe is just above the line at 57.5%.

Then the numbers drop.

Maidstone is 56.7%. Sevenoaks is 55.3%. Dartford is 54.6%. Gravesham is 54.3%. Dover is 53.5%. Canterbury is 53.3%. Tonbridge & Malling is 50.4%.

Thanet is bottom, with only 49.0% of children seen in the previous year.

That is the most human number in the whole piece.

Thanet does not look weak for adults. It looks comparatively strong. But for children, it falls to the bottom of the 12-area table.

That mismatch needs explaining.

Children don’t choose the dental market. They don’t decide whether a practice takes NHS patients. They don’t know what a UDA is. They don’t compare NHS and private fees. They don’t ring around asking whether anyone will see them before pain turns into a family emergency.

Adults do that for them.

And when child dental access fails, the consequences are not abstract. They arrive as pain, infection, missed school, antibiotics, extractions, and a parent wondering why something as basic as a check-up has become a battle.

This is where the Commons Library report adds real bite. It explains that NHS dental contracts are not based on the number of NHS patients a dentist sees, but on the amount of activity performed. That activity is measured in units of dental activity, or UDAs. The report says providers agree in advance to deliver a set amount of dental activity each year. If they under-deliver, commissioners can claw back funding. If they complete their contracted activity early, they have little scope to do more NHS work, even if they have time and capacity.

That is why, as the report puts it, some patients are told their dentist cannot see them for an NHS appointment but can see them privately.

There it is.

The moment the whole system stops sounding like healthcare and starts sounding like a bad magic trick.

The chair is there.

The dentist may be there.

The patient is there.

The NHS appointment is not.

The adult gap against England makes the Kent and Medway postcode lottery sharper.

Canterbury is 9.8 percentage points below England. Tonbridge & Malling is 8.5 points below. Sevenoaks is 7.7 points below. Maidstone is 6.7 points below. Dover is 3.5 points below. Medway is 2.8 points below. Dartford is almost on the line, but still slightly below.

The adult red-flag cluster is clear: Canterbury, Tonbridge & Malling, Sevenoaks and Maidstone.

That doesn’t mean residents elsewhere have it easy. It means those four places sit furthest from the national adult benchmark.

A proper local answer would not be a press release saying dentistry is challenging nationally.

Everyone knows that.

A proper answer would explain why Swale’s adult access is 44.3% while Canterbury’s is 30.2%. Why Ashford is above the line while Tonbridge & Malling is far below it. Why Folkestone & Hythe just clears the adult benchmark while neighbouring Dover does not.

The Commons Library report gives a clue that should make every local commissioner uncomfortable. NHS England allocates dental funding to Integrated Care Boards based on dental activity provided in 2006, when the current national contract model was introduced, rather than current need. The report also says Public Health England explained that this effectively capped dental care spending.

So the local dental map is not simply a reflection of today’s need.

It is partly a fossil of yesterday’s provision.

That matters in Kent and Medway because populations shift, towns grow, coastal deprivation deepens, families move, older people need care, and private dentistry expands where the market can bear it.

Need changes.

Old contracts don’t always keep up.

For children, the warning lights move.

Thanet is 8 percentage points below England. Tonbridge & Malling is 6.6 points below. Canterbury is 3.7 points below. Dover is 3.5 points below. Gravesham is 2.7 points below. Dartford is 2.4 points below. Sevenoaks is 1.7 points below.

Tonbridge & Malling is the district that looks bad twice: second-worst for adults and second-worst for children.

That is not a statistical quirk.

That is a pattern with a waiting room attached.

Dover also deserves scrutiny because it is below England for both adults and children. If routine dental access is weak for adults and weak for children, the question is not whether a problem exists. The question is why the problem has been allowed to sit there.

Maidstone is weak for adults but close to the child benchmark. Gravesham is the reverse: adults above England, children below. Medway is below for adults but above for children. Thanet is strong for adults but worst for children.

Those splits matter. They tell commissioners where to look.

They also show why a single Kent and Medway answer will not do.

The system may be national, the contract may be national, and NHS Kent and Medway may commission across a wide geography. But toothache is local. It happens in Canterbury, Margate, Dover, Sittingbourne, Ashford, Maidstone, Dartford, Gravesend, Sevenoaks, Folkestone and Chatham.

People do not live inside an Integrated Care Board.

They live in streets.

They wait in kitchens.

They ring from cars outside schools.

And if they cannot get an appointment, the failure is felt at home long before it is noticed in Westminster.

The Commons Library report adds another uncomfortable point. In 2024, the GP Patient Survey found that just over half of respondents had tried to get an NHS dental appointment in the previous two years. Among those who tried, three out of four were successful. But people who had not been to the practice before were much less successful: 33%, compared with 83.7% among those who had been before.

That is the quiet gatekeeping effect.

The system works better if you are already inside it.

For everyone else, good luck.

The same survey found that, among people who did not try to get an appointment, 24.7% said they didn’t try because they didn’t think they could get one. That number matters because it shows why access statistics can understate the real problem. Some people do not fail at the door. They never go to the door because they believe it is already shut.

That is not demand disappearing.

That is resignation.

And resignation is very useful to broken systems because it makes the queue look shorter.

The report also puts money back at the centre of the story. NHS dentistry is funded by NHS England payments and patient charges. It says NHS England’s real-terms contribution to dental funding fell by around 26% between 2010/11 and 2023/24, while the total cost of dental services in England fell by 22% in real terms over the same period. Patient charges provided around 26% of total funding in 2023/24.

So when NHS access fails, the private option is not just an alternative route.

It is a sorting machine.

Those who can pay may escape the NHS queue.

Those who cannot wait, suffer, or hope the pain does not get worse.

Children are supposed to be protected from some of that. Under-18s are entitled to free NHS dental treatment. But free treatment does not help if access cannot be found.

That is why Thanet’s child figure matters so much.

The policy promises are familiar. More urgent appointments. More dentists in areas that need them most. Contract reform. Supervised toothbrushing for three- to five-year-olds in targeted high-need areas.

All sensible.

All insufficient unless they actually reach the places where the numbers are flashing red.

The Commons Library report says Labour’s 2024 manifesto promised 700,000 more urgent dental appointments, recruitment of new dentists to areas that need them most, reform of the NHS dental contract, and a supervised toothbrushing scheme for three- to five-year-olds in high-need areas. It also says the government has not provided a timescale for contract reform.

That last bit matters.

Because the contract is not a side issue.

It is the machinery.

And the machinery is what produces the absurdity of a patient being unable to get an NHS appointment while a private appointment may be available.

The previous recovery plan does not offer much comfort either. The Commons Library report says the National Audit Office found that the plan was not on course to deliver the promised extra 1.5 million courses of treatment. It also records the Public Accounts Committee’s conclusion that the plan “comprehensively failed to deliver improvements in access to NHS dentistry”.

That quote should be pinned to every glossy dental recovery announcement before anyone prints another smiling stock photo.

The question for Kent and Medway is not whether ministers can make national promises.

It is whether a child in Thanet, an adult in Canterbury, a family in Tonbridge & Malling, or a patient in Dover can get seen.

Swale and Ashford show the local picture is not flat. Some areas are doing better. That makes the poor figures elsewhere harder, not easier, to excuse.

If Swale can top the table for adults and children, why is Canterbury bottom for adults?

If Ashford can sit above the line on both measures, why is Tonbridge & Malling below it on both?

If Medway can beat the England child benchmark, why can’t Thanet?

Those are not trick questions.

They are the questions the data asks on behalf of residents.

NHS Kent and Medway should now publish a clear district-level account of how many practices are actually taking new NHS adults and children; how many urgent appointments are available locally; how commissioned NHS dental activity is distributed; how much activity is undelivered; and what specific action is being taken in Canterbury, Thanet, Tonbridge & Malling, Dover, Sevenoaks and Maidstone.

Not a map of dental practices.

Not a vague statement about national pressures.

Actual access.

Because a dot on a map is not an appointment.

A contract is not a check-up.

And a recovery plan is not recovery if the patient is still waiting with a swollen face and a private bill they cannot afford.

The adult map says Canterbury is the red flag.

The child map says Thanet is the alarm bell.

The combined map says Tonbridge & Malling needs serious questions.

The Commons Library report says the whole system has deeper faults: no GP-style registration, activity-based contracts, old funding patterns, private drift, unequal access and a recovery plan that has already been judged to have failed.

That is the bigger story.

NHS dentistry in Kent and Medway is not just a health service problem. It is a fairness problem. A geography problem. A money problem. A children’s problem.

And for too many people, it is a pain problem.

The spreadsheet showed where the gaps are.

The report shows why the gaps are built in.

Now someone responsible needs to open their mouth.

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