title: Revolution in the provision of dental services in the UK.
abstract: The National Health Service (NHS) in England provides a comprehensive dental service funded largely from taxation but supplemented by co-payments.
  
  
  OBJECTIVE
  This paper provides a historical overview of NHS dental services and some personal reflections on the main challenges over the next five years.
  
  
  METHODS
  A narrative review of the literature and some subjective observations and comments.
  
  
  RESULTS
  In 2006 there was a radical change to NHS dental services in England; central budgets were capped and general dental practitioners. Dentists who were previously paid on a fee-for-item basis moved to a new contract that required them to hit activity targets to maintain their historical income. This contract was unpopular with dentists and has been criticized for not improving access or quality. A new dental contract has been promised based on capitation. Against this background significant issues have to be addressed including: a rapidly growing gap in between demand and resources and a need to make substantial cost savings across the whole of the NHS; a significant decline in dental need; inequalities in utilisation of dental services; and provision of treatments of doubtful effectiveness.
  
  
  CONCLUSIONS
  The NHS dental healthcare system faces significant challenges and consideration needs to be given to the consequences of a focus on need rather than demand. Logically this would require a needs-based resource allocation formula and a needs-based approach to service and workforce planning. A move to a needs-led service is a political decision with associated political risks.
authors.affiliation: Dental Public Health and Primary Care, School of Dentistry, The University of Manchester, Manchester, UK. martin.tickle@manchester.ac.uk
authors.forename: Martin
authors.initials: M
authors.lastname: Tickle
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D003729:Dental Care / Q000458:organization & administration; D003813:Dentistry / Q000458:organization & administration; D018166:Health Care Reform; D006801:Humans; D013222:State Medicine / Q000458:organization & administration; D006113:United Kingdom