Mapping NHS-funded dentistry to protect against 'dental deserts'

Access to NHS dentistry is in decline. Dr Stephen Clark uses innovative modelling methods to identify areas and populations that are vulnerable to dental deserts and oral ill-health.

Dr Clark, a Research Fellow at the Leeds Institute for Data Analysis (LIDA), has written two research papers investigating England’s access to NHS-funded dentistry.

Dentists’ provision of NHS-funded treatment is in decline across England, causing concerns for the population’s oral health.

Some areas are worse off than others, as services are not evenly distributed throughout the country. Neighbourhoods with little to no access to NHS-funded dentists are seen as ‘dental deserts.’

Previous analysis of NHS-funded dentistry focused on the number of practices in each location. However, this does not account for each practice’s capacity to complete treatments or the total demand including people who travel to get treatment.

Realising this, Dr Clark has created a more detailed model to map units of dental activity (UDAs) and produce a Spatial Accessibility Index (SPAI). This accounts for different demands, services and patient locations in each area.

Who has the most and least access to NHS-funded dentistry?

Access to NHS dental care varies by not only the location but also the characteristics of the neighbourhood and its population.

Dr Clark included a range of socio-economic and demographic indicators in his analysis of NHS-funded dentistry over eight years.

Among other results, he found that:

Towns of varying sizes have the highest capacity, followed by the core cities outside London and then London itself
Villages, small communities and areas of ‘moderate deprivation’ have the lowest capacity
Cities experience a smaller reduction compared to a much higher reduction in villages and small communities
The starkest decline is the 17% reduction in practices in cosmopolitan student neighbourhoods, however, such neighbourhoods already had good provision.

The paper ‘The contract between NHS dentistry and communities and how this varies by neighbourhood types’ visually maps the results.

A map of Kingston upon Hull, with coloured dots showing the capacity of dental practices. The city centre has more capacity, whereas the suburbs have less.

The previous image shows an illustrative case study of the city of Kingston upon Hull in East Yorkshire.

There is good accessibility in the city centre, but towards the suburbs, the accessibility diminishes.

Neighbourhoods such as Kingswood in the north and Cottingham in the west have particularly poor accessibility.

Informing future dental care and oral health

Dr Clark’s investigation shows the accessibility of NHS dental treatment across neighbourhoods and demographics.

His research shows how dental care matches changes in population, recruitment and policy.

It discusses where dental deserts may be located or growing and the issues that a lack of access to dental care creates.

Dr Clark writes that his study shows a “sobering picture” of NHS-funded dentistry in England. For all neighbourhoods, there is not enough capacity to provide basic dental care to the population.

This is despite the importance of dental check-ups in the early detection of gum disease, oral cancer and other life-changing health issues.

He acknowledges that his analysis can’t capture the needs of marginalised individuals such as homeless people and migrants whose healthcare is as important.

A substantial section of the population has a preference for private dental treatments, which are not included in this analysis of solely NHS provision.

Dr Clark’s model can inform the new government’s policies to increase NHS-funded dentist appointments. It could help them identify the areas and populations with the most need.