NHS Knee Operations — But No NHS Dentists?

NHS Knee Operations — But No NHS Dentists?

An explainer for UK and Peterborough readers.

Many people across Peterborough are asking the same question: How can the NHS fund a knee operation — even in a private hospital — yet offer no access to an NHS dentist?

At first glance, it makes little sense. Teeth are part of the body, dental pain can be severe, and oral health is closely linked to overall health. Yet access to NHS dentistry has become one of the most difficult parts of the healthcare system.

The explanation lies not with individual dentists or patients, but with how NHS dentistry is funded and organised.

NHS dentistry is not treated like the rest of the NHS

Most NHS services, such as hospital surgery, operate on a demand‑led basis. If a patient needs a knee replacement and meets clinical criteria, the NHS must fund it. If NHS hospitals do not have enough capacity, the NHS can and does pay private hospitals to carry out the operation.

Dentistry works very differently.

Dentists are independent contractors, not NHS employees. NHS dental care is only available where a practice holds an NHS contract — and each contract is strictly capped, with a fixed amount of funding and a fixed volume of treatment.

Once that limit is reached, the practice is not allowed to provide any more NHS care, even if patients are in pain and even if the dentist wants to help.

A capped system means care is rationed

In Peterborough, as in many parts of England, demand for dental care far exceeds the number of NHS appointments available.

Unlike knee surgery:

Extra dental need does not unlock extra NHS funding
The NHS does not automatically commission more dental care
Patients are often told there are “no NHS places available.”

This is why many residents struggle to register with an NHS dentist — sometimes for years.

Why this matters for patients awaiting surgery

There is a little‑known but serious consequence of the dental access crisis:

If a patient is due to have an NHS operation, the procedure can be postponed or cancelled if they have an untreated dental infection.

Hospitals routinely require patients to be free from active oral infections before surgery — especially joint replacements — because bacteria from the mouth can enter the bloodstream and increase the risk of post‑operative complications.

This means that people who cannot access an NHS dentist may find their surgery delayed through no fault of their own.

The payment system is part of the problem

Since 2006, NHS dentists have been paid using a system called Units of Dental Activity (UDAs).

In practice, this means:

Simple and complex treatments can attract the same payment
Time‑consuming, high‑need patients are often underfunded
Rising costs for staff, equipment, materials, and regulation are not fully reflected

Many dentists report that providing NHS care — particularly complex treatment — can be financially unsustainable. As a result, some practices reduce their NHS work or stop offering it altogether.

NHS Knee Operations — But No NHS Dentists?

Why this affects Peterborough particularly hard

Peterborough faces a combination of challenges:

A growing population
High levels of dental need
Limited NHS dental contract capacity

Urgent dental care is still available locally through NHS 111 and dental access centres, but this is short‑term pain relief, not routine ongoing dental care.

For many people, the only realistic option for regular check‑ups is private dentistry — something not everyone can afford.

What would it take to fix the problem?

Health policy experts broadly agree that restoring NHS dentistry would require:

Making dental care a genuine NHS entitlement
Removing hard funding caps
Replacing the UDA payment system
Investing properly in the dental workforce
Shifting the focus towards prevention, not crisis treatment

These would be major policy changes, not small technical adjustments.

The reality today

The situation in Peterborough reflects a wider national issue. People can receive NHS‑funded surgery in private hospitals, yet may be unable to access NHS dental care locally.

This is not because dentistry is unimportant, but because it has been systematically underfunded and deprioritised for many years.

Until that changes, difficulties accessing NHS dentistry are not a temporary failure of the system — they are the expected outcome of how it is designed.

All information in this article relates to systemic NHS commissioning and funding arrangements. No statements should be interpreted as criticism of any individual dental practitioner or private dental provider.

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