Rescue package for NHS dentistry may make shortages even worse

DENTISTRY in the National Health Service is in deep trouble and a rescue plan could make the situation even worse, the government spending watchdog says.

The National Audit Office says in a report published today that new contracts planned by the Department of Health could be no more effective than the old. Undertreatment by dentists who are paid a salary could replace overtreatment caused by the present piecework system.

Until the contracts are agreed and the public is told how much treatment will cost, the efficiency of the changes will not be known. With only ten months to go before the system is implemented, time is getting short, the NAO says.

It also questions whether the primary care trusts (PCTs), which have responsibility for the new system, are competent enough.

Edward Leigh, MP, the chairman of the Committee on Public Accounts, said that the current system pays dentists for 10-30 per cent more treatment than is needed. “Replacing it with contracts that emphasise prevention and the maintenance of oral health is much more in step with a modern approach to dentistry,” he said.

“What the Department of Health has failed to do is to give patients and dentists detailed information about how this ambitious new system is going to operate in practice and how much patients will have to pay.

“People are anxious about the flow of dentists out of NHS dentistry and into the private sector. There is a big question mark over whether this will be arrested under the new arrangements. The Department of Health has a big job to do reassuring patients and NHS dentists.”

Dentists are free to decide whether to carry out either private or NHS work, or a combination of the two. Most patients, except those who are exempt from charges, pay 80 per cent of the cost of treatment.

Therefore patients pay little more to go private, while dentists who choose this option enjoy their work without the treadmill of NHS patients. But poorer patients who are exempt from charges often cannot find an NHS dentist willing to take them on. In some areas hundreds of people have queued when a new dental surgery opens its doors.

The British Dental Association (BDA) said: “NHS dentistry is at crisis point and botched changes may well push it over the edge. Despite the desperate need for change, there are concerns within the dental profession and patient groups that this overhaul may be blighted by under-funding and insufficient capacity within the PCTs.”

Ian Wylie, the chief executive of the BDA, said: “Our own research found that only 1 in 10 dentists believed their PCT could cope with their new responsibilities. With less than a year to go until implementation, and still without a draft contract, it’s no wonder that many dentists are seriously considering whether their future lies with the NHS.”

Rosie Winterton, the Health Minister with responsibility for dentistry, remains confident. She said that trials of the new contract had worked well, the Government was putting in £59 million to tackle local difficulties and an extra 1,000 dentists were being hired, many from abroad. When PCTs start commissioning dentistry next October, they will get £368 million to ensure there is enough money to pay for the changes. The plan is to agree with each dentist how much NHS work he or she will do, and pay a salary accordingly. A dentist working full-time on NHS work would earn £69,000 a year.

As now, dentists will have to recover from patients their share of the cost of treatments, normally 80 per cent. The NAO is concerned that dentists will be less motivated to collect this money than they are under the piecework system.

Ms Winterton said that fears of dentists drawing their salaries and not doing the work were misplaced. “We are starting from the premise that they are professionals,” she said. But she was unable to provide information on treatment costs. She said the system of charging will be published “shortly”, but actual charges will take longer.

Frances Blunden of Which? said: “The situation with accessing NHS dentists is already horrendous, with large swaths of the country being off-limits to people seeking NHS treatment.

“The point has now come for the Government to answer the fundamental question: does the public have a right to NHS dental treatment? If so, it must commit to adequate long-term resources and provide incentives for dental professionals to work in the NHS sector.”

PAINFUL HISTORY OF CHARGES
# Free dentistry arrived with the NHS in 1948. But it didn’t last long.
# In 1951 charges for dentures were introduced by Hugh Gaitskell, partly to pay for the Korean War.
# Charges for the patient have steadily risen since then, while payments to the dentist have fallen in real terms.
# Children and pregnant mothers pay no charges, and those on income support or jobseekers’ allowance are also exempt.
# Those over 60 are exempt from prescription charges regardless of income, but do have to pay for dentistry: 82 per cent of adults over 60 get no help with dentistry charges.
# Those who pay — the great majority of patients — pay 80 per cent of the cost of a course of treatment up to a maximum of £378.
# Payments to dentists are based on 400 different procedures, each with its own fee — £6.85 for an examination, £10.80 for a scale and polish, £7.30 for a simple filling, for example.
# In real terms, almost all these fees are lower than they were in 1948. Then, the fee for an examination would have been £11.14 in today’s money, for a scale and polish £18.39 and for a filling £22.29.
# Charges to patients have also exceeded the rate of inflation. In the mid-1970s, the total paid in dentistry charges was only £33.4 million.
# By 1982-83 it was £149 million — a 450 per cent increase over a period in which the retail price index had risen by 135 per cent. Today the figure is £500 million

This article was reproduced from the Times on 25th November 2004:
http://www.timesonline.co.uk/article/0,,8122-1374168,00.html