I am deeply concerned about the worsening crisis in NHS dentistry. I raised this issue at Prime Minister's questions as long ago as June 2004 when John Prescott (the Prime Minister was abroad) simply blamed the problem on the Tories for closing two dental schools. I think it it is absurd to suggest that this decision by the University Grants Committee now some19 years ago is responsible for the current crisis. Our problem is not due to a shortage of dentists but about how they are employed, and that they are leaving the NHS in droves.
Over the last year or so several people had complained to me that they felt they were almost being held hostage: they had received a letter from their NHS dentist to tell them that the practice would no longer treat adult NHS patients, they would however continue to treat their children under the NHS, but only if they as the parents now remained with the practice as private patients. I complained to the Minister about this. Now the Government has acted: but, instead of dealing with the underlying cause which is driving dentists from the NHS, it has simply empowered primary care trusts to prevent dentists from providing NHS dentistry only to children. The consequence is that these same parents, who at least did manage to secure NHS dentistry for their children, are now getting letters saying that their practices will now no longer be able to stick to their side of the bargain and treat their children under the NHS. I have received two such complaints this week, one of which was particularly worrying because the child had been involved in an accident and had been having orthodontic work done, which is now going to prove prohibitively expensive.
I fear that the situation is now set to get very much worse because the Government has imposed a new NHS contract on dentists as from the 1st April. Negotiations with the British Dental Association broke down weeks ago but they simply imposed it on the dentists anyway. It is far from clear yet how many dentists have signed up under the new terms: the indications are worrying: as many as 10% of dentists may have abandoned the NHS on 1st April and many more may have signed up only temporarily until they have finalised alternative arrangements to go private.
The whole implementation of the new dental contract has been a complete shambles and the fundamental problems have not been addressed. The underlying problem is that the old contract put dentists on a “drill and fill” treadmill by only paying them a fixed fee for procedures carried out. It was out of date and inflexible. It did not encourage preventive treatment and it simply did not allow for the huge of advances in dentistry over recent years.
In my estimate the only real way forward is a system that pays dentists a capitation fee for every patient on their list, somewhat similar to the system for GPs. All the Government's new new contract does, however is to dress up the old system in new jargon: the old list of procedures has been replaced by the UDA (unit of dental activity!) for which those dentists that are left will now be paid, but many of the dentists planning to remain with the NHS are now to be severely hampered by the new system because the Government has budgeted and allocated UDAs to practices on the strength of the work they were doing during a study that concluded months ago. Since when a number of practices have expanded their NHS service to try and address the growing shortage. Consequently, even at a time when we are desperately short of NHS dentists, some are being sacked because the Government has allocated their practice too few UDAs.
I did ask the Minister to postpone the new contract until the problems were all sorted out but I didn't get a reply. I rather think that the Government is hoping that the shortage is going to be resolved by its latest new initiative: Dental Access Centres. Apparently these will be created and staffed by dentists from Poland and they will be managed and financed primary care trusts. Well, given New Forest Primary Care Trust's continuing financial crisis and the fact that it is in the process of being abolished anyway, the future could hardly be bleaker. As I often end letters to constituents when giving them bad news: “I am sorry I cannot be more positive”. |
