Monday, June 28, 1999 Published at 11:51 GMT 12:51 UK
NHS dentistry warning
Children are a priority for NHS dental care
Gaining access to an NHS dentist could become increasingly difficult if the government does not increase investment in the sector, an independent study has said.
It has been reported that some patients already have to travel up to 100 miles if they want to get the NHS treatment to which they are entitled.
William Laing, of Laing and Buisson, which produced the study, told BBC News Online the shortage of NHS dentists was a trend fuelled by government cuts in funding.
The British Dental Association (BDA) said the problem is leading to a two-tier dental service, where only those dentists who take on more private work can afford modern equipment to ensure quality.
Move to private sector
Children, students and pensioners are excluded from dental charges on the NHS. For those who pay, NHS treatment is usually much cheaper than private.
"There is a shortage because NHS dentists perceive that they are underpaid for NHS work so over the last eight or nine years they prefer if they possibly can to move across to treating private patients," Mr Laing said.
"It's not something that's driven entirely by the demands of the customer, it's something that's driven by their own fee rates - typically a privately-practising dentist can get a fee rate that's 50 to 60% higher than fee rates paid by the NHS, so they close the door to NHS patients."
The only way to reverse the trend was to increase fee rates, but the government was unlikely to do this, the report said.
Spending on NHS dentistry was likely to decrease while spending on private work was likely to increase, as this what had happened over the last 10 years and nothing had happened to prevent it continuing, Mr Laing said.
The BDA said access to NHS dentistry was an ongoing problem, and pointed to a recent survey it conducted showing more patients had asked health authorities for details of their nearest NHS dentist.
It also showed that health authorities were finding it difficult to recruit salaried dentists.
Overall, the BDA estimates another 550 dentists are needed to provide adequate cover for England and Wales.
In the meantime, there is a danger of a two-tier system developing, a spokeswoman said.
She said the problem was not so much to do with how much dentists are paid, more to do with how much they get to run their practices.
Most dentists are self-employed and are paid in fees that cover the costs of running their practice.
NHS fees were just not high enough to ensure dentists could buy the latest equipment, she said.
"What is happening is dentists who remain exclusively NHS are finding it increasingly difficult to invest in new technology and equipment whereas if you're taking on more private patients you're able to do that.
"There's a sort of two-tier system growing up - if you take on private patients, you can invest in the new technology and offer the your patients the best treatments, but if you're an NHS dentist it's increasingly difficult to do that."
However, most patients are still treated on the NHS, but the government would have to act if it did not want to see a decline in access to NHS treatment.
"They talk about the NHS being there when you need it, about it being modern.
"But as far as dentistry is concerned it's not there when you need it - you may have to travel many miles and take time off work which is clearly not acceptable."
Government promises action
The Department of Health said the government had inherited a poor situation where there were areas with poor access to NHS dentistry.
It said pilot schemes were being launched that would address the shortage.
"We are now examining options and deciding how to make best use of resources available to improve further access to NHS dentistry," it said in a statement.
A government dental strategy, that has been delayed for some time, is due to be published later this year.