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Last Updated: Monday, 3 October 2005, 00:11 GMT 01:11 UK
Will dentist reforms make a difference?
By Nick Triggle
BBC News health reporter

Dental equipment
There are 9,000 dental practices in England
Tony Blair has said he is powerless to stop dentists opting to do private work instead of sticking with the NHS.

In a few months the profession will undergo a radical shake-up. Will that convince dentists to stay?

In an era when dentists are increasingly seeing patients privately, the Rocky Lane Dental Practice in Manchester is a throw-back to the old days.

More than 90% of patients are seen on the NHS, compared to less than two thirds for the average dentist.

The six-strong practice is part of a pilot which has allowed the dentists to spend more time talking to patients about preventative issues as they are no longer paid on a piece-work "drill and fill" basis.

Ben Atkins said: "It has worked really well.

Oral health

"By addressing people's oral health in this way we are able to reduces the chances of them needing invasive treatment in the future."

It was originally envisaged that the pilot would form the basis on the shake-up in NHS dentistry that has been long overdue.

For the past 15 years dentists have been increasingly turning to private work - partly to earn more money, but also to spend more time with their patients.

Ben Atkins
Ben Atkins' practice has been piloting a new system for 18 months

In 1990 only about a tenth of dental work was done privately. Now it stands at nearly 40%.

But dentists are warning the new contract, which kicks in for 85% of England's 9,000 dental practices next April, betrays the model pioneered by Mr Atkins and some of his colleagues.

The contract demands dentists carry out 95% of the work they do at the moment, not the 70% many of the pilots are doing.

Lester Ellman, of the British Dental Association, said: "It really is not a vast improvement on what we are doing now.

Fear

"We expected much, much more, but unfortunately we have not got it. My fear is that we will see more and more dentists go private, and that is not going to benefit the poorest patients."

And if that does happen, Mr Ellman warns some of the scenes of recent years, where long queues have been seen in areas where new dentists have opened, could be repeated.

Only half the population is registered with a dentists - although the government says some of this is down to people not wanting to register themselves - as there is a shortage of dentists.

DENTAL REFORMS
A dentist treating a young patient
Under a new contract in April, dentists will only have to do 95% of the work they are currently doing for the same money, allowing them to spend more time on preventative work
A simpler fees systems with three different bands, instead of over 400 charges, will also be introduced
Number of dental students has risen by a quarter to 1,000 this year. But they will take five years to train

A few years ago it stood at over 1,800 but that has been reduced by about 1,000 as the government has encouraged international recruitment.

There has also been a 25% increase in dental training places this year to 1,000, but it will be another five years before these graduate.

And even then it seems there is no guarantee they will devote themselves to the NHS.

Robin Seymour, dean of dentistry at Newcastle Dental School, said: "If there aren't the right incentives in place the graduates will just do private work when they finish their training.

"Even though the new contract does look like it will improve things, I think some will still choose to do private work.

Treatment

"And if that keeps on happening we will get a two-tier service, where the rich can pay for treatment, and the poor have to make do with what's left behind."

Campaigners are blaming what they see as a climb-down by the government over the long-delayed contract.

Nigel Carter, chief executive of the charity British Dental Health Foundation, said: "It seems the pilots are rather more generous that what is now on offer and dentists will be disappointed.

It [new fees system] will mean patients pay more for a simple filling
Anthony Halperin, of the Patients Association

"It is still not clear what the impact will be, patients could even walk away themselves as the cost of basic work is going up.

"There are some rumblings and I can't see many being tempted back."

And Anthony Halperin, a trustee of the Patients Association, criticised the shake-up in dental fees.

Under the new system, patients will pay one of three bands - 15 for a check up, 41 for a filling and 183 for more complex work such as crowns.

It replaces the more complex current system of over 400 different charges which are capped at 384.

Dr Halperin said: "You can see the sense of this from an administration point of view, but does it benefit patients?

Filling

"For example, it will mean patients pay more for a simple filling."

But the Department of Health maintains the contract will make a difference, pointing out dentists are being guaranteed the same money for seeing 95% of the patients they used to for the next three years.

A spokeswoman also said that under the contract the general check up is being overhauled, with dentists being allowed to carry out a comprehensive assessment, x-rays and scale and polish for a slightly increased fee.

However, with many dentists still to be convinced it seems crunch time is here.

In the next few weeks dentists will be meeting with local health bosses to thrash out how the new contract will work in practice.

Dr Carter said: "This is when we will find out which way it is going to go."


SEE ALSO:
Blair 'powerless over dentists'
30 Sep 05 |  Health
NHS dentists 'disaster' warning
19 Sep 05 |  UK Politics
Q&A: Dentist reforms
06 Jul 05 |  Health


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