By Nick Triggle
Health reporter, BBC News
Dentists are turning away patients because local health chiefs are running out of funds, dental leaders say.
The new contract started in April
A new dental contract started last year, but early figures suggest the government overestimated how much money would be taken in patient fees.
NHS trusts have begun to cut their budgets in response and the British Dental Association said this has led to some dentists refusing patients care.
A government memo has urged health chiefs to get to grips with the issue.
Surrey - NHS trust facing shortfall in fees, although unclear how big at moment. Bosses admit they have had to say no to dentists who want funds to treat patients. Local dentists report having to turn away patients.
Bradford - Health chiefs expecting to get just over half of the £5.7m it was expecting in fees. Unclear how shortfall will be met, PCT says dentists are treating more exempt patients than expected.
Sheffield - NHS trust facing a £2.3m shortfall in patient fees, which bosses say will have an impact on dental services. Some local dentists running out of money to treat patients.
Norfolk - Dentistry budget to be cut by nearly £3m - about 10% - to cover shortfall in fees, with NHS bosses admitting there are problems accessing dentistry in some areas. Dentists say they are turning away patients.
Coventry - NHS trust facing shortfall in fees of about £600,000. Officials say they are tightening orthodontistry access restrictions, cutting dentistry budgets and using money elsewhere to plug gap.
London - Health bosses say seven out of eight north west London trusts facing shortfall in fees - mirroring the picture nationally.
Cambridgeshire - Shortfall predicted to be £2.2m - 25% of what county expected to make in fees. Managers said "significant" problems being reported across country.
The memo and many trusts say dentists are treating more exempt patients than expected - children and those on low income do not have to pay for care.
Under the contract, many adult patients make a contribution towards the cost of their treatment.
The Department of Health said trusts should be making £630m from these fees, making up a quarter of their entire dentistry budget.
But health chiefs have now started warning they will not make enough, leading to cuts in budgets.
Health chiefs in Yorkshire, London, Surrey, East Anglia and the Midlands have all reported problems.
This has had two consequences - firstly trusts have not been able to expand services as much as expected and secondly dentists have been denied funds to treat patients.
The contract, which started in April, was designed to expand NHS services amid reports many patients were being forced to pay for treatment privately.
It gave local health chiefs working for primary care trusts responsibility for providing services, while attempting to make NHS work more attractive for dentists by offering them the same money for seeing fewer patients.
Since the new deal came in last April, dentist numbers have fallen from 21,111 in England to 20,285, but the government said those left working in the health service were doing more NHS work rather than private practice.
Jackie Sowerbutts, dental adviser to Surrey PCT, admitted the trust had had to say no to a number of requests from dentists for money.
She said: "The government totally and utterly changed the system. It is not surprising the estimation [of patient charges] is turning out wrong.
"Many trusts are in this position."
THE GOVERNMENT MEMO
The Department of Health issued guidance to primary care trusts in England last October.
It acknowledged some areas were reporting "lower than expected" patient charge revenue putting pressures on NHS trusts.
The memo said early data suggested a significant cause for this was dentists seeing too many exempt patients - children and those on low incomes do not pay.
It said some dentists may be giving a "greater priority to exempt patients" and urged PCTs to encourage practices to change their procedures if this was so.
However, it also suggested dentists may be encouraging patients to be treated privately - most dentists do a mix of NHS and private care - by "misrepresenting the type of quality service available to NHS patients".
Trevor Mann, a dentist in Redhill, Surrey, said: "I have had to start turning patients away because the PCT cannot pay me for treating patients as it is using its funds to plug the gaps.
"Patients are pretty philosophical about it because they are so used to the problems with dentistry, but this contract was meant to sort them out."
Norfolk dentist Nick Stolls, who has had to make two of the five dentists in his practice part-time, added: "We have had to start saying to some patients that they will have to come back in a few months because we know we can't afford to see everyone."
The Department of Health memo, seen by the BBC, made a number of recommendations to PCTs.
These include urging them to talk to dentists about getting them to accept more fee-paying patients if they were treating a high number of people exempt from the charges.
It also suggested some dentists may be encouraging patients to pay for private treatment - a practice known as "gaming" which is used to boost dentist pay.
Lester Ellman, of the British Dental Association, denied dentists were responsible by encouraging patients to opt for private treatment.
He added: "The government got their sums wrong and it is now meaning dentist services are being hit."
A Department of Health spokesman said it was too early to tell if there would be a shortfall in the budgets.
"We will not know the final position until June, and we cannot yet predict with any confidence what the total charges collected over the year will be."
But Liberal Democrat spokeswoman Sandra Gidley said: "This is yet another botched NHS contract by a government hell-bent on driving through reforms with little understanding of the impact on patients and professionals."