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Q&A: Dental reforms

Dental equipment
Access to NHS dentistry is a long-running problem
New contractual arrangements for dentists were designed to increase the number of people who access NHS dentistry. However, a report by MPs suggests they have not succeeded.

Why was NHS dentistry reformed?

The changes were introduced in April 2006 in the face of widespread discontent with the previous system, both from patients and dentists.

The main problems were the lack of NHS dentists, leading to problems accessing NHS care in some areas, and an overcomplicated fee structure with over 400 separate charges for different procedures.

It meant dentists had a financial incentive for carrying out complex dental procedures, rather than preventing problems, and often left patients unclear on what their dental treatment would cost.

How did the reforms work?

These issues were addressed in three ways:

Local Primary Care Trusts were given the responsibility for commissioning dental services in their own areas, with the idea that this would give the NHS more control on the level of dentistry available, hopefully helping to bring NHS services to areas where people found it hardest to find a dentist.

Dentists themselves, rather than having the uncertainty and complexity of charging the NHS for every item they carried out, were offered a fixed annual payment depending on the level of treatment they provided.

For patients, the charging system suddenly became much simpler, with three bands of fees.

Currently, for a simple examination, x-ray, or scale and polish the fee is 16.20, rising to 44.60 for more complex treatments such as fillings, extractions, or root canal work.

The highest fee, 198, is paid by people who need the most time consuming work, such as bridges, dentures or crowns.

The need for registration with an NHS dentist was also removed.

The contract was introduced into England and Wales in April 2006. In Scotland and Northern Ireland, a slightly different system which reformed the fees paid to dentists, though not those paid by patients, has been introduced.

How were the changes received at the time?

The introduction of three charging bands meant that while some complex procedures cost less, the cost of some routine treatments, such as fillings, increased, which attracted some criticism from patient groups.

Dentists groups were even less welcoming, suggesting the amount of time available for preventative work was insufficient, and predicting an exodus of NHS dentists into retirement, or exclusively private practice.

The new contract was rejected by approximately one in 10 dentists, according to the British Dental Association, and 60% of those who did sign were "in dispute" over the deal offered to them.

Two years on, how has the system worked?

The report from the House of Commons Health Committee, published in July 2008, is the latest in a line of surveys and reports which suggest that the new contract has yet to resolve the fundamental problems which dogged old-style NHS dentistry.

The number of patients without an NHS dentist is claimed to be roughly the same, and the same patchwork of cover persists, with one town amply provided with NHS dentists, while another close by might have long lists of people waiting for an available place.

85% of dentists told the British Dental Association that they felt the system had not improved access to NHS dentistry.

The Health Committee report offers evidence that the number of complex treatments carried out has fallen as a result of the changes, with the number of root canal treatments falling by 45% in the first year of the reforms. At the same time, the number of extractions has risen.

One interpretation would be that delays in seeing a dentist, or the cost of complex treatment, are contributing to this, although the Department of Health said that one aim of the contract was to reduce the number of complex treatments given inappropriately by dentists under the old fee structure.

Other reports a year after the introduction of the contract suggested teething problems with the budgets held by PCTs to provide local dentistry services.

These were partly supported by estimates of the fees likely to be paid by patients - and in some cases, the fees actually collected fell far short of predictions.

The Department of Health says that the changes are starting to make a difference, and points to increases in the number of NHS dentists.

It has invested in extra training places for dentists, and recruited some dentists from abroad.

What is the latest report calling for?

The Health Committee wants the reintroduction of registration with a practice, and a number of other changes including changes to the way dentists are paid which would reward them more highly for appropriate treatments.

It wants the way PCTs commission local dentistry services to be improved and for research into the reasons why the number of complex treatments has fallen.

The committee also heard fears that another exodus of dentists from the NHS is expected next year, and has called on the Department of Health to be vigilant for this.

NHS dentistry reforms 'failing'
01 Jul 08 |  Health

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