Page last updated at 14:23 GMT, Monday, 22 June 2009 15:23 UK

NHS dentistry 'facing overhaul'

By Nick Triggle
Health reporter, BBC News

Patient being treated by dentist
The review has looked at complex treatments

Ministers have agreed to an overhaul of NHS dentistry - just three years after the last shake-up of the system.

They have acted after heavy criticism of the 2006 dental contract, which has led to fewer patients accessing care.

The government said it would accept "in principle" the recommendations of an independent review of NHS care.

Unions welcomed the move which will see income determined by three factors - patient list size, quality of care and the number of courses of treatment.

It represents a return to patient registration - as called for by the Tories - which was scrapped under the 2006 changes.

Both the opposition parties said reform of the system was vital with the Tories branding the 2006 changes a failure and the Lib Dems saying NHS dentistry was a "national disgrace".

This review is a vision of a better deal for both patients and dentists
Professor Jimmy Steele, review author

Over the last three years dentists have been working in a system where they were given a set number of courses of NHS treatment to provide to any patient that asked for care.

It was structured so that they were effectively paid the same amount of money to see slightly fewer patients.

The deal was introduced in a bid to end the so-called "drill and fill" culture.

It was hoped that the changes would make NHS work more attractive to the profession - dentists also carry out a significant amount of private practice.

But instead of improving access, official statistics show that more than 1m fewer patients have been treated in the two years since it was introduced than the two years before.

One of the key problems was that some dentists had used up all their allocation of courses before the end of the year, meaning they had to turn away patients.

Rows broke out between the government and profession over whether this was due to the contract failing or dentists "playing the system".

'Unfinished business'

Health Secretary Andy Burnham rejected claims that the 2006 contract had been an outright failure.

But he added: "I recognise this is an area of unfinished business. We have to make sure the NHS is on the right path."

The proposals put forward by the review, which was led by Newcastle University expert Professor Jimmy Steele, will now be piloted in the autumn.

Perhaps one day there will be a review where the public will be asked for their opinion
Rob Allsopp, Oldham

As well as the changes to the contractual arrangements, the report said patients needed to be provided with better information.

Local helplines are to be set up and NHS Direct given information about which dentists have spaces on their books for NHS patients.

It also suggested the three bands of patient fees - NHS patients contribute towards the cost of their care - should be widened to up to 10 bands as the current arrangements were overly simplistic.

The changes will also need a clear set of targets to be produced so that the quality element of dental income can be determined.

Nonetheless, Professor Steele said he was confident the proposals would work.

"This review is a vision of a better deal for both patients and dentists. I think there is a will to change."

John Milne, of the British Dental Association, which was highly critical of the 2006 changes, said the measures offered an opportunity to improve care.

But he said: "Clearly, the detail of how that approach will be delivered will be vital."

Anthony Halperin, of the Patients Association, said the changes were much needed because the current arrangements had "fundamental flaws".

He said the re-introduction of registration was particularly welcome as it would help to build a relationship between dentist and patient.

"We look forward to a system where the patient is assured of quality care."

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