White teeth - belong to the past?
The shortage of NHS dentists in London has been a source of growing patient frustration. Will plans to tackle the problem make things better or worse?
When I moved up from Cornwall to London, I did try to get myself registered with an NHS dentist but I gave up - I just could not find one who could take me on.
I am one of about 4m people in London who does not have a regular NHS dentist, and this figure is going up.
Last month the government brought in new NHS contracts, and dentists are livid.
They say that the umbrella association that represents them was not listened to, that the contracts were delivered to them so late there was hardly any time to know what they were signing, and it has now tied them into a clock-watching, treadmill system that the government promised it would deliver them from.
There are lots of complicated changes; dentists were keen to explain the minutiae, but I have to admit, most of it left me slightly glassy eyed.
What I do know is that their freedom has been curbed - Primary Care Trusts control the budget, decide how many dentists are where, and how many patients they will treat.
If dentists want to treat more people, they cannot just do that and bill the NHS; they stick to the quota or they treat for free.
They have been put on a guaranteed income; ministers say £80,000 a year but dentists tell me that most will earn a lot less.
But the main objection is it has taken away the ability to expand their businesses.
Will new system lead to decay?
Simpler but not better?
For patients, it is simpler but not necessarily better.
Four hundred bands of payment have now been streamlined into three bands.
Basically we are to pay for a course of treatment, instead of for each single thing we have done.
This works out well if you are having a lot of work done but very badly if, say, the dentist decides you need minor care.
The worse thing about this is that financially, it makes more sense for patients to wait until the problem is worse before making an appointment.
So new contracts are not popular, and last month 2,000 dentists left the NHS nationally.
Only, what the government did not say is that in London, there are about 400 contracts that are signed, but are in dispute.
This means that the practices that come under this contract, because often it is more than one, are still treating patients on the NHS, but just on a three month contract.
If they do not get the deal they want, there could be hundreds more dentists leaving the NHS.
Winners and losers
The most worrying thing about talking to dentists is the acute despondency.
Personally, my heart does not bleed for them; they earn a lot of cash.
But nobody I spoke to saw a future for dentistry in the health service.
They do not believe the government wants to keep paying for dentists and think it is going the same way as opticians.
And rather than just stop funding, they think the government will quietly make it not worth their while; so they get the blame and not the ministers.
Ultimately, it is not the dentists that will suffer, but patients, and, more specifically, people in London least able to afford yet more bills.
The Politics Show London
Join the Politics Show on BBC One on Sunday 21 May 2006 at 12.00pm with Tim Donovan.
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