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Page last updated at 12:44 GMT, Friday, 26 June 2009 13:44 UK

Dental reforms

Chris Lyddon
The Politics Show
BBC South West

New proposals to turn around the beleaguered NHS dental service have been met with broad approval by dentists and MPs in the South West.

Will dental reforms get to the root of the problem?

However, the academics in the region who are training the dentists of tomorrow are expressing concern, saying the system will not get to the root of the problem.

The independent review aims to wipe out the culture of the past and shift the focus to prevention and oral care.

Patients in the chair

The incentive should see more patients in the chair.

And it cannot come soon enough in one area of the South West in particular: Cornwall, identified as one of the worst areas in England for access to dental care.

Dentist c/o BBC Science Photo Library
Will dental reforms put more patients in the chair?

The last shake-up was in 2006.

But it is now widely viewed as a failure by the dental profession and health watchdogs.

Just two years after it happened there were 8,000 fewer patients in Cornwall with an NHS dentist.

The idea now is to link dentists' incomes with the number of patients registering.

New dental practices

The Politics Show South West visited a new practice in St Austell which is registering 7,000 new patients.

It is being officially opened on Monday 29 June by England's Chief Dental Officer Dr Barry Cockcroft.

Here, some have gone without a dentist for years.

One patient told the programme: "I didn't have a dentist for six years, because at the practice I was at he left and there just wasn't another one in St Austell."

Another patient told the programme: "My old dentist went private so I had to get help. I called the NHS helpline and they helped me and here I am!"

Dentist accountability

The independent review recommends making dentists more accountable for providing high quality work.

This means if a filling or crown fails, then the cost of fixing it will fall on the dentist.

Patients' rights and what kind of treatment they can expect will be more clearly defined.

Tooth decay c/o BBC Science Photo Library
There will be a new helpline to link patients with NHS dentists

And there will be a special helpline to hook more people up with NHS dentists.

The current system in NHS dentistry has ground down what was already a beleaguered service.

Dentists have heavily criticised the fee structure which sees them paid the same amount for carrying out one filling as five.

Dental work

Dr Helder Esteves, an NHS dentist in Cornwall, told the Politics Show:

"The amount of work needed to complete the treatment plan should be quantified in some other way, not for the patients' charging but in terms of what the dentist does.

"At the end of the day I have patients that have four appointments at 40 minutes each.

"That's a hell of a lot of time, do you know what I mean, and at the end of the day I'm not getting so much money for those patients. I almost have to pay to work on them."

Peter Hodgkinson, a dentist in Helston and a regional spokesman for the British Dental Association, said:

"If you look at what the review is saying, it's basically pulling away from just measuring treatment and its success, and is looking towards something that is about overall oral health care being the most important driver.

"I think this approach is what we really welcome."

Rotten teeth

Researchers at the Peninsula Dental School in Plymouth have reported a 66% rise over nine years in the number of children going to hospital with dental problems.

Following a fact-finding mission to Cornwall in 2008, Dr Barry Cockcroft said everyone in Cornwall who wanted an NHS dentist would get one.

So could this new reform mark a new dawn in NHS dentistry?

Campaigners think so.

Julia Goldsworthy
Julia Goldsworthy has been campaigning for better dental provision

Julia Goldsworthy, the Liberal Democrat MP for Falmouth and Camborne, has been campaigning for years with her fellow Lib Dem MPs for improved NHS dental provision in Cornwall.

"I think the scheme as it exists now is flawed," she said.

"I think we need to grab any opportunity to make improvements to it and I think Professor Jimmy Steele's review identifies the problems and puts forward proposals to try and tackle the key issues.

"And I think that it's an opportunity that we should be grabbing with both hands."

Future fears

But there is concern among academics.

Those who train the next generation of dentists say their focus is based on quality of care given to patients but this report fails to understand exactly what good patient care is.

Professor Elizabeth Kay is the Dean at the Peninsula Dental School which is training 64 dentists each year in its role as the first new dental school in the UK for 40 years.

Model of mouth
Patient care is at the core of training the new generation of dentists

Students are training at Plymouth's university campus initially and then at new facilities in Devonport, Truro and Exeter.

Eventually they will treat more than 500 NHS cases a day.

Professor Kay told the programme: "That translation of applied scientific research into the NHS. There's a gap there and it needs to be addressed.

"It happens a lot and it's something the Peninsula Medical College recognises and is very interested in trying to close the gab between the NHS currently and the evidence out there.

"And there is evidence that we can do what Professor Steele is suggesting, but it's not quite there in this report."

Restoring confidence?

The last shake-up cost the government billions but there is still no total confidence that this review will be the last.

In autumn 2009 selected dental practices across the UK will pilot the new review's recommendations.

South West MPs and dentists in Cornwall are pushing for those trials to take place in the region where the effects of the last shake-up have left a general decay in patient confidence in NHS dentistry.

The review team recognises that access to NHS dentistry is improving following work by the Department of Health and the NHS, including establishing new dental surgeries.

This was demonstrated in a Which? survey published in mid June 2009 that showed that nine out of 10 people who tried to get an NHS dentist in the last two years were able to get one.

It also reports that the dental reforms of 2006, especially the focus on ensuring local services meet local needs, provide a firm basis for the future of NHS dentistry.

Improving NHS dentistry

However, the review recognises that more needs to be done to improve NHS dentistry for patients.

The review team recommends improvements must be piloted to promote better access, prevention and high quality patient care.

The Health Secretary, Andy Burnham said: "Prevention and quality are two of the most important principles of today's NHS.

Andy Burnham
Andy Burnham says prevention and quality are two key principles

"I thank Professor Jimmy Steele and his team for their recommendations on how we can improve the dental contract to promote high quality care and do more to improve oral health.

"The team have also done a great job in engaging the profession, and I want to continue this as we implement the recommendations from the review.

"Access to NHS dentistry is already improving and new NHS dental surgeries are opening up all over the country.

"From the autumn, many of these will be asked to pilot the changes that the review has recommended.

"I recognise that more needs to be done to bring NHS dentistry up to the standards that patient should expect, and we and the NHS are committed to ensuring that anyone can access high quality dental services."

The review team was led by Professor Jimmy Steele, who holds the Chair in Oral Health Services Research at the School of Dental Sciences in Newcastle.

Piloting new dental practices

Many of the recommendations will be piloted in new dental practices from this autumn and in existing dental practices in 2010.

Early findings from pilots are expected in 12 to 18 months' time which will inform plans for further roll-out nationally.

Professor Steele said: "This review is a vision of a better deal for both patients and dentists.

"It's about making sure that patients can see an NHS dentist who will take long-term responsibility for their care."

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