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Last Updated: Thursday, 19 February, 2004, 11:54 GMT
What happened to NHS dentistry?
Queue in Scarborough
Three-hundred anxious people queue for a dentist in Scarborough

Madonna or David Beckham could hardly have expected a better turnout. Instead, the queue of 300 people which snaked around the block had formed for nothing more exciting than an NHS dentist.

Such is their shortage in some parts of the UK today.

Scottish newspapers reported a "stampede" in January after a new NHS dentist arrived in Kincardine. Last summer, in Camarthen, Wales, anxious residents lined the high street as they patiently waited to get on the books of a new dentist.

The experience of Mary O'Reilly, a finance manager living in Bristol, is typical. Since her dentist quit seven years ago, she has been unable to find another NHS practitioner prepared to take her on.

When we do take the odd patient on now they need a fair amount of treatmeant because they haven't seen a dentist in so long
Dentist John Renshaw

"I got the names of four or five local dentists on the internet but their books were full," says Mary, 44.

"Twice in that time I've needed urgent dental work and have had to pay for it by going private. At the moment I've a crown coming loose. My gum is red and raw but there's no NHS dentist prepared to treat it."

Latest figures show most people in England do not have an NHS dentist. Just 44% of adults and 60% of children are registered with an NHS practice.

What happened to the idea of NHS dentistry for all?

For once, the problem is not a labour shortage. There are 21,000 practising dentists in the UK today compared to 16,000 in the early 1990s, according to the General Dental Practitioners Association.

Increasingly, however, they are only seeing patients privately.

The root of today's shortage dates back to 1992, says John Renshaw of the British Dental Association, when the government cut fees to NHS dentists by 7%.

Almost all dentists in the UK are self-employed and have traditionally mixed NHS and private patients on their books.

Patient in a dentist chair
We spend 1.9bn a year going private
In 1999 Tony Blair pledged an NHS dentists for everyone by 2001

The NHS system works like this:

  • Every job has a fixed NHS price, for example a check up is 6.85; a scale and polish, 10.80
  • NHS patients pay 80% of the cost of the work to the dentist
  • The remaining 20% is reimbursed to the dentist by the government

    The fee cut at the start of the 90s caused enormous resentment in the profession and dentists began to shed NHS patients in favour of more lucrative private work.

    Yet is the money really so bad in the public sector?

    An investigation by Which? magazine in 2001 found a dentist fully committed to the NHS can earn 55,000 to 65,000 a year after expenses.

    But since it all depends on patient numbers, not quality of care, many dentists say the NHS is backbreaking work, with little job satisfaction.

    I didn't know that you could still get an NHS dentist
    Sarah Miles, Worcestershire

    "It's not like a GP who has time to talk to patients. It's all 'chair-side' work which is operative and very stressful," says Mr Renshaw. "Patients are apprehensive and conscious, which just increases the pressure."

    Rotten state

    Dr Renshaw says he turns away more than 1,000 potential NHS patients a year because his books are full. Of the few he does take, their teeth tend to be in a bad state.

    "He who strives for excellence on the NHS will be the first to go bust
    Dentist Amolak Singh
    "They need a fair amount of treatmeant because they haven't seen a dentist in so long. There's no doubt this is affecting the nation's teeth."

    Dr Azhar Sheikh, a dentist for 20 years, is in the process of dropping his NHS commitment to go wholly private.

    "To put it crudely, the NHS is 'piece work': low margin, high volumes. It's not stimulating work," he says.

    Another dentist, Amolak Singh, who mixes his NHS and private work 50/50, puts it thus: "He who strives for excellence on the NHS will be the first to go bust."

    In tandem with all this, science has expanded the horizons of dentistry, making it more like cosmetic surgery than basic healthcare, and more challenging to those in the profession. Inevitably, the NHS does not fund this sort of work.

    "I deal in smiles; straight white teeth," says Dr Sheikh, who has renamed his surgery the London Smile Studio.

    But for those unwilling to spend anything more than the bare minimum on their teeth, improvements have been promised by the government. Next year the responsibility for dental care will devolve to a local level, in theory making it easier for NHS blackspots to be targeted.

    Jackie Glatter of the Consumers' Association says it is "absolutely a positive move" for patients. She also backs a consultation by the government which could see the end of the NHS pay-per-job arrangement.

    "There do need to be more training places and more work does need to be done to retain dentists."

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