New dental contract makes April Fools of us all

12.00.00am BST (GMT +0100) Fri 31st Mar 2006

Commenting ahead of the deadline for the new NHS dental contracts to be signed on April 1st, Sandra Gidley, MP for Romsey and Liberal Democrat Shadow Health Minister, has released latest figures contained in a parliamentary answer from the Department of Health showing the rapidly decreasing numbers of people in Hampshire who are registered with an NHS dentist.

The parliamentary answer showed that between 1997 and 2005 the number of adults registered with an NHS dentist in England has decreased by 13 per cent. The answer also showed that in the four PCT areas that serve Hampshire the number of adults registered with an NHS dentist has dropped by an average of 18 per cent between 1997 and 2005.

The new NHS dental contract will replace the current fees system with 3 bands of charges; a check-up will be £15.50, fillings will cost £42 rather than the £8 it costs at the moment and crowns and dentures will cost £189.

Romsey Citizen's Advice Bureau believes the situation is so dire that they are producing a Social Policy Report on the lack of NHS dentists in the area.

Sandra said:

"My postbag has been filled to the brim with constituents' concerns over their struggle to find an NHS dentist.

"NHS dentistry had reached crisis point before these new contracts were imposed. Now the situation looks grim for Hampshire as many dentists are refusing to sign the contract and are leaving the NHS altogether. Other local dentists are being told by their PCT that as of April 1st they can no longer treat children on the NHS.

"The new dental contracts are not giving local NHS dentists enough confidence to make a long-term commitment to the NHS. It is no wonder the dentists have lost faith in the Government as there was no consultation period for the new contract which many dentists received with only a month to go until the April deadline.

"Many dentists have also had to employ lawyers in order to understand the jargon within the contract and are extremely reluctant to sign something which they don't fully understand.

"The Government has failed to tackle the lack of NHS dentists. In 1999 Tony Blair promised that by 2001 everyone would have access to an NHS dentist. Not only has this not happened- the situation has actually worsened; in 2005, compared to 1997, there are now nearly 12, 000 more adults and children in Hampshire that are not registered with an NHS dentist.

"The failure to increase registrations through this new contract is an indictment of Labour's failure to restore the NHS to what it should be: a universal, comprehensive service that provides ongoing health care to everyone who needs it".

Research undertaken by Sandra Gidley MP has revealed the following:

Eastleigh & Test Valley South PCT

• Currently there are 28 NHS dentists; 18 of whom are "NOT accepting any NEW NHS patients for treatment" and 7 of whom are only "registering children aged 0-18 years for NHS treatment"

Mid Hampshire PCT

• Currently 31 NHS dentists; 26 of whom are "NOT accepting any NEW NHS patients for treatment" and 4 of whom are only "registering children aged 0-18 years for NHS treatment"

New Forest PCT

• Currently 32 NHS dentists; 30 of whom are "NOT accepting any NEW NHS patients for treatment" and 2 of whom are only "registering children aged 0-18 years for NHS treatment"

Southampton City PCT

• Currently 37 NHS dentists; 30 of whom are "NOT accepting any NEW NHS patients for treatment" and 2 of whom are only "registering children aged 0-18 years for NHS treatment"

There are therefore only nine dentists in these four PCT areas still accepting new NHS patients.

• Information from PQ answer from February 27th 2006; "To ask the Secretary of State for Health how many adults and children in England were registered with an NHS dentist in each year since 1997 in each primary care trust area."

• The new contract relies on Units of Dental Activity (UDAs) and Annual Contract Values (ACV) to establish a dentist's earnings for any year.

• ACV is calculated by how much work a dentist has done historically (i.e. over the past year). The ACV for this year was calculated over the reference period of October 2004 - September 2005.

• After April 2006 as well as salary being calculated by the ACV system a dentist will be given a quota of UDAs to meet in order to receive a salary. If a dentist doesn't meet the target they receive less money; if they exceed the target they receive nothing extra.

• Dental Activity will be divided into bands and each will be costed;

• Band 1: Check-up, x-rays and oral guidance: £15.50

• Band 2: Fillings: £42

• Band 3: Crown and dentures: £189

• This system means, however, that a patient receiving one filling will pay the same as a patient receiving four fillings (£42); and a dentist administering one filling will receive the same number of UDAs that if he was doing four fillings (3 UDAs).

The dentist is outputting more time and resources and still receiving the same amount of money and UDA; therefore any incentive to provide more treatment and perhaps better or preventative treatment for the patient is eradicated.

There are disincentives in the new contract for the patient; under the new charging system it makes better sense for a patient to wait until they need maybe two or three fillings as they can pay for them all under band two rather than paying three times when they are needed; this is not good preventative oral health.