Dental industry leaders have demanded guarantees that NHS funding will not be squeezed when Primary Care Trusts are given greater control over spending.
From April 2009, ring-fencing will end and PCTs will be expected to fund local dental services from their general budgets. It means NHS dentistry will have to compete for cash against other parts of the health service.
The government has said PCTs are under a legal obligation to provide sufficient dental services.
Baroness Royall, a government spokeswoman in the House of Lords, said last month: ‘The government are fully committed to supporting the NHS in developing dental services for the longer term.
‘The 2006 reforms established, for the first time, a statutory duty on primary care trusts to provide or commission dental services to reflect local needs.’
She added: ‘The proposal to move resources for dentistry into PCTs’ main health budgets from 2009/10 is designed to reinforce further the importance of developing dental services, based on the same principles that underpin commissioning of other NHS services, including public and patient involvement and professional engagement.’
Baroness Royall said the government had invested an additional £400 million in dentistry in the last three years, alongside a further £100 million programme of capital investment, from 2006 to 2008, in premises and equipment.
She said: ‘To support continued growth in the NHS dental workforce, the department has also invested in a 25% expansion in undergraduate dental education, with the first students from this expanded programme due to graduate and begin their NHS vocational training in 2009.’
However, some industry leaders said practitioners were not convinced that funding would be safeguarded.
Peter Ward, chief executive of the British Dental Association, said: ‘The end of ring-fencing of primary care trusts’ dental budgets in 2009 is a source of anxiety for dentists and patients alike.
‘The possibility that PCTs will divert money away from dentistry to fund other areas of care is destabilising to dental practices and does nothing to ease the concerns of the profession as they attempt to plan for the future.
‘Reassurances that PCTs will continue to spend these budgets on primary dental care are not enough. The profession needs more than reassurance – it needs a guarantee.’
Derek Watson, chief executive of the Dental Practitioners Association, said although trusts were under an obligation to provide dental services, it was ‘up to PCTs to decide for themselves’ what this meant in practice.
He said: ‘The DoH is being a little disingenuous in trying to imply that because of this obligation PCTs will decide to maintain services at their current level. There is no guarantee of this. Most PCTs won’t say what they will be prepared to commission after 2009.’
Dr Watson expressed fears that, following the end of ring-fencing, large corporate bodies would rush to pick up contracts by undercutting existing practices.
The danger was that ‘every dentist not in a chain will have to go into the private sector’.
To address those concerns, Dr Watson called on the DoH to issue ‘firm guidance’ to PCTs and health boards on minimum standards and provision.
Each PCT should be made to carry out a ‘needs-analysis’ of its population, to ensure local demands were being met and to end uncertainty for existing practices, he added.