First-year report ‘justifies concerns’

The government’s first-year report on the new NHS dental contract has confirmed the controversial reforms have failed to increase access to services.

However, the Department of Health insisted that NHS dentistry is on a more secure footing, despite the figures.

The report showed that 28.1m people had been to an NHS dentist in the previous 24 months. This was 50,000 down on the figures on the eve of the new contract in April 2006. The number of dentists in the system has also fallen.

As previously reported, dentists and association leaders within the profession have long complained about what they see as a ‘drill and fill’ treadmill environment.

The official figures show that there were 21,038 NHS dentists in England at the end of March 2007, down on the 21,111 figure in March 2006.

The contract did end up attracting new dentists into the system because 1,000 dentists left the NHS when the new deal came in to either retire or concentrate solely on private patients.

The government’s report admitted there were ‘significant challenges ahead’ and some areas still had access difficulties, but it said patient access was likely to improve in the future.

Health Minister Ann Keen said: ‘I know the transition to the new arrangements has been challenging.

‘One year on, we have a system that provides a much more secure basis for developing dental services over the coming years.’

But Peter Ward, chief executive of the British Dental Association, said: ‘This first-year report on the new untested contract for dentists justifies our concerns and will do little to rebuild trust with the profession. By the government’s own admission, we now have fewer NHS dentists and access to care for patients remains patchy. This is not a picture of success and confidence.

‘The report recognises the importance of genuine local flexibility for patient care but this can only be achieved by moving away from the rigidity of this crude target-driven contract. The government must start listening to the profession and patients if local commissioning is to provide the services that local communities deserve.

‘Contractual performance has to be monitored but UDAs are only a single and very crude method. We need a more sophisticated approach which is sensitive to the reality of delivering dental care to patients and which supports preventive care, rather than works against it.’

Quentin Skinner, chairman of DPAS Ltd, said of the report: ‘While talking of prevention rather than treatment, the report fails to address the fact that the new contract has no structure to financially reward preventive care.

‘The thinking behind access is clearly aimed at directing NHS funding towards those members of the population who do not visit the dentist regularly, often in less affluent areas. Dentists still offering NHS care in practices in pleasant leafy suburbs beware – you will not be a future priority for cash-strapped PCTs.

‘The report enumerates dental services commissioned – this is different to what was actually delivered, and masks the fact that nearly half of NHS contracts around the country show a shortage of UDA delivery of more than four percent for the year. For those dentists, year two of the new contract either means having to work harder for no more remuneration, or otherwise suffering a claw-back of gross revenue already paid to them.’

Liz Phelps, of Citizens Advice, said: ‘We continue to report huge problems for people trying to find an NHS dentist locally. The urgent priority must now be to make the reforms work for patients by funding the new arrangements adequately.’

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