One million lose out in NHS dental reforms

By Rebecca Smith | Instead of improving access to NHS dentistry the reforms have made it worse, the report by the House of Commons Health Select Committee found.

The number of dentists working in the health service has fallen, the number of NHS treatments carried out has dropped and in many areas patients are still experiencing severe difficulties in finding a dentist to treat them.

Worryingly, complex treatments carried out on the NHS have dropped by half while both referrals to hospital and tooth extractions have increased.

This suggests dentists are simply removing teeth rather than taking on complicated treatments because they have become uneconomical to provide.

The report said that in the two years following the introduction of the new contract in April 2006, 900,000 fewer people saw an NHS dentist than in the last two years of the previous system. Even this could be an underestimate, it said.

Ministers introduced the reforms to the dental contract despite widespread concern they would not improve access to care. The contract was so unpopular that more than one in ten dentists refused to sign it and more than a third signed it in dispute.

However, the then health minister in charge of dentistry Rosie Winterton insisted: “The reforms will improve access, encourage more preventive dentistry and provide a stable income for dentists.”

The Government hoped the new contracts would give more patients the chance to register with an NHS dentist, encourage more preventive work and reduce the “drill and fill” culture.

They were also designed to simplify the payments system, so that instead of being paid per treatment, dentists were given a flat annual salary in return for carrying out an agreed amount of work known as units of dental activity (UDAs).

However, the select committee found that as a result of the changes, dentists no longer had any financial incentive to give appropriate treatment.

The volume of complex work like crowns, bridges and dentures had fallen by 57 per cent, it said.

The MPs said it was “extraordinary” that the Department of Health did not carry out pilot studies on the system before introducing it across England.

Kevin Barron, chairman of the Health Committee, said: “It is disappointing that so far the new dental contract has failed to improve the patient’s experience of dental services.

“While we readily accept that in some areas of the country provision of NHS dentistry is good, overall provision is patchy.

“Fewer patients are visiting an NHS dentist than before the contracts were introduced in April 2006, we heard little evidence that preventive care has increased, and patients seem less likely to receive complex treatments they might require within the NHS.

“The Department did not test through a pilot the new remuneration system and we were astonished that in such a crucial area of reform the Department chose not to undertake rigorous testing prior to its introduction.”

As a result of the changes, dental work is now split into three bands, with band 1 being a simple course of treatment such as a check-up or X-ray, costing the patient £16.20.

Band 2 treatment costs £44.60 and covers everything in band 1 plus fillings, root canal work or extraction. Band 3 costs £198 and also covers crowns, dentures or bridges.

However, the MPs heard expert evidence suggesting the contracts provided dentists with a “financial incentive to persuade a patient to have a decayed tooth extracted rather than undergo the more complex procedure of restoring it”.

Dentists now had no financial incentive to treat complex cases and patients were being pushed unnecessarily into the hospital system, the MPs heard.

Another impact has been that patients now pay the same amount – and dentists receive the same amount – for one filling as for three. As a result, people are delaying seeing the dentist until they need multiple fillings so they get their money’s worth.

The report said unrealistic targets were set for dentists and were applied too rigidly, encouraging them to simply race through as many patients as they could.

There were reports that dentists were forced to close for the last three months of the financial year as they had completed all their allocated treatments while others were forced to pay back money for failing to reach their target.

Susie Sanderson, Chair of the British Dental Association’s Executive Board, said: “This is a damning report which highlights the failure of a farcical contract that has alienated the profession and caused uncertainty to patients.

“For the past two years, dentists and patients have told the Department of Health that it got it wrong. Now MPs have agreed with the BDA.

“The committee has said unrealistic targets have been set for many dentists and urged an improvement in local commissioning.

“The Department must listen to this condemnatory report and act swiftly, looking seriously at these recommendations, for the sake of patients and the profession.”

Shadow Health Minister, Mike Penning added: “The Government has consistently refused to acknowledge the shambolic current state of NHS dentistry. This report gives a scathing assessment of the true scale of the problems.

“Labour must take responsibility for the failure of their dental contract. It has vastly reduced the number of people able to gain access to an NHS dentist. The situation is simply unacceptable, as the Select Committee has now made clear.”

As a result of the changes, private dentistry appears to have expanded. While there are no reliable figures, estimates suggest it could now make up half of all dentistry provided in England.

Liberal Democrat health spokeswoman Sandra Gidley, a member of the select committee, said: “This is another example of the Government meddling and rushing through changes without thinking about the consequences.

“The facts speak for themselves. The number of patients seen by NHS dentists between December 2005 and December 2007 has fallen by a million.

“The scandal for patients is that many are receiving less sophisticated treatment and are paying more for the privilege.

“The Government has plunged us headlong into a dark age of dentistry.”

A spokesman for the Department of Health said: “The focus and funding is already starting to show results – patients are starting to see the benefits with new NHS practices opening all over the country, and we are working with the NHS to ensure that, as the committee recommends, the quality of dental commissioning by PCTs improves.

“It takes time for the extra services now being commissioned to feed through into the access figures that currently do not provide an up to date picture. More and more patients are benefiting from increases in services and we are confident that this will start to show through in the figures later this year.”