It should be noted that successive Governments have failed not just the public in this area, but dentists as well. The Government needs to ideally work to a situation where more dentists divulge more time to the NHS Dentistry sector . It is a two way street, when we see better pay and conditions and more resources given to dentists, you will see many more moving back to the NHS, or at least dividing their time between private dentistry and public NHS Dentistry.

Going back to a previous survey, the Ipsos MORI survey found that lack of access is the most common reason cited by people in England and Wales for not seeing an NHS dentist since April 2006, along with not needing treatment. It was mentioned by 31% of respondents in England and Wales who have not been to an NHS dentist since April 2006. This is the equivalent of approximately 7.4 million people who have not been to an NHS dentist since April 2006 because of difficulties in finding one. Of these, the equivalent of approximately 4.7 million have sought private treatment instead and the equivalent of approximately 2.7 million have gone without treatment altogether.

The research also reveals that the problem is more evident in the South West (53%) and the North West (39%).

Citizens Advice Chief Executive David Harker said:

“These figures show the scale of the lack of access to NHS dentistry, reflecting the evidence which bureaux across England and Wales have been reporting ever since the early 90’s.  People on low incomes are particularly affected as private treatment is just not an option.

“We are therefore delighted that the Government has responded to the problem by announcing an 11% increase in funding for NHS dentistry in England from 2008. This has the potential to deliver real improvements in access to dentistry but it needs to be carefully targeted on those areas where patients are experiencing the most acute problems.

“Primary Care Trusts have a duty to ensure that dentistry services meet local requirements and it is vital that they start planning how to allocate their additional funds now. We also hope that the Welsh Assembly Government will follow suit and increase funding for NHS dentistry in Wales.

“Patients who have been trying to find an NHS dentist should contact NHS Direct to find their local dental helpline now in order to benefit from any new services that are set up.”

Case studies

A CAB in Cornwall reported a client who rang the helpline saying he was prepared to travel anywhere in the county to find an NHS dentist.  He was told no dentists in Cornwall were currently taking on NHS patients, and was put on the waiting list with no idea how long he might have to wait.

The same bureau reported a client on a low income who had to travel by both bus and train, stretching his limited finances, to the nearest NHS dentist for an emergency appointment.  Delays in public transport meant he was 15 minutes late and was turned away and told he would have to book another slot at 8.30 am the following day.

A CAB in North Yorkshire reported a pensioner on a low income who needed emergency dental treatment in hospital. They advised her she would need further treatment and would need to find an NHS dentist. There were two available in the area but both have 12 month waiting lists.

A CAB in Hampshire rang the helpline on behalf of a client and her disabled husband who wanted to find a dentist.  They found that the nearest dentist with NHS capacity is now – approximately 17 miles away with no public transport to get there. One year ago the closest NHS dentist was – approximately 10 miles away.

More and more we are needing Foreign Dentists to move to the UK to live and work as dentists. It can be  win, win, for the UK public and for dental professionals from Europe wishing to practice here as dental associates.

Changes to dentists’ contracts will make it easier for patients to find an NHS dental surgery, the UK Health Secretary has promised.

NHS Dentists are no longer to be rewarded primarily for the number of fillings they carry out.

NHS Dental Service

Dental Practitioners will instead have a bigger chunk of their dentist salary decided on the number of patients they have, and serve. “Quality” and “prevention”, rather than quantity of treatments, are the new buzzwords.

The reforms, outlined in an independent review chaired by Professor Jimmy Steele, were immediately accepted “in principle” by the health secretary.

Professor Jimmy Steele

The Professor said that fewer visits are the key aim. Dental Health and prevention rather than cure must be the primary aims.

NHS Dentistry is a hot topic once again with a general election looming. From the public’s perspective they have real difficulty finding an NHS Dentist who will take them on. Once they have found one, many are not entirely happy with the care due to the fact they feel any work they have done may be below the levels of private work.

It’s unfair to heap all the blame on the dental community. Decades of underfunding by successive governments have left NHS Dentistry in trouble. It is also fair comment to say the financial incentives have not been properly structured and have left opportunity for criticism of dental professionals.

The Tories have promised, if elected, to bring another one million UK NHS Dental patients back into the NHS fold, and to have a dedicated NHS Dentist.

Professor Steele’s view is that:

“Over the last 60 years, dental services have been about quantity, about delivering fillings, We need to move away and move on to quality – to accept that less is actually better.”

“Value for money is not about more at a lower price; value for money is not having to do it all. Dentists should take responsibility for some of the things they deliver. We should provide restorative work to last. Patients should not have to pay for substandard treatment.”

Asked how often patients should see a dentist, he said that :

Some , depending on the state of their teeth , need go no more than once every two years.

The idea of six-monthly check-ups was outmoded. Longer recall intervals are a marker of success, not an abdication of duty.

Prof Steele said he hoped more private dentists would be attracted to sign contracts with the NHS under the terms of the newly proposed financial rewards.

The Secretary of State for Health, Andy Burnham,  gave an enthusiastic endorsement to the proposals, declaring: “I recognise that this is an area of unfinished business where we need to ensure that NHS dentistry is on the right path.”

Access to NHS dentists had been improving recently, he maintained. A recent Which? magazine report said that nine out of 10 people searching for NHS dental treatment had been successful in the last two years. The new reforms, he added, “are going to provide NHS dentists for everyone who wants one.”

“From this autumn, selected dental practices will pilot some of the independent review team’s recommendations including linking a significant part of dentists’ income to the number of NHS patients registered with them, not just the number of treatments they provide.” More than one model of financial incentives might be trialed to see which was the most effective.

To make it easier to register with a dentist, patients will in future be able to call NHS Direct or check the NHS Choices website for information on local services, he said. Extending water fluoridation would also be a priority to protect, in particular, children’s teeth.

The review observed that under the current contract “there are limited incentives for dentists to … take on new patients”.

The British Dental Association welcomed the review as a move away from unpopular targets that had distorted health service provision. It stressed that the reforms should, unlike previous changes, be piloted carefully to ensure that they are practicable.

John Milne, chair of the BDA’s general dental practitioners committee, said: “We have an opportunity to learn from the difficulties of 2006. The report’s recommendations appear to be far-reaching. They describe a new approach … I hope it will mean a move away from the targets-driven arrangement that is currently in place.”

Critics have blamed dentists for exploiting the system by breaking down simple treatments into multiple sessions known as “units of dental activity” (UDA), each one of which triggers a separate payment.

“We heard accounts from younger dentists that suggest the single-minded pursuit of UDAs can, and has, become ingrained in young practitioners to a worrying degree,” the review said. “Behaviour may be adopted that maximises the rate at which UDAs are achieved, often referred to as ‘gaming’.”

More incredible than that, the NHS report found that 159 dentists earned between £250,000 and £275,000, 113 earned between £275,000 and £300,000, and 382 earned more than £300,000.

The statistsics are based on an official NHS report which has all the data from the 19,500 dentists in the UK.

• The average dentists’ wage was £89,062 .

• 7,500 dentists’ run their own practices with a contract with local primary care services to provide NHS dental services  had an average  gross income of £345,651 before taxes.

• The 12,000 dentists working in a practice without an NHS contract earned on average £65,697 (before tax). With typical expenses of £33,512, this took average total earnings to £99,208.

The report covers just the earnings and expenses of full- and part-time, self-employed primary care dentists who undertook some NHS work in England and Wales in the year, and covers both their NHS and private work. Earnings include fees for treating both NHS and private patients in 2007-08, the second year of the new dental contract.

The Health minister Ann Keen said: “NHS dentistry is improving and many dentists are now keen to expand their NHS work. Today’s report confirms that NHS dentists have good levels of earnings.

“Access to NHS dentistry is continuing to improve, following record investment, an expanding workforce and a continuing increase in the amount of services being bought by the NHS.”

The full NHS government report can be found for England & Wales here:

www.ic.nhs.uk/pubs/dentalearnexp0708