Patients and dentists let down by ‘unpopular’ NHS reforms

The NHS dental contract is ‘extremely unpopular’ with dentists and has failed to improve services for patients, a committee of MPs said last week.

The Commons Health Select Committee, in a damning report into the 2006 reforms, said the Government’s goal of improving patient access had ‘not been realised’ by the new contract.

The MPs noted assertions from the chief dental officer, Barry Cockcroft, that the situation had stabilised and improvements would soon be seen.

But they cast doubt on his conviction that the new arrangements would work if PCTs and dentists used common sense and goodwill, saying: ‘The committee saw little evidence that this will happen. The MPs said it was ‘extraordinary that the remuneration system for dentists, based on an annual income in return for an agreed amount of work measured by units of dental activity (UDAs), was not piloted or tested before it was introduced.’

Their report said the UDA system had proved ‘extremely unpopular with dentists’, adding: ‘Too many PCTs seem to have set unrealistic activity targets and have applied UDAs too rigidly.’

The committee made a series of recommendations, including increasing the number of UDA bands, allocating funding on the basis of a local needs assessment rather than following the historic pattern of services in various areas, and rewarding dentists who improved the oral health of their patients.

The report also called for the reinstatement of patient registration to improve the dentists-patient relationship.

The Department was urged to ‘monitor closely’ the career plans of NHS dentists to prevent an exodus of practitioners in 2009 when guaranteed income ends.

Evidence presented to the Commons Health Select Committee found that the number of tooth extractions has risen since the new contract was introduced, while the volume of more complex work like crowns, bridges and dentures has fallen by 57%.

MPs were also told how the number of patients being referred to dental hospitals and community dentists increased following the introduction of the new contract.

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

Figures released last month showed that almost a million fewer people are now seeing an NHS dentist than before the Government’s reforms.

More than 800,000 fewer people saw a dentist in the two years to December 2007 than in the two years to April 2006, data from the Information Centre for health and social care revealed.

Committee chairman and Labour MP Kevin Barron 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 preventative care has increased, and patients seem less likely to receive complex treatments they may require within the NHS.’

He added: ‘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.’

Shadow Health Minister Mike Penning said: ‘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. In line with Conservative proposals, the report calls for a return to a registration system and an increase in the range of UDA banding.

‘This will help to shift the focus back to preventative treatment and to secure better outcomes for patients.’

Mr Penning added: ‘The Select Committee’s findings are compelling evidence of the reasons why dentists are leaving the NHS in droves. We believe that this failed experiment with the UDA-based contract must be scrapped.’

The Department of Health said the Government would ‘carefully consider’ the Committee’s recommendations before publishing a formal response to its report.

A DoH spokeswoman said more than £200million had been invested in in NHS dentistry this year, over and above increases in the last three years.

She 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.’

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