Background:
March 31st 2006 was the final day for dentists in England and Wales to sign the controversial new NHS contract, which came into effect on April 1st. The new NHS dental contract has replaced the old fees system with 3 bands of charges; a check-up will be £15.50, fillings will cost £42 rather than the previous £8, and crowns and dentures will cost £189. The new contract relies on Units of Dental Activity (UDAs) and Annual Contract Values (ACV) to establish a dentists earnings for any year. ACV is calculated by how much work a dentist has done historically (i.e. over the past year). After April 2006, as well as salary being calculated by the ACV system, a dentist will be given a quota of UDAs to meet in order to receive a salary. If a dentist doesnt meet the target they receive less money; if they exceed the target they receive nothing extra.
This system means, however, that a patient receiving one filling will pay the same as a patient receiving four fillings (£42); and a dentist administering one filling will receive the same number of UDAs than if he was doing four fillings (3 UDAs).
British Dental Association: "The new contract will not secure patient access, improve oral health or raise the quality of care."
Lib Dem line:
Between 1997 and 2005 the number of adults registered with an NHS dentist in England has decreased by 13 per cent from 19.7 million to 17.2 million
69.35 million UDAs have been distributed amongst the 303 PCTs in England. With a population of 50,093,100 in England, this equates to just under 1.4 UDA per person per year. This would allow for only one check up per person per year (with no further work done whatsoever), if all local people could use their NHS dentist.
In September 1999 Tony Blair promised that by 2001 everyone who wanted access to an NHS dentist would have it the allocation of UDAs as a result of the new contract has ensured that universal access to an NHS dentist is almost entirely impossible.
2,000 dentists have refused to sign the new contract and have left the NHS.
In 200405, dental charge income was £465 million; in 200607, it will be £623 million. That is a 28 per cent. real-terms increase in dental charge income. The Government's contribution to dentistry over those same two years is rising by just 9 per cent.
This is contrary to the Government's claim that the contribution made by patients towards the cost of dentistry would remain the same. For example, a check-up will cost £15.50 instead of £5.
42 per cent. of patients get their treatment in band 2 and, of those, three quarters will pay more under the new system. So patients are subjected to yet more charging and more costs.
The Liberal Democrats have consistently opposed the new contracts and their effect on dental services.
The Liberal Democrats criticised the lack of public consultation over the introduction of the contract and there have been severe delays in sending the contract documents out to dentists.
The British Dental Association stated that, on receiving the contract, a mere month before the April deadline for many dentists, 90 per cent of dentists was confused at the detail. One Primary Care Trust stated that, the core of the contract was cobbled together from a multitude of sources, and they [Department of Health] could not even get the paragraphs cross references right, let alone spelling and pagination.
The failure to increase registrations through this new contract is an indictment of Labour's failure to restore the NHS to what it should be: a universal, comprehensive service that provides ongoing health care to everyone who needs it.
A great concern over the scheme is that, within units of dental activity, insufficient allocation is given to preventive work.
Up to half a million children may be de-registered from an NHS dentist.
Orthodontic provision to children is now under threat.
Conservative view:
The Conservatives have taken a similar view on this issue to the Liberal Democrats. They have criticised the Government for lack of investment on NHS dentistry and stressed that contracts offered by the Department of Health to dentists for working as NHS employees are not attractive enough to retain them. The question is not just about remuneration, but of the work load with which dentists have to struggle and the amount of quality time they can offer their patients.
Labour view:
Ministers argue that NHS dental contracts will see power given to local Primary Care Trusts to commission local dental services that will meet local needs. This means that if a dentist leaves the NHS the PCT will buy in replacement services leaving a patient better protected.
Q&As:
What would the Liberal Democrats have done differently to improve NHS dental services?
Over half the population in England are not registered with an NHS dentist. Yet 2,000 dentists (one in ten) refused to sign the new contract and instead left the NHS. We would work with the Dentistry profession to ensure that the new contract delivers more dentists working in the NHS, and not less.
A motion was passed at the Lib Dem party conference in September 2005.
To increase access to NHS dental care, we would have rebuilt trust between the dental profession and the Government. As a first step we would have negotiated an end to current the drill and fill contract and introduce a new payment system for NHS dentistry which rewards preventive treatment for adults. This shift towards preventive oral healthcare would have been supported by the introduction of Personal Dental Plans.
These plans would then set out how frequently people should come for a check-up, how better to look after their teeth, and for those with serious dental problems their future course of treatment.
How are patients affected by the introduction of the new dental contracts?
There certainly are disincentives in the new contract for the patient; under the new charging system it makes better sense for a patient to wait until they need maybe two or three fillings as they can pay for them all under band two rather than paying three times when they are needed; this is not good preventative oral health.
