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Reform of dental care proposed NHS dentistry 'facing overhaul'
(about 3 hours later)
An independent review has recommended significant changes to the way NHS dentistry is organised in England. Ministers have agreed to an overhaul of NHS dentistry - just three years after the last shake-up of the system.
They include a return to linking a significant part of a dentist's income to the number of NHS patients registered on their books. They have acted after heavy criticism of the 2006 dental contract, which has led to fewer patients accessing care.
Another proposal is to make dentists "more explicitly accountable" for providing high quality, long-lasting treatments. The government said it would accept "in principle" the recommendations of an independent review of NHS care.
Ministers say they will pilot some of the recommendations in the autumn. Unions welcomed the move which will see income determined by three factors - patient list size, quality of care and the number of courses of treatment.
It represents a return to patient registration - as called for by the Tories - which was scrapped under the 2006 changes.
Both the opposition parties said reform of the system was vital with the Tories branding the 2006 changes a failure and the Lib Dems saying NHS dentistry was a "national disgrace".
This review is a vision of a better deal for both patients and dentists Professor Jimmy Steele, review author Q&A: NHS dentistryThis review is a vision of a better deal for both patients and dentists Professor Jimmy Steele, review author Q&A: NHS dentistry
Health Secretary Andy Burnham said: "I recognise that more needs to be done to bring NHS dentistry up to the standards that patients should expect. Over the last three years dentists have been working in a system where they were given a set number of courses of NHS treatment to provide to any patient that asked for care.
"We and the NHS are committed to ensuring that anyone can access high quality dental services." It was structured so that they were effectively paid the same amount of money to see slightly fewer patients.
Professor Jimmy Steele, who led the independent review, said: "This review is a vision of a better deal for both patients and dentists. The deal was introduced in a bid to end the so-called "drill and fill" culture.
"It is about making sure that patients can see an NHS dentist who will take long-term responsibility for their care." It was hoped that the changes would make NHS work more attractive to the profession - dentists also carry out a significant amount of private practice.
New contract But instead of improving access, official statistics show that more than 1m fewer patients have been treated in the two years since it was introduced than the two years before.
A new dental contract for dentists was introduced in April 2006 in an attempt to widen access for NHS patients. One of the key problems was that some dentists had used up all their allocation of courses before the end of the year, meaning they had to turn away patients.
It aimed to reform the so-called "drill and fill" culture by effectively paying dentists the same amount to see slightly fewer patients. Rows broke out between the government and profession over whether this was due to the contract failing or dentists "playing the system".
In theory this allowed them to spend more time with their patients so they could also give them advice about oral health, rather than trying to maximise throughput to maximise their income. 'Unfinished business'
But it has proved highly unpopular with the profession - and with the public. Health Secretary Andy Burnham rejected claims that the 2006 contract had been an outright failure.
But he added: "I recognise this is an area of unfinished business. We have to make sure the NHS is on the right path."
The proposals put forward by the review, which was led by Newcastle University expert Professor Jimmy Steele, will now be piloted in the autumn.
HAVE YOUR SAY Perhaps one day there will be a review where the public will be asked for their opinion Rob Allsopp, Oldham Send us your commentsHAVE YOUR SAY Perhaps one day there will be a review where the public will be asked for their opinion Rob Allsopp, Oldham Send us your comments
Opposition parties have also been highly critical of the effect of the contract, with the Conservatives in particular calling for a return to patient registration. As well as the changes to the contractual arrangements, the report said patients needed to be provided with better information.
Figures show 1.2 million fewer patients visited a dentist in England in the two years to June last year than in the period before the reforms were introduced. Local helplines are to be set up and NHS Direct given information about which dentists have spaces on their books for NHS patients.
Under the contract, patients paid fixed charges for particular types of procedure and local primary care trusts were given the power to commission and pay for dental services. It also suggested the three bands of patient fees - NHS patients contribute towards the cost of their care - should be widened to up to 10 bands as the current arrangements were overly simplistic.
There has also been criticism that because dentists now receive a flat salary, they no longer have any financial incentive to carry out difficult work such as crowns and bridges. The changes will also need a clear set of targets to be produced so that the quality element of dental income can be determined.
In the first year of the contract, the number of complex treatments - including bridges and crowns - which involve laboratory work was halved, and the number of root canal treatments fell by 45%. Nonetheless, Professor Steele said he was confident the proposals would work.
In Scotland and Northern Ireland, not covered by the changes, the number of complex treatments rose. "This review is a vision of a better deal for both patients and dentists. I think there is a will to change."
The contract also covers Wales, although the review only deals with services in England. John Milne, of the British Dental Association, which was highly critical of the 2006 changes, said the measures offered an opportunity to improve care.
But he said: "Clearly, the detail of how that approach will be delivered will be vital."