New NHS Dentist Contracts

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 In many parts of the UK finding an NHS dentist is a huge problem. In April 2006 big changes to the way NHS dentistry works were introduced, but the vast majority of dentists are very unhappy with the new system. Will the dentist reforms lead to better access and patient care in the future?

More and more NHS dentists are going private

Dentists are largely self-employed and can choose whether to provide NHS treatments or private treatments, or a mixture of the two. In the early 90s, the amount of money paid to dentists to carry out NHS treatments was cut, prompting many dentists to stop doing any NHS work. Now many people simply cannot find an NHS dentist and are either spending the extra money to go private, or going without care if they cannot afford it.

Under the old system, dentists were paid by the government for every NHS treatment carried out - the more treatments the more money. Under this system dentists spent little time with patients, with no emphasis on preventative care. Dentists prefer to spend more time with patients and like doing complex and modern procedures which are often not available on the NHS.

How does the new NHS dentist system work?

Since April 2006, dentists are paid a flat rate covering the amount of work they are contracted to do each year.

Contracts are agreed with the local PCTs (primary care trusts), which now have responsibility for providing NHS dental care in local areas. They are allocated money each year which must be spent on providing NHS dentistry. The money is divided up among dentists willing to carry out NHS work, who are now contracted to carry out a certain amount of NHS work each year.

Dental work is measured in UDAs (units of dental activity). Dentists now essentially have ‘UDA targets' to meet each year, as agreed in their contract.

New patient charges for NHS dentistry

Most adults will still need to contribute to the cost of their NHS dentistry. Along with the new contracts, a new charging system has been introduced. Before, there were over 400 different prices covering different NHS treatments. Now there are only three possible prices you will pay, depending on the complexity of the work needed (Bands 1, 2 and 3).

The idea is that you will always know how much you should be you charged, and you can be sure your dentist is not charging you for any private work. However, the new system means you pay the same for 3 fillings as 1 filling, making 1 filling bad value for money!

What's wrong with the new NHS dentist system?

Dentists aren't happy with it. 2000 dentists refused to sign the new contracts and left the NHS in April 2006, while many more signed ‘in protest'.

A British Dental Association poll of 394 dentists, about a year after the new contracts started, showed clear dissatisfaction with the system. 85% of dentists asked did not think the new contracts had improved patient access, and 95% did not think the new contracts allowed them to spend more time with patients.

Research published by the Citizen's Advice Bureau indicated that, by September 2006, no more people were seeing an NHS dentist than before April 2006.

In many areas, it seems that the annual PCT budgets were not enough. In early 2007, many dentists were turning away NHS patients, or even being forced to take holidays, because the PCT had no more money to pay for NHS treatment.

So far it seems money has not been effectively targeted at problem areas, where there are few NHS dentists. Citizen's Advice say that the new system has not solved the ‘postcode lottery' of finding an NHS dentist.

What's right with the new NHS dentist system?

One advantage of the new system is that when a dentist goes private, local NHS dental provision should not be lost - as money goes back to the PCT which must then use it to fund alternative NHS services.

Under the new system, if you can't find an NHS dentist in your area, you can go directly to your PCT, who now have the responsibility to find you a dentist (perhaps putting you on a waiting list). There are reports of this working well in many cases, but most people don't know they can contact their PCT for help in this situation. This needs to be better publicised.

Will NHS dentist reforms work?

The Citizen's Advice Bureau believe that the new system will eventually provide better access to NHS dentistry, providing money is properly targeted at areas of greatest need.

It is important that people know they can now approach their local PCT if they cannot find an NHS dentist. There are stories of people getting appointments with dentists which had previously turned them away, after approaching their PCT.