Yes

Dr Anthony Halperin

Dentist and trustee of the Patients Association

“The feedback that we're getting at the Patients Association from patients - and from dentists - is that the new contract is failing to provide a better quality of work than the old contract. We have evidence that dentists are not doing the necessary work that they are contracted to do under the NHS. Dental Laboratories Association figures show that the amount of crown and bridge work has fallen and that extractions and insertions of simple dentures have risen. While this has been put down to various factors by the Chief Dental Officer, the one factor that can't be ignored is that under the Denplan capitation system, the amount of complex treatment has not fallen. This would indicate that NHS dentists are not providing more complex treatments; in fact they are shying away from them.

Under the old contract system the Government was concerned that dentists were doing too much treatment and that they couldn't control it. Now the treatment costs have been placed in three bands. For instance, a band two treatment costs the same whether it is an extraction or a root canal therapy. Extraction would take up to 15 minutes; a root canal therapy can take an hour and a half. It's a skewed system where the dentist is encouraged to carry out a simpler form of treatment; if he carried out a more complex treatment it would be at his own expense.

The only conceivably good thing that's come out of the new contract is that the complexity of dozens of different payment structures has been reduced. But I don't think that patients see that as an advantage - they're more concerned about the quality of dental care. The simplification of the pricing was one of the reasons for the new contract, but that was not looking at it from a patient's point of view; it was from the point of view of making admin easier for the NHS.

The new contract has been in place for two years and we've got no checks on quality. Under the old contract there were regular check-ups on the quality of dentists; now the dentist selects half a dozen patients for independent quality checks. We find that unacceptable. It's not that dentists are out to take advantage of the patient; but they have to reach government-set targets. If they don't their salary is cut.

NHS dentistry should be on the same basis as the GP system. Dental health is important, oral cancer is increasing; patients should not have to pay for it, except for some cosmetic procedures, as is the case elsewhere in the NHS. I believe that it should be a full salaried service with subsidiary payment by patients for more complex treatment. But I can see no solution because the health minister Ann Keen has said that the contract is not going to be altered.

The contract was never properly piloted. It is not liked by patients, and I don't think it is particularly liked by the majority of dentists, who want to give quality work to their patients and receive adequate remuneration. The contract should be scrapped and we should start again."

No

Barry Cockcroft

Chief dental officer for England and former dentist

“Dentistry had been a longstanding issue in the NHS. The old contract had been the same since 1948, and that was ridiculous: oral health had changed dramatically but we still had the same contract. Dentists controlled everything, from where practices were set up to how much money was spent. Some dentists created an area where there was only private services and no NHS dentistry at all.

The new contract gave a budget to the primary care trust (PCT) to bring back NHS services. Now there is no shortage of NHS dentists, and the amount of services being delivered is up. However, it is difficult to change something that has been set for 60 years. It is understandable that people were not happy when we took away control. Criticism of the new contract comes not so much from dentists, but from people who have a vested interest in private practices that are threatened by a strong local NHS.

Dentists are paid to provide treatment that is clinically necessary. As oral health improves, there is less need for complex treatments. Under the old contract the more you drilled and filled, the more you got paid. Dentists say that they are for prevention-based service, but when we allowed them to do it, what they were doing was not evidence-based at all.

We piloted alternative ways of working in 1998. Under the pilots you saw the same reduction in complex treatment with no impact on oral health. When decay is going down, to incentivise people to intervene seems perverse. So the reduction in complex treatment is not a bad thing.

Similarly, as oral health gets better, people should need fewer appointments. However, changing the culture of seeing patients every six months is difficult. A few dentists seem to be calling in patients inappropriately. The PCT must sort this out at a local level.

It is wrong to suggest that there are no checks on quality - a range of monitoring activity goes on. Dentists have a contract to provide a number of courses of treatment based on what they did under the old system. If we see that they are not adhering to that, there is an opportunity for the PCT to do something about it. We have introduced a clinical data set, so we know in great detail what is going on within each band of treatment. Dental reference officers examine data, clinical records and do patient surveys. If something looks odd, they will call patients in. Private dentistry is not regulated, although we hope to do something about it in the future.

It is almost unheard of to suggest getting rid of dental charges. The charges have been there since 1951 and bring in about £550million a year. All children go free and 30 per cent of adults go free. If we did not have revenue from patients, we would have to commission fewer services.

We will need to make minor changes to the contract but first we have to give it time to settle down.PCTs are investing substantial sums of money and we are expecting to see positive changes early next year.”

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