AS THE man given the task of providing a gleaming smile to the battered face of British dentistry, Barry Cockcroft knows only too well the criticisms and clichés associated with one of the NHS’s most embattled sectors.

Finding a dentist is like pulling teeth; the profession is decaying; the workforce is turning away from a thankless “drill and fill” culture. While people queue for a place on a patient list, dentists are drafted in from Poland to plug the service’s many cavities.

Yet to hear the acting Chief Dental Officer for England tell it, NHS dentistry is not in crisis, but on the edge of real progress. If all goes to plan, the biggest reforms in almost 60 years will come into force in April, with a new contract for NHS dentists and a complete restructuring of the sector’s complicated set of charges.

While the critics claim that the changes may prompt an exodus of dentists to the private sector, exacerbating NHS dentistry’s most scrutinised problem, Cockcroft believes that they will pull the profession into the 21st century.

“Any period of change causes uncertainty, and there hasn’t been any change to NHS dentistry of real significance since 1948. This really is a fundamental change as to how we deliver services.

“It is disappointing when any practice reduces its commitment to the NHS . . . it is a reflection of dissatisfaction with the system. Now we are doing something about (it) and taking away the elements that dentists say are wrong.”

Rather than have dentists paid from a central budget with separate fees for each individual item of treatment, the reforms will guarantee them an annual lump sum from their local trust for a pre-agreed workload. Instead of the current roster of some 400 different charges, there will be just three: £15 for a standard check-up, £41 for a filling and an upper limit of £183 for dentures, crowns and more complicated procedures.

On Friday, the British Dental Association claimed that the “shambolic” changes — particularly the proposed way of monitoring the contract by counting “units of dental activity” — would fail to improve patients’ access to dentistry, the nation’s oral health or the quality of care.

But after 27 years in dentistry, much of it in his home town of Rugby, and a further three years in Whitehall, Cockcroft begs to differ. He argues that the reforms are long overdue, and that the combined “package” of the contract, funding increases and recruitment policies, will pull the profession out of the perceived doldrums. His work as cheerleader- in-chief for the government programme — a role he has held since Raman Bedi, the previous chief dental officer, departed in October — is far from over. With the contractual deadline looming, Cockcroft continues to travel the country to answer colleagues’ questions and put uneasy minds at rest.

“There has been an awful lot of noise and a lot of misinformation, but the feedback I am getting is that the vast majority of dentists will sign up. It is my job to ensure that people know what’s what.”

As Cockcroft sees it, the new era of NHS dentistry will bring more advances and a concentrated effort to educate, promote the benefits of water fluoridation and reduce regional inequalities in oral health.

“If people need to see a dentist, then they should be able to do so; and if they want to have that treatment on the NHS then we should be able to meet that need,” he says.

Neither the dentistry profession nor the general public could disagree with such sentiments. But the means of achieving them may, as that dental understatement goes, hurt just a little.

Born: November 6, 1950, Monton, Lancashire

Career: Qualified as a dentist in 1973 and practised in Warwickshire for most of his 27 years in NHS dentistry. Was chairman and secretary of the local dental committee before moving to regional and national positions. Made deputy chief dental officer in 2002, becoming acting CDO last year.

What he says: “The public now recognises the importance of good oral health both from health and social points of view. It is not acceptable in career situations and social occasions to not have good teeth and gums.”

Little-known fact: Cleans his teeth three times a day, but admits to chomping the odd Mars bar between meetings.

Sam Lister is The Times health correspondent

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