Dentistry plans `will not stop NHS exodus'

Dentists are steeling themselves for a major shake-up of the profession with the launch tomorrow of a long-awaited White Paper on the future of dentistry.

Proposals are likely to include a "core service" to replace comprehensive NHS provision, and abolition of "continuing care payments" designed to discourage dentists who overtreat some patients to boost income.

Dentists' leaders last night warned the Government that its proposals would do nothing to stem the "haemorrhage" from the NHS to private practice.

Nearly 1 million people have been deregistered by their dentists since 1991. According to the General Dental Practitioners' Association, the number of practices that will accept NHS patients - fee-paying or exempt - has fallen from 90 per cent to 50 per cent since 1991.

Bob Nixon of the association said yesterday: "This isn't about better care for patients but about saving money. It is sad that the Government has performed a complete U-turn over continuing care payments - something that they initially said would improve dental care. It will do absolutely nothing to stop dentists leaving the NHS."

The Government is known to want to divest itself of some of the £1.2bn it spends on dental services. The core NHS service as outlined in the White Paper would include a basic examination and treatments such as scaling and polishing, fillings and extractions.

Check-ups are likely to be made cheaper (now £4) to appease consumer groups, but the cost of complex treatment would have to be met fully by the patient. At present, patients pay 80 per cent of the cost of treatment up to a maximum of £300.

Continuing care payments were only introduced in 1990 as part of a new dental contract. The aim was to encourage dentists to develop a long-term relationship with their patients so they would not feel pressured financially into recommending expensive, lengthy, treatments. Dentists are paid for each item of work they do on an NHS patient.

The publication of the White Paper is the culmination of a three-year row between the Government and the dental profession triggered by a 7 per cent cut in fees. This followed the introduction of the new contract and a drive to recruit more patients so that £200m worth of extra work that had not been budgeted for was carried out by dentists.

To claw back some of this money, the Government imposed a fee cut, taking fees back to the level they were in 1989. This led to hundreds of dentists stopping taking new NHS patients or deregistering existing patients. Many decided to leave the NHS altogether.

John Hunt, chief executive of the British Dental Association said yesterday: "The time for fee cuts is over. Dentists up and down the country are finding it increasingly difficult to provide proper quality treatment and preventive advice under the existing fee structure. If the Government is unwilling to provide more resources, then it must target these to where need is greatest, namely children and those who cannot afford to pay for treatment."