Dentists face curbs on abuse of salary system

The Department of Health is planning a crackdown on dentists who have been "exploiting" the system to maximise their incomes, denying thousands of patients access to treatment, The Independent has learnt. Dentists recall healthy patients for checks too frequently and divide courses of treatment to trigger extra payments, it is alleged.

Primary care trusts (PCTs) across the country are thought to be affected by the practice which, if eliminated, could release an estimated 800,000 appointments nationwide. No figure for the overall cost is available but each PCT is said to be losing "tens of thousands of pounds".

The Government's Chief Dental Officer, Barry Cockroft, is discussing with PCTs how to halt the practice. By examining coding on sheets submitted by dentists for payment it is possible to identify those at fault, officials say.

A Department of Health source said: "There is gaming [playing the system] going on and we have got to deal with it. If we don't, we are losing too many appointments. The overriding public concern over dentistry is about access, not quality of service. We can't improve that when there is gaming going on. If we can deal with it, it will go a long way to meeting access targets."

The Health Department has been under fire since it overhauled dentists' contracts in 2006 to end a perceived "drill and fill" culture. Dentists used to be paid a fee for each item of treatment but now receive an annual income for carrying out an agreed amount of work based on "units of dental activity".

The contract proved unpopular with dentists and more than a million fewer people now see a dentist than before the changes, according to a report from the NHS Information Centre. Less than half the population was found to have seen a dentist in the previous two years.

Average pre-tax earnings of all NHS dentists were £96,135 in 2006-07, the first year of their new contract. Earnings of higher-paid dentists who own their practices rose almost 35 per cent to £172,494, including income from private work.

A Department of Health source said gaming was more prevalent in the south of the country, where access problems to NHS dentists were worse than in the north, but all areas were affected.

"These dentists are seeing the same healthy patients a lot. Instead of recalling them every year or two years they are coming back every three or four months. They are also splitting courses of treatment so they don't do all the work at once and the patients come back. It is worst in areas which have not got strong NHS provision already."

There were no plans to prosecute dentists, the source said. "We don't want to get into trying to court martial people. We just want to stop it."

The British Dental Association said it "did not have the necessary data" to comment. Peter Ward, its chief executive, said: "The interval between patients being recalled by their NHS dentist is, according to Nice guidelines, a matter for the practitioner's clinical judgement in consultation with the patient. The BDA supports this guideline, as we do not believe a one-size-fits-all approach is clinically appropriate. Dentists develop treatment plans in consultation with the patient, ensuring they are clinically appropriate and fit the individual's wishes."