Ministers order another overhaul after huge surge in spending fails to reverse decline in patient numbers

NHS dentistry is to undergo another major shake-up – just three years after the last time it was reformed.

At the Department of Health yesterday was like Groundhog Day as ministers accepted a report recommending – once again – a switch of focus from the drill and fill philosophy of the past and its replacement by a new emphasis on maintaining oral health. The changes are to be introduced following heavy criticism of the 2006 dental contract, which had the same aim but saw extra investment in NHS dentistry worth billions of pounds rewarded with a decline in the number of patients treated. In two years the number of patients receiving NHS dental treatment fell by more than a million.

The recommendations in the new report, which are to be piloted in the autumn, will see a return to patient registration backed by a capitation payment – as demanded by the Tories – and a new payment for quality of care. To cover the extra costs, payments for activity such as fillings will be reduced.

Patients will continue to pay NHS charges, which traditionally have covered 80 per cent of the cost of treatment, but these could be divided into up to 10 payment bands, compared with the existing three, to tie them more closely to the amount of work done.

One of the criticisms of the existing contract is that under the three-band charging system, one filling attracts the same fee for the dentist as six fillings (band two).

Under the new proposals, designed to incentivise long-term care, greater financial weight will be placed on looking after the patient's oral health and less on the speed with which they can drill and fill. Dentists could in the future receive more than half their total income from the registration and quality of care payments, with less than half coming from the amount of dental activity carried out.

Professor Jimmy Steele of Newcastle University, who chaired the review, said NHS dentistry had had "a very difficult time over recent years." Good oral health and the quality of the service, should be the benchmarks by which success was measured, his report said. "So long as we see value for taxpayer's money as measured by the production of fillings, dentures, extractions or crowns , rather than improvements in oral health, it will be difficult to escape the cycle of intervention and repair that is the legacy of a different age."

Capitation payments will be adjusted according to the demographics of the practice – with extra weighting in areas of deprivation – and quality would be assessed against measures including how often patients were recalled for treatment, increases or decreases in the rate of restoration in a sample of patients, and the proportion of patients attending for emergency care or requiring antibiotics.

Andy Burnham, the Health Secretary, denied the 2006 contract had been a failure but added: "I recognise this is an area of unfinished business. We have to make sure the NHS is on the right path." The British Dental Association welcomed the move away from "target driven payments" and pledged to co-operate with the pilots.

The Tories said the review was "bad news for the Government." Shadow Health Secretary, Andrew Lansley said: "The review's proposed shift from 'dental activity' to 'oral health' is a clear rejection of the structure of the Labour dental contract and an endorsement of Conservative proposals."

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