Stephen Dorrell, the Secretary of State for Health, is preparing legislation which would bring far-reaching changes to the work of Britain's 17,000 dentists.
The Bill, which could be in the next Queen's Speech, would give local health authorities powers to "buy" health care from dentists for NHS patients.
The aim is to allow health authorities to tackle evidence of worsening dental health, particularly for children in some areas, by setting local targets. It would end the system of "demand-led" care under which dentists respond to patient demand and are then paid for their work. The new system is likely to be coupled with tighter cost controls, ruling out more expensive treatment on the NHS.
Mr Dorrell plans a series of pilot schemes. However, the move could mean that some patients whose dentists withdrew from the NHS could have their care restored. Local authorities would purchase the care directly from the dentists. Ministers believe this will help them to defend their record on the health service more effectively at the general election.
The collapse of NHS dental care came after the Government slashed fees for dentists by 7 per cent in 1990. The cut provoked an exodus as dentists moved to the private sector because they felt it was not worth working for the NHS. In some areas, particularly the Home Counties, many practices ceased NHS care. That has led to accusations of a two-tier service, in which some poorer families have had to go without regular check-ups.
Dentists who remained on the NHS lists are concentrated in poorer areas. In Gateshead, Tyne and Wear, the fees paid to dentists on the NHS have gone up 130 per cent since 1990.
One dentists' leader said: "They cannot pay for the whole of the health care. At some stage, some government is going to have the courage to say we cannot do everything."
A spokesman for the Association of British Dentists said: "We are waiting to hear what the Government says, but we have a problem over how you relate it to the demand-led process."Reuse content