NHS dispute divides quiet dental practice

A disagreement over new patients is going to court, writes Glenda Cooper finds tension in a Tewkesbury surgery over new patients

Walk into the Old Police Station Dentistry in the sleepy medieval town of Tewkesbury and the tensions are immediately obvious.

Downstairs, Vrajesh Ruparelia continues to see patients despite being taken to court by his colleagues for taking on new NHS fee-paying patients despite an agreement within the practice that no more should be admitted. Upstairs, his former colleagues Andrew Moszczynski and Susanne Hobday have secured an injunction against him.

The two halves communicate only by memo and solicitors letters. Difficulties arise over how much paper in the photocopier belongs to each. The dispute encapsulates present troubles in the NHS. Thousands of dentists are refusing to take on new NHS fee-paying patients because of a dispute with the Government over NHS fees and plans to reform the dental service.

In the surgery battle lines are strictly enforced.The right side of the reception counter is now occupied by Mr Ruparelia's receptionist with the other partners employing another on the left side of the counter. Neither answers the others phone. "It takes time but you learn to recognise your own ring," said Dawn Wilson, Mr Ruparelia's receptionist. "No, we haven't divided up where patients sit, that would be too difficult."

Local opinion so far appears to be on Mr Ruparelia's side with more than 200 people signing a petition of support.

"Every person in the country has a right to be seen on the NHS regardless of the dentist's position or view," Mr Ruparelia said.

"I am not against private treatment for those who can afford it but there are some of us who are less well off than others who don't come into the benefit bracket."

But Mr Moszczynski points to the fact that when Mr Ruparelia bought a third of the practice in 1994 he signed a contract which prohibited taking on new fee-paying NHS patients.

"Mr Ruparelia committed a breach of contract which is the reason why legal action has been taken," said Mr Moszczynski "We're all still seeing NHS patients exempt from charges - children, people on income support and family credit. It's not a blanket ban. There's no political motive.

"It's one thing to sign an agreement and then have it in practice," said Mr Ruparelia, "and once you've got an agreement it's easy to move the goal posts. 'New patients' has been changed over the last year or so to include those who haven't been for two years."

His patients, he says, deserve freedom of choice "It's like if you walk into a TV shop and there's only one TV for sale at pounds 500. I would want to say that you can buy a 14inch colour or a 20inch colour, with pounds 100 or pounds 250." He estimates private charges can be five times those of the NHS.

But Mr Moszczynski said that to take on new NHS fee-paying patients would "conveyor-beltise" the practice. "It would turn the pressure on. We would have a local conveyor-belt. We would not have the time that we presently take to treat patients."