Higher dental treatment charges proposed: Dentists' leaders say Green Paper unlikely to lead them back into the NHS. Celia Hall reports

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REDUCED check-up fees but higher charges for complicated dental treatment were proposed in the Government's Green Paper on dental services yesterday, but the package of proposals is unlikely to bring disaffected dentists back into the NHS fold, their leaders said.

The Green Paper, Improving NHS Dentistry, sets out a range of simpler options for paying high street dentists.

Two, for the short term, are paying them by the session in a similar way to hospital consultants; or redesigning a system of fees to put more emphasis on prevention. This would move away from the current system in which the more treatments dentists carry out the more money they earn.

In the long term, but not before four years at the earliest, the Government wants to move dentistry into the NHS market, with local health authorities buying dental services from dentists in their area.

Michael Watson, spokesman for the British Dental Association, said that sessional payments looked like a 'salaried service by the back door' and that the Green Paper was disappointing. 'While it is true dentists agree that we need a new way forward, in all consultations with the profession they have rejected a salaried service. We cannot see this stopping the move into private practice.'

David Blunkett, Labour's health spokesman, said the Green Paper failed to end the uncertainty surrounding dentistry; 2,000 dentists had already left the NHS. 'I am particularly concerned that the proposals to move towards a sessional system will mean many dentists reducing the amount of time they give to the NHS. In effect, what is being signalled is the development of a two-tier dental system with a safety net for the very poorest - and the rest of us being forced to go private or sign up for costly dental insurance schemes.'

The dentists' dispute with the Government began nearly three years ago when dentists started to do 'too much' work, and as a result were being paid more than the sums set aside for them. A 7 per cent 'clawback' of payment was introduced and furious dentists began to refuse to take on new NHS work.

The BDA estimates that 60 per cent of dentists in London and the South-east have 'significantly reduced' their NHS workload. The figure stands at about 10 per cent in the North.

Introducing the Green Paper, Dr Brian Mawhinney, the Minister for Health, pledged free treatment for children and for those groups receiving benefit, as at present. He also pledged the continuation of the maximum fee for treatment. At present this is pounds 275. 'The Government proposes to develop and strengthen the community dental service to ensure there is an effective safety net where necessary,' he said.

Dr Mawhinney also published a set of targets to reduce dental decay by 2003 and said that the Green Paper consultation period would end on 1 October. But if it is decided to reduce the examination fee to encourage people to go to their dentist the money lost would have to be found elsewhere. The all-party health select committee recommended that patients should pay 100 per cent of the maximum for advanced dental work, including crowns, bridges, inlays and dentures.

(Photograph omitted)