NHS dentistry 'should be limited to the most needy'

THE GOVERNMENT should consider limiting access to NHS dental treatment to ensure the most vulnerable groups continue to benefit from the cash-limited service, an inquiry has concluded.

A report yesterday on the system for paying Britain's 18,000 dental practitioners presented ministers with a range of options for streamlining the pay arrangements that culminated in a head-on clash after the Government attempted to impose a 7 per cent cut in fees to remedy an alleged pounds 113m overspend on NHS dental treatment in 1991-92.

Sir Kenneth Bloomfield, former head of Northern Ireland's civil service, suggested that the present complex system, little changed since 1948, may need remodelling along the lines of the new internal market in NHS medical care.

All but a few hundred dentists are independent contractors. They receive NHS fees for their services, based on the number and type of treatments they carry out, the size of their patient lists and practice expenses. Most adults pay 75 per cent of the cost of each course of treatment, up to a maximum of pounds 225. Children, students under 19, pregnant women, nursing mothers and people on income support or family credit receive free treatment.

Sir Kenneth acknowledged that there were dangers in seeking to confine NHS dental treatment to a core for those in greatest need, but he doubted whether requiring non-exempt adults to pay 100 per cent of their dental charges would have any great effect on demand. But he added that 'the only category of patient exempt from making a contribution that is questionable is pregnant women and nursing mothers. It is not easy to see on what grounds a woman well able to pay a contribution to, or indeed pay the full cost of, a dental treatment should receive privileged treatment . . .'

Another idea he believes ministers should examine is to boost the number of salaried dentists employed by health authorities, mainly in deprived urban areas.