Leading article: The NHS dentistry sham

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The Independent Online

This week a 15-year-old girl living in Eastbourne - let us call her Donna - tried to find an NHS dentist. She comes from a deprived background, is overweight, and her teeth are in a poor state. Despite trailing round dentists all over town, Donna has been unable to find anyone to take her on. One dentist she visited accepted her 15-year-old cousin because his teeth were in good repair but still rejected Donna.

If patients like Donna cannot get dental treatment on the state, then the National Health Service is not worth its name. The fault lies with the new contract, which reduces 400 separate payments into three price bands, because it has created a disincentive for dentists to take on the neediest patients.

First the good news. The new system is simpler and fairer and should encourage preventive work instead of the old-style drilling and filling. The lowest NHS charge of approximately £15 for an examination and report represents a near £10 increase, but the highest charge of £189 for crowns and dentures is about £200 less than the previous top charge. The middle band charge of about £45 covers one to six fillings, previously priced at £10 to £12 each.

Now the bad news. If we take the middle band charge of £45, it is immediately obvious that patients with a couple of fillings lose out, paying roughly twice what they would have been charged previously.

Patients with five or six fillings appear to gain, as their charge drops from more than £70. But it is the dentist who loses out as he is paid about £60 (three units of dental activity) regardless of whether he does one or six fillings.

The idea behind the change is laudable - the dentist now has a financial incentive to improve his patients' dental health because the less work he has to do the better off he will be. But the practical effect of the change can be seen in Eastbourne where dentists have taken one look at Donna's mouth and concluded she is more trouble than she is worth.

Rosie Winterton, the health minister, boasted yesterday that 96 per cent of dentists had finally signed their new NHS contracts. While this means 2,000 dentists have left the NHS - no ground for celebration there - what she now has to answer is how many of them are taking on new patients. Unless they are prepared to do so, the new contract will be a sham.

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