Pay deal bridges gap in NHS treatment

A Government boost to NHS dental services for children has provided a new climate for attempting to rescue the shrinking dentistry service for adults, the British Dental Association (BDA) said yesterday.

The package, however, which brings to an end a four-year-old pay dispute with Britain's 16,000 dentists, means that children will initially take a greater share of the NHS dental service, at the expense of treatment for adults.

"On its own, this won't bring anybody who has quit the NHS back in," John Renshaw, the vice-chairman of the BDA's General Dental Services Committee, said. "But it will allow some of the people still there to carry on a bit longer. The best we can hope for is that it will slow the rate of exit."

But it would allow new negotiations in a more positive atmosphere over adult services where fees and allowances remain inadequate, he said.

Under the package the Government has written-off pounds 250m it claimed dentists owed them for doing too much work under a new contract which came into effect in 1990.That led the BDA to advise dentists in 1992 not to take on new patients. As a result one-third of patients nationally and half of those in the South-east, South-west and in East Anglia have found it difficult or impossible to find NHS dental treatment as more and more dentists have gone private.

Under yesterday's deal, dentists will be paid fees for fillings and extractions in children on top of a payment per head aimed at encouraging preventative care. As a result the children's share of NHS dentistry will rise from 18 to 26 per cent, the association said, helping in particular those children from deprived areas with serious dental problems.

The money will come out of adult services, partly by cutting the registration period from 24 months to 15 months - a move that will save pounds 25m a year. As it takes effect, it will see almost 5 million patients having to reapply to stay with their NHS dentist or find another if they have not been for a check-up in the 15-month period.

In addition, prior approval will be needed more often before dentists carry out complex work such as crowns and bridges. The details of that have yet to be agreed but it is aimed at cutting pounds 10m off the pounds 200m currently spent on such treatment.

In the longer term, legislation to allow pilot schemes under which health authorities will buy in dental services will be introduced after the autumn. More immediately, a limited scheme will allow about 20 health authorities to bid for pounds 40,000 grants to deal with local shortages of dentists. That, however, was described as "chickenfeed" by Mr Renshaw.

Announcing his "new agenda" for NHS dentistry, Gerald Malone, the Minister for Health, said he hoped it would "do much to end uncertainty and provide an atmosphere of stability and security for the dental profession." He added: "It creates a firm foundation for future work."

He recognised, he said, that there were "localised problems of accessibility" and hoped the ending of the pay dispute would lead to more dentists accepting NHS patients.

Henry McLeish, Labour's health spokesman, said the package still failed "to ensure the right of all sections of the community in all parts of the country to comprehensive NHS dental care".