Tuesday, June 12, 2007

Andrew Murrison: Two million fewer people have access to an NHS dentist than in 1997

In 1999 the Prime Minister said that everyone would have access to NHS dentistry. To give him his due in April he finally admitted that he's failed.

But the truth is that not only has access not improved, it's actually got worse and under this government more people pay more for dentistry.

Less than half the population is now registered with a dentist. Two million fewer people have access to an NHS dentist than in 1997. The exodus that has accelerated over the past year.

We find that over the full FY 69 million UDAs have been delivered against the 73 million the government said was needed to maintain access at 05-06 levels.

This ties in with the BDA's survey earlier this year that showed that 85% of dentists believe the new contract has not improved access to NHS dentistry.

Together with the dental profession the Opposition told ministers that the new contract would be a costly disaster - and so it has proved. In March we learnt of the £120 million black hole that the new contract has punched into NHS finances.

Even earlier advice came from the NAO which in Nov 04 cast doubt on the ability of PCTs to commission dental services. It was ignored.

The new dental contract was not negotiated with the profession. The Opposition consistently opposed it on the floor of the House and in committee.

I well recall the standing committees on the regulations relating to the new GDS contract and PDS arrangements. Ministers did not listen and ploughed on regardless.

When asked for the results of the pilots we were pointed at the PDS pilots.

Actually we were quite happy with PDS pilots set up under the 1997 NHS Act. They appeared to be doing nicely, they were popular with dentists and presented a platform for the future.

But they didn't contain UDAs and they did not contain banding with all their perversities, undershoots and overshoots. So they were not in any way pilots for the system we now have as your debate this afternoon will affirm.

In politics you spend a lot of time being Victor Meldrew - bleating about things. We're very good at that.

But there does come a time when you have to say what you would do and if you're serious about effecting change that means trying to extract healthcare gain from a position of assumed fiscal neutrality.

I happen to be interested in public health - preventing illness more than treating it. And I am convinced that there are few other areas in healthcare so amenable to preventive health than dentistry. The diseases that you largely deal with are either preventable or remediable through timely intervention.

But in this the new contract has failed. 93% of dentists believe it does not encourage a more preventive approach. Hardly surprising given the rise in the minimum NHS charge from £6 to £15.50.

How can we build preventive health into dentistry?

Well, dentists will do preventive oral health where they can because it's the right thing to do and because they're professional people in an altruistic environment.

But how can the contract be used to support them?

I believe a system that takes the best from the PDS Pilots, that is based around genuine registration and the building of patient lists and that uses payment by capitation not Units of Treadmill Activity is the way forward.

Dentists would then operate in a way that is not greatly dissimilar from GMPs.

Crucially, they will have every incentive to engage patients in prevention. A list composed of patients in good oral health will - without the UDA treadmill - be a real prize for the professional.

This is particularly the case if goodwill value in practices can be enhanced through contractual agreement with PCTs, an issue that I know is understandably exercising the profession at the moment.

A few hotheads have suggested that we should solve our dental deficit by handcuffing professionals to the NHS post qualification. I say dentists generally want to do NHS work but you have to offer a contract that is attractive.

Obliging them to work for the public sector as a condition of their training makes no more sense than it does for lawyers, architects, biochemists and so on.

Remarks such as those of Labour Chairman of the Health Select Committee Kevin Barron who this week is reported to have said that;

'dentists do not have the same public service ethos that GPs do'

are unhelpful in my view. However, let's not forget the large sums invested by dentists in their businesses. I for one welcome the independent contractor model in both primary NHS dental and medical practice.

It is outrageous to suggest that to serve the public you have to be employed by the State

I would like to finish by saying a few words about the wider dental health team. Across healthcare there has, in recent years, been a reduction in barriers between professionals. It has been a healthy development - the removal of the last vestiges of the closed shop.

But I am not convinced that he process is sufficiently well advanced in dentistry. I hope that dental nurses, hygienists and technicians, representation of which joined our dental summit in the Commons in April, will be able to develop their skills further and contribute even more fully and autonomously to the valuable work that you do.

Thank you for having me here to today.

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