Published: 07/03/2002, Volume II2, No. 5795 Page 18
For all the ministerial hunger for NHS improvements, the one health issue that seems to have been cryogenically frozen on the edge of crisis is dentistry.
The exodus of dentists into the private sector, many of whom were angered by the 1991 contract reforms, has left those who continued to provide NHS services struggling to meet public need.
The last major announcement was made three years ago at the 1999 Labour Party conference.
Prime minister Tony Blair proudly told delegates that everyone would have access to an NHS dentist by September 2001. Many thought it would herald a revolution in the form of more dentists. Sadly, the reality for many patients when the deadline came to pass was little different from the John Major years, when public sector provision first went into decline.
The reason was simple. The prime minister apparently only ever meant that everyone would be able to phone up NHS Direct and be told where their nearest NHS dentist was. In a worst-case scenario, that could still result in a 100-mile round trip to a neighbouring city because it remained the nearest place where a practice still had vacancies on its NHS list.
Access, yes - but not as we know it.
For the British Dental Association, it still comes down to a fundamental shortage of dentists doing NHS work - an argument apparently supported by a recent Conservative Party survey.
Shadow health spokesman Simon Burns contacted 104 health authorities (86 per cent replied) about the proportion of registered NHS patients they had last September. The results published in January ranged from a paltry 27 per cent in Kingston and Richmond to 57 per cent in Wirral. The average figure was just 49 per cent. Mr Burns' conclusion was that the prime minister's promises were in reality 'worthless'.
A Department of Health spokesperson admitted that work remains to be done, and it could not yet be promised that everyone would be able to have a 'long-term relationship'with a dentist.
Other initiatives have left people unimpressed too. In September 2000, the government released its strategy Modernising NHS Dentistry. It was criticised for lacking adequate funding to bring about reform. Eight months later, in May 2001, came the Commons health select committee's damning assessment that an estimated 2 million people were still unregistered - mainly in deprived areas, and mainly in the North and the extreme South West where the commercial viability of private dentistry to supplement NHS incomes is limited.
What may be surprising, given dentistry's recent history as a political issue, is that the profession itself is feeling optimistic. Its enthusiasm rides on the hope that the expansion of primary care trusts - due to take place this month - will bring dentists in from the cold.
The BDA believes that the powers laid out in Shifting the Balance could provide 'a major opportunity for NHS dentistry to come back fully into the NHS family', through participation by dentists on the professional executive committees of PCTs and the setting up of dental networks.
BDA chief executive Ian Wylie says: 'I think we see there are new opportunities available now.There has always been this question about being part of the NHS family, and for a long time I think dentists have felt they were on the outside. What's happening in primary care is important because it gives us the chance to address those problems.'
The association says some of the structures needed to deliver improved services are already in place. In particular, it emphasises the role of personal dental services in tackling the most deprived areas that find it difficult to attract dentists. With specifically designed contracts between HAs, trusts and dentists, it is a system already leading to numerous pilot schemes helping poverty-hit areas most affected by dentists' shift to the private sector.
'PDS is a major opportunity to test new ways of delivering care and paying dentists, ' a spokesperson for the BDA said. 'It is extremely important that we move ahead with piloting some of the innovative ideas that we have.
PDS can be used to open practices and recruit dentists to localities where dentists do not want to take the financial risk to set up practice - particularly in areas where private dentistry will not be affordable and so dentists cannot subsidise their practices through private work.'
In the future, this could mean dentists working more closely with GPs, pharmacists and opticians in 'one-stop'medical centres.
For Mr Wylie, sharing premises is key: 'Dentists have traditionally worked alone and have often been isolated.By bringing them together with other dentists, the isolation should disappear and issues of regulation should improve.'
He added: 'The DoH must recognise that access is only a symptom of the fundamental problems in NHS dentistry, and unless we go on to address those problems undermining the service, the access issue will simply reappear in a different form.'
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