The mass exodus of dentists from the NHS, which many in the profession predicted, did not happen. The new NHS dental contract begins today with an estimated 10% refusing to sign. However, many more who did sign, signalled they were "in dispute" with its conditions. Stand by for long, drawn-out legal wrangles. What is already clear is that the new contract will not arrest serious deterioration in the country's dental service.
Like a bad molar, the problem has deep roots. They go back 16 years to a previous contract. Like many patients, ministers prefer to put off dealing with dentists. But fresh hope was kindled by Tony Blair's promise to the Labour party conference in 1999 - repeated in the NHS plan of 2000 - that everyone would have access to an NHS dentist within two years. More than six years on, alas, this is farther away than ever. A forlorn Mr Blair confessed six months ago in an interview on BBC Breakfast News, that there was no way he could force dentists to carry out NHS work. True, but with more imaginative management from his ministers, his government should have been able to lure more dentists back into NHS work, particularly given the extra funds being invested.
Official figures show less than half the population in England are registered with an NHS dentist - 44% of adults and 60% of children. More than a third of dental work is now carried out privately compared to one-tenth 15 years ago. The value of private work shows an even faster acceleration rising from £289m in 1995 to £1.2bn in 2001. The aim of the new contract was a worthy one: replacing a "drill and fill" approach with more preventive work. But dentists, who are a difficult group with which to negotiate, are right to complain about the process. The new contract requires them to carry out all their current work in 95% of the time, leaving them with just 5% to tackle more fundamental causes of bad oral health. Worse still, ministers imposed dreaded "activity" targets, which they are expected to meet, that could reintroduce "drill and fill".
There are other serious weaknesses in the process. Even though the introduction of the contract had been delayed for a year, primary care trusts (PCTs), which now control local services, only received draft 160-page contracts from the centre in February. Each had to be checked before being sent out to 17,000 dentists. It is no wonder there is anger both within dentistry and PCT managerial ranks. The mismanagement of the contract is just another sad sign of disarray at the top of the NHS.
