If you want to understand the muddle facing NHS dentistry across England, try paying a visit to a practice near the Clem Attlee housing estate in Fulham, west London. But don't necessarily expect to get treatment after the end of this month. NHS Dentist, an expanding practice on North End Road, is about to "overperform" on its contract - so there will be no more public money available to treat further patients until the new financial year.
The practice was set up eight years ago by Henrik Overgaard-Nielsen, a dentist who qualified in Denmark, and Sharon Bierer, his British-born wife. Their mission was to treat only NHS patients. Few in the profession thought they could survive on the health service's modest fee scales, but the business prospered and expanded as word spread about the quality of service.
About 600 new patients arrive through its doors every month, ranging from City gents to refugees recently come to Britain. They are treated by members of a 32-strong team, including 11 dentists, three hygienists and a back-up staff of nurses and administrators. Between them, they speak 20 languages. They have a good-practice award from the British Dental Association and have Investors in People status.
But this model of what NHS dentistry should be offering has been thrown off balance by a new contract that the Department of Health imposed on the profession last year. With good intentions, ministers decided that dentists should be commissioned to carry out an agreed quota of work over the course of a year, measured in units of dental activity (UDAs). The aim was to reward the profession for doing more preventive work, improving patients' oral hygiene instead of providing a financial incentive to do little more than drill and fill.
For an expanding practice such as NHS Dentist in Fulham, the quota has turned into a nightmare. Overgaard-Nielsen and Bierer signed their UDA quota under duress, knowing it to be insufficient to cover local demand. They refused on principle to ration their services by turning away patients who walked through the door asking for treatment. The practice is now about to complete its quota and cannot expect further payments from Hammersmith and Fulham primary care trust until April.
Bierer was outraged by a letter to the Guardian (February 10) from Rosie Winterton, the minister responsible for dentistry, who said that a small minority of dentists were complaining about delivering the quota early. "This is odd, given that their contracts were based on the amount of work they had carried out during the previous year," she said. "It appears they may be speeding through their work, rather than spending time to offer patients a better, more preventive service."
Bierer said Winterton compounded this slur on her practice's professionalism with an untruth. The minister claimed that patients would not be refused dental treatment because of a cash crisis in the NHS, but Hammersmith and Fulham PCT is pleading shortage of cash as one of the reasons for refusing the practice any additional quota.
Like many others, the PCT is heading to overspend its dental budget due to a mistake at the Department of Health. More treatment than expected is being provided to poorer patients who are exempt from charges, and there is a big shortfall in income from charges. The PCT might have offered over-performing practices some of the quota of under-performers, but now it cannot afford to do so. Any savings from under-performance will have to be used to reduce the dental deficit.
The Fulham dentists meet today to work out what to do when NHS revenues dry up. What a shame it is that their public spiritedness is being tested to the limit in a part of the health service that appears to know little about the value of patient choice.
· John Carvel is the Guardian's social affairs editor
