Sir, The current shortage of NHS dentists is a simple case of supply and demand (report, Feb 10). Dentistry is a skilled profession; dentists have to train for nearly as long as GPs, are subject to most of the same pressures and yet they can expect to earn far less. As a consequence, many have turned, in full or in part, to private practice, for which they are branded “greedy”.
The new contract for dentists is typically new Labour: though well-intentioned, it is overly bureaucratic, disastrously executed, subject to egregious spin and fails to address the core issues. Most NHS dentists will not earn £80,000 per year; the cost of NHS dental care to patients for many short courses of treatment will actually increase, and dentists are justifiably concerned that the unit of dental activity scheme appears not to accurately reflect the time taken to administer complex treatments.
Furthermore, the Government’s confrontational approach to implementing the contract has alienated many loyal NHS dentists and persuaded them that the Government’s real ambition is to force all dentists into private practice. If the Government were truly committed to high-quality NHS dentistry, it would work with dentists; instead it is forcing a badly designed contract on them while artificially depressing demand by reducing the frequency with which patients can see their dentists on the NHS.
MARTIN WILLCOX
Sheffield
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Sir, Dentists carrying out NHS treatment are not currently paid a salary and will not be paid a salary under the new contract. They continue to fund their own businesses and are self-employed.
You report that Ms Winterton wishes to “save NHS dentistry”, and that “the Government wants to reform the way in which dentists are paid”. You also report that dentists “will be asked to take on more NHS patients in return for an £80,000 salary, £80,000 in expenses.” Some dentists may be offered a gross value contract of £160,000 out of which they must fund their premises, their equipment and pay their staff. Many are offered less. Personal income is the residual value after these expenses. There is no guaranteed personal salary. Most dentists will have business expenses that far exceed the £80,000 quoted by the Government.
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ANDREW LEE
Leamington Spa, Warks
Sir, Dentistry has received (after inflation) just 9 per cent extra in 15 years — doctors and the rest of the NHS, 75 per cent (National Audit Office). Average earnings for private and NHS dentists differ by only £500 (Inland Revenue).
Your figures on “piecework” earnings on the NHS may be correct but you have to see and treat 40-50 patients per day to achieve it. This is not good for the dentists, their quality of work or for the patients’ safety because disinfection time in between is sacrificed (remember, everything we do is invasive).
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Three “points” can be “earned” from one filling or ten, or from root fillings which can take over an hour of clinical time or from one extraction. Which is the most likely? Comprehensive treatment for the most disadvantaged will become impossible to obtain.
The days when dentists had to “work like dogs and treat their patients like cattle” should be long gone.
DR PAUL FITTON
Nottingham
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Sir, It is hypocritical of the British Dental Association to declare that the new NHS contract does not allow enough time for preventative work.
Previously the NHS piece-rate system of dental payments spawned the “drill and fill” era in which many unscrupulous dentists were unnecessarily drilling and filling, usually with toxic mercury amalgam, the mouths of children who now as adults require restorative dentistry at much personal cost.
One wonders whether advice on the prevention of tooth decay and gum disease was also given to such patients during the previous era.
PHILIP L. J. BARTON
Exeter