In April 2006 the Labour Government finally “imposed” the New Dental Contract on the Dental Profession. The Contract had been “promised” on three separate occasions and was originally meant to be implemented just before the General Election of 2005. I believe the reason for holding the new Contract back for so long is obvious: National Health Service (NHS) dentistry is now not only unavailable, but ordinary treatments - for example a simple filling, now costs the patient nearly 300% more. The New Dental Contract is not a good vote catcher!

At the Labour Party Conference in l999, Tony Blair made his now infamous pledge: “everyone will have access to a NHS dentist within 2 years". Eight months later this pledge was reaffirmed with Government announcing that it “was firmly committed to making high quality NHS dentistry available to all who want it by September 2001". In 2006 this promise is now 5 years old and still has not come to fruition.

Since l997, the proportion of the population registered with a NHS dentist has fallen by more than 2 million. Recently released figures show that in some areas (for example Burnley and Coventry), the number of patients registered with a NHS dentist between 1997 and 2005 has in fact fallen by between 53-60%.

I believe dentistry has consistently missed out on the funding increases, which other sectors of the NHS have enjoyed. For example, in l992 dentistry's share of the overall budget was 5 percent whilst now in 2006, the British Dental Association say this figure is reduced to a mere 3 percent. So what have the Labour Government done to improve the situation? Has Tony Blair's “pledge” been honoured or is it just another broken Labour Government promise?

Many dentists see the new NHS Contract as unworkable in the long term and, more to the point, they see the Contract as unfair. The extra funding promised by Government has not been forthcoming and Dentists believe that Government have failed to establish a Contract that makes it worthwhile for the majority of dentists to offer NHS dentistry. Dentists en masse think that the Contract is “target driven” and that Contracts are based on yearly figures grossed up in October 2005 (base year): in other words, the figures are out of date. Thereby, not only are the targets now set unreasonable, but penalties apply if these targets are not met something of a cleft stick situation is this not? Add to this the fact that there is actually no incentive offered to meet NHS criteria, and one can see that the new Dental Contract has many flaws.

The “problems” with the new Contract leave dentists like myself feeling that the new NHS Contract is doomed to failure. Government has actually imposed its will upon the dental fraternity, and many new Contracts are signed “in dispute". The new Contract is, to put it mildly, very unpopular!

So, what are the major constraints with the New Dental Contract? As well as the points raised earlier, a criteria is in operation for the setting up of a dental practice. It is not simply a case of finding premises and securing the funding for the necessary equipment. Dentists are now required to make application to the local Primary Care Trust in order to fund a practice and, as previously noted, there is little growth funding within the dental arena, so often these applications end with a refusal. And, if one is persistent and does indeed succeed in opening a practice, increased patient fees for treatment produce a disincentive. A small filling once cost the patient as little as £5 whereas today, this same treatment can be as much as £42. Is it any wonder that care of the nations teeth is now polarised between those who can afford and those who cannot? I, and others like me, believe that Government needs to promote oral health and prevention, and that this service should be funded by Government. Such primary dental care should be provided within a NHS funded scheme.

The new pricing structures have been variously condemned by the British Dental Association as a “revenue raising exercise contrary to the founding principles of the NHS". But, even so, this Government has done nothing to stem the rise in patient dental charges, some of which are up by a massive 35 percent. Where now the New Labour mantra “Things can only get better?"

There will be no more funds for dentistry within local NHS Primary Care Trusts till after April 2009. And, after this date all monies will form part of a general Primary Care Trust budget. This being the case, it would seem highly unlikely that dentistry will feature as a frontrunner to say maternity care in the race for diminishing funds. The major concern for dentists like myself is that if no further funding is received from Central Government specifically for dentistry, then those few practices that are seeing NHS patients will become completely “grid-logged", then where will patients turn?

The NHS is failing patients in the area of dentistry. It is a well known fact that graduates leaving dental school now are looking to work in private practice rather than within the NHS system. If one hopes for a good HNS dental system, then that system needs to encourage such graduates to want to work within it. The system needs to reinstate the concept of registration a consensual relationship between patient and dental practitioner a concept which has never been strong in dentistry. I for one consider that it is a missed opportunity not to foster an ongoing dentist-patient relationship and I fully support the view of another contributor to this site: “we need to see a radical rethink in the way dentistry is funded and charged in the United Kingdom".