The dental service was set up after the last world war. Its primary aim was to stop the enormous amount of dental caries (decay) prevalent at the time. The population had of course been through many years of poverty and under nourishment and teeth had become an expendable entity. Dental disease was something people lived with. Dental abscess and its associate problems were common place and a set of dentures was something people looked forward to for their 21st Birthday. In effect, teeth were seen as trouble; one waited until they decayed and then had them pulled out.

Bevans new National Health Service (NHS) set out to train dentists and then aid them to start dental practices of their own (to lessen the burden on NHS hospital dentistry). The Government undertook to pay a set fee for every repair performed on the nation’s teeth. The harder a dentist worked, the more patients he saw, the more fees he earned and, the healthier the nation’s teeth became. Government paid for most ordinary procedures in response to a claim by the dentist. More complex procedures required more paper motivation by the dentist, but were invariably agreed to by Government if the dentist felt they were needed. There existed a mutual care for and of patients between the dental practitioner and the Governments NHS. The NHS tasked the Dental service with the same goals as that of other health service providers and the aim was to enhance the health of patients.

But like all medicine, dentistry and the profile of disease has changed along with the generations. The repair orientated dentistry of yesteryear has been replaced by something akin to an aesthetic dentistry. Generally, today’s older generation have more of their own teeth than did their parents, and they want to keep them for longer. Today’s younger generation have far less decay, expect to keep their teeth for life and are prepared to undergo complex procedures to make their smile an important part of their self-image and confidence. So the parameters of dental care must be defined in terms of a reasonable standard. A healthy mouth is not just a commodity; it is a measure of commitment by Government to the health needs of the nation.

But these issues are complex and are often clouded in emotion. Patients are more and more required to pay something for every procedure performed, even the ordinary repair filling. Dentists find themselves more and more unable to treat enough patients to earn a living wage, spending more and more of their time filling out Government forms. The cost of dental treatment is fast returning to the domain of the few and the nations teeth are suffering. Government urgently needs to assess the dental service and make decisions on certain basis issues.

The old Dental Service had a very successful and proven delivery of adequate care and one does not have to remove it all (as seems to be the requirement from Government at present); one merely needs to modify some of its inherent parts. If as one is told, there is a large contingency fund available, why not utilise this to adequately fund the old national system, with modification where needed.

With this in mind, in this writer’s opinion, the new Dental Contract needs to provide for basic oral health education, diagnosis and pain relief and this should be readily available and adequately state funded to ensure the control of disease. There needs to be an even level of care for the young which does not depend on the ability to pay - perhaps this would have to be means tested on the basis of parental tax code or banding. Adult treatment is more complex and needs to be re-assessed in terms of inclusion into the service, but routine fillings, root canal therapy and scaling should surely be available to all. Such base level treatment should receive adequate funding to make the system viable for dental professionals. More advanced treatments may not be available on a system that is limited and one must admit these limitations in terms of the more aesthetic requirements in dentistry today. But if one accepts the above as fair and reasonable then specific cover for specific treatments needs to be agreed. More complex treatments might be covered by a topping up State/NHS payment or from some form of private add on scheme. If the dental service is to deliver both volume and quality, then it should be allowed to be sensitive to market forces.

Likewise, viability should be allowed to have an effect on local contracting in dentistry. If market force, rather than Government rationale is utilised, there would be room for local variation and at the same time this would maintain the efficiency of a nationally negotiated deal. In this respect it is common knowledge that separate practice negotiations are costly, both in time and staff, and local Primary Care Trusts (PTCs) spend far too much time in non-productive meetings which result in less time treating patients.

Government seems ill informed in their dealings with both the problem at hand and the major concerns of dentists. The writer himself has spent more than two years researching the new Dental Contract and the major players appear to have more concern with control of the system and financing, than with patient care. This situation ignores many very real problems, for example the shortage of dentists and the costs of actually setting up a dental business. And Ministers brush over the point that at present a fee of 7.00 is available to cover the dentist, the building, the reception, the telephone, the nurse, the paper work, health and safety requirements, electricity and insurance per patient. To put it mildly, one would have to be very optimistic to think that such fees would help to convince a new student that their career lies in dentistry.

As a practising dentist I am worried. I see and hear nothing from this Government regarding policy, which will improve availability of dental care to all patients, either in affordability for the patient, or fair payment for the dental operative. And I fail to see any logic in introducing a fee per item for dental service and at the same time retaining the old global sum system for the General Dental Practice (GDP). Once again New Labour uphold their preference of change for change sake!