Report calls for dentistry shake-up

19 Sep 02
NHS dentistry must be overhauled as it wastes £158m each year and fails to serve those who need it most, the Audit Commission said this week.

20 September 2002

In a report, the commission also questions whether the government has met the prime minister's pledge that by October 2001 every patient would be able to find a health service dentist by ringing NHS Direct. The watchdog said this depended on whether he was referring to access to emergency care, which has improved, or continuing care, which has worsened.

Primary dental care services in England and Wales said the current 'piecework' system of payment squandered at least £150m in England and £8m in Wales on over-frequent examinations, cosmetic treatments and interventions that have no proven worth.

The Commission said extending the time between check-ups for those people with the most healthy teeth could save £79m in England and nearly £4.5m in Wales. Improvements in oral hygiene mean that most adults need visit their dentist only every two to three years but the current system creates an incentive to have more frequent check-ups.

Patients who have a check-up every two years may find themselves removed from their dentist's register – dentists can do this if patients have not visited for 15 months – and the practice will only accept them back on a private, fee-paying basis.

The report found that 40% of practices no longer accepted adults or children for continuing NHS care. Dentists were more likely to register children, although 2% would do so only if their parents were willing to pay privately. In deprived areas, dental health was worse and fewer people were registered with a dentist. In some localities children's decay levels are as bad as they were 15 years ago.

Last month, the Department of Health launched a four-year pilot to investigate new ways of paying dentists but the commission said patients needed change quickly.

Audit Commission controller Sir Andrew Foster said: 'Today's system does not provide the right incentives to ensure that the remaining pockets of poor health are tackled, or to provide equitable access. It needs to be changed, to become more flexible.'


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