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Mr. Ian Austin: Is my hon. Friend as surprised as I am by the failure of the hon. Member for Northavon (Steve Webb) to tell us how many dentists the Liberal Democrats would employ, how many patients they would register, how much any of that would cost and how it would be paid for? Was that not the same menu without pricesthe same list of uncosted commitmentswith which the hon. Gentleman and his party always present us, and did it not provide further evidence of why no one will take anything that they say about this subject seriously?
Ms Winterton: My hon. Friend is right. As usual, the Liberal Democrats are quick to jump on the bandwagon but not so quick to come up with a solution. Perhaps they are following a new trend in making uncosted spending commitments. Their new habit is not having a policy at all. We were astonished by the so-called alternative programme that they presented to us.
There is no doubt that the drift of NHS dentists to the private sector has caused real problems in parts of the country. That is why in 2002, following wide consultation with the dental profession among others, we published the paper "Options for Change", which was implemented through the Health and Social Care Act 2003. I will explain how those measures will fundamentally reform and modernise our dentistry system.
Mr. Russell Brown: My hon. Friend speaks of the drift to the private sector. I believe that there is more to it than that. In my area, Dumfries and Galloway NHS trust has employed salaried dentists. When they arrive in local communities, local NHS dentists move to the private sector. That development involves economics and the marketplace, and a strong dislike of salaried dentists who arrive on the scene to treat NHS patients only. The local dentists do not like the competition.
That is an interesting point. I hope that I shall be able to explain what we are doing to make the NHS more attractive to dentists. I hope that many
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dentists who have received five years of detailed training at the taxpayer's expense will feel that a commitment to the NHS should come at the end of that. I hope that they will not see salaried dentists as a threat and move to the private sector, because we are trying to build an NHS dentistry system that serves all our people.
Mr. Mark Todd (South Derbyshire) (Lab): Is it not worrying that where the NHS has provided capital funds to establish a new NHS practice, as it did in Swadlincote in 2002, three years later the practice should choose to go private and retain only its core NHS commitment despite substantial public funding? That is certainly of concern to my constituents. Does my hon. Friend share their concern?
Ms Winterton: My hon. Friend is right. I looked into that when a number of Members brought it to my attention. If an NHS dentist leaves the NHS completely rather than merely reducing the number of NHS patients, the primary care trust can reclaim some of the grant. It is important for the PCT to be able to do that. However, I think that our tightening of the arrangements will prevent the same thing from happening in future.
Mr. Mark Francois (Rayleigh) (Con): I realise that the debate is mostly about dentistry, but it is also about primary care. Perhaps I could briefly bridge to that. In my constituency, I have campaigned for several years for expansion of the small health clinic in the town of Southwood and Ferris. Maldon and South Chelmsford primary care trust is reviewing the possibility of expansion, but as yet there is no firm plan. May I write to the Minister next week with the full background to the proposal? I hope that the campaign can be brought to fruition, because it is very important to my constituents.
Ms Winterton: Of course the hon. Gentleman can write to me next week. I am sure that he is discussing the matter with the PCT, because he knows that that is where the decisions will be made, but he is more than welcome to write to me.
I was talking about the changes that resulted from "Options for Change" and the Health and Social Care Act. They have three key elements. First, funding and commissioning responsibility will be devolved to PCTs so that they can plan local dental provision. A problem often cited by Members is that, if an NHS dentist, under the current contract, decides to leave the NHS, the local PCT has no funds to fill the gap, so to speak. The money returns to the centre and is redistributed if another NHS dentist comes in. That is not a satisfactory arrangement. The key element of our proposals is to devolve that funding and decision making, so that local PCTs have the responsibility and the funding to plan properly for NHS dentistry.
Let me deal with the second element, which is the introduction of a new contract for dentists, so that, rather than being paid for each individual
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treatmentwe have discussed the drill-and-fill treadmilldentists are paid for looking after individual patients, with a particular emphasis on preventive oral health advice. Thirdly, we gave a commitment to simplifying the system of patient charges, to reducing bureaucracy for dentistsanother of their key complaintsand to increasing transparency for patients.
Mr. Borrow: NHS dentists need give no notice at all to PCTs before they go private. The PCT in my constituency, for exampleit is responsible for NHS care in my areawas given no notice that the dental practice in Longton intended to go private and, as a result, had no time to prepare an alternative strategy. Surely there should be some mechanism that forces NHS dentists to give at least a minimum period of notice if they are going into the private sector, in order to allow PCTs to plan properly and to bring in alternative dentists.
Ms Winterton: I agree and, in fact, such dentists should give approximately three months' notice to the PCT, but in practice some avoid doing so, which makes it very difficult for the PCT to plan, as my hon. Friend says. The new contract and the new way of commissioning will ease that problem. Dental leads in PCTs have been discussing with dentists their commitment to the NHS and their future plans. That has eased the situation because, as a result, they have been able to secure more notice from dentists who are thinking of leaving.
We recognise that, in certain parts of the country, access is an increasing problem. That is why we announced in 2003 the establishment of the NHS support team, which works with specific PCTs, and backed that up with £9 million-worth of additional funding. In 2004, a further £50 million was allocated to strategic health authorities to help address access problems.
Malcolm Bruce: I am grateful to the Minister; I recognise that I am being persistent. Does she accept that getting the right contract is likely to be the key solution to the problem if we are to avoid having a two-tier dental service in the long term? Just after the election, a dental practice in the town of Inverurie sent letters out on the Friday, stating that patients could queue on the Monday to sign up for a private plan. Some 700 people queued all day to sign up because there was no alternative. We must ensure that we bring these dentists back into the NHS or we will finish up with no NHS dental service at all.
The hon. Gentleman is right and we should also bear in mind the point that the hon. Member
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for Northavon made about queuing. We have made it absolutely clear to PCTs that where new NHS dentists are opening, it is important to manage the situation properly. There is no reason why lists should not be kept of people who are waiting to gain access to an NHS dentist. We have made it very clear to PCTs that we expect them to put in place systems that prevent people from being put through the indignity of queuing. Obviously, that point does not apply in this case, as the hon. Member for Gordon is talking about a dentist who gave just three days' notice that he was quitting. He will doubtless take up that issue with Scottish Ministers.
In July 2004, the then Secretary of State announced that we intended to recruit the equivalent of an additional 1,000 dentists by October 2005, through a mixture of attracting back NHS dentists and international recruitment. We also said that we would train another 170 dentists per year, starting from this October, supported by additional investment of £80 million. We announced that we would increase funding for dentistry by 19.3 per cent.an extra £250 millionfrom April 2005, and that we would encourage dentists who wished to do so to move to new ways of working under the personal dental services pilot schemes.
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