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The Minister of State, Department of Health (Ms Rosie Winterton): I congratulate my hon. Friend the Member for City of Durham (Dr. Blackman-Woods) on securing the debate. The topic is not only important but timely. As we speak, general dental services dentists' individual contract values are being sent to them and details of the new system of charges for patients and the regulations governing the new GDS and personal dental services contracts will be released shortly. My hon. Friend pointed out that many dentists were waiting for some of that information before committing themselves. They will now be able to see exactly what the new contract means for them. I hope that that will address many of the issues that she raised.
My hon. Friend referred to the situation in Durham and I want to touch on some of the improvements that have been made there, bearing in mind that there are still some difficulties, as she pointed out. I want also to talk about how local commissioning will give all primary care trusts assistance in developing local dental services.
As my hon. Friend rightly said, there have been severe access problems. We have tried to address them through a variety of means, including domestic and international recruitment and the expansion of personal dental services. In Durham, the PCT took various steps to deal with the problems. It appointed two salaried dentists a year ago and expanded personal dental services. In Durham and Chester-le-Street, six of the 23 practicesabout 26 per cent.are in PDS, which is close to the national average of about 28 per cent.
Dr. Blackman-Woods: Will the Minister give some further clarification about the two dentists directly employed by the PCT? Only one of them is employed in City of Durham. The PCT had intended to employ two salaried dentists in my constituency, but for the reasons I gave earlier it was unable to do so.
The PDS practices have a combined contract value of £1.78 million, which includes growth funding of £558,000. That is new money, and it has been made available by the Department of Health to my hon. Friend's local PCT. As she said, there are problems, but those practices were treating almost 24,000 patients at the end of October. The roll-out of the new dental contracts will provide an opportunity for the PCT to look at the PDS agreements and make sure that the units of dental activity agreed with the practice reflect significant recent growth. May I emphasise the fact that the PDS contracts are pilots from which lessons have been learned? In the next few months, we will sit down with dentists to look at levels of activity under PDS contracts to see whether there is room for growth in certain areas. The PDS pilots, combined with the new guidelines from the National Institute for Health and Clinical Excellence, provide greater flexibility. For example, patients do not necessarily need to see their
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dentist every six monthsthe time between check-ups can be up to 24 months. The lesson of the PDS pilots is that there is flexibility and room for growth in certain areas. That is one of the benefits of the new system, and it gives PCTs local flexibility.
My hon. Friend's PCT received £65,000 from the £50 million that the Government made available to improve access last year. That sum funded 1,300 additional patient contracts across 10 local practices in the area. The PCT must await details of next year's budget before it makes further NHS dentistry commitments. However, I can assure my hon. Friend that those details will be released shortly, allowing the PCT and local dentists to look at the way in which local commissioning can be used for local investments. They can look at local priorities to ensure that dental services meet all local oral health needs.
Sir Paul Beresford (Mole Valley) (Con): I have a slight interest in our debate, although it is becoming slighter and slighter as I continue my parliamentary career. I hope that we can apply a little lateral thinking. At the moment, we look at the number of patients who are seen, contacts and so on. However, we have a mixed dental service, and patients can be treated on the national health service or privately. Dentists can offer different treatments for the same disease, but most of those treatments are available only outside the NHS. It is important that dentists remain with the NHS, because patients should have a choice as to whether they receive treatment on the NHS or privately. A treadmill system has been introducedI know that the Minister does not entirely agreeand I urge her to reconsider the proposals and provide flexibility so that more patients can approach more dentists for NHS treatment if they wish to receive it.
Ms Winterton: I contest the notion that this is another treadmill. It is important that, under the new system, dentists can continue to undertake a mix of private, public and NHS work. The new contracts will reflect the way in which they have previously worked. We expect dentists who have recently undertaken units of activity or interventions to make a reasonable commitment to the same level of activity with the same cohort of patients, although we accept that they may undertake a mixture of private and NHS work.
My hon. Friend is concerned about access problems caused by the fact that people outside the city are registered with local dentists. That has been the case for many years, and we have no plans to replace the system because doing so would require many people to find different dentists from those to whom they have become accustomed. It is true that the system is not based on residency, but changing it could affect continuity of care for existing patients.
My hon. Friend asked what would happen if dentists did not take up the new contract. The point of the changes that we are making is this: in the past, when a dentist has left the NHS the money has returned to the centre; now, the primary care trust will retain it locally. That money must be spent on NHS dentistry, which means that more dentists can be brought into the area if there is a shortage. It can be spent on salaried dental services if the PCT thinks that appropriate, although such services usually involve community dental access
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centres and the like. PCTs can also commission additional services from existing dentists. The money will be there to meet local needs.
As my hon. Friend said, in the longer term we are reversing the closure of two dental schools. The British Dental Association has spoken of the need to increase the number of dentists, and there is such a needalthough more dentists are registered, fewer of them work for the NHS.
My hon. Friend is right about what we hope to achieve with the new system. We have discussed with dentists the need to move away from the drill and fill treadmill and to introduce a much simpler charging system. I hope that that will result in a commitment to NHS dentistry. We want to rectify many of the problems that dentists say they have experienced with earlier contracts. Our recruitment of some 1,400 more dentists over the past year demonstrates that there are dentists out there who wish to work for the NHS, but we will continue the programme if some dentists do not want to join in our reforms.
Dr. Blackman-Woods: I am grateful to the Minister. Will she say a little more about why she and her Department are so confident that the dentists will be happy with the contract? The consultation in Durham revealed that no dentists were in favour of it.
Ms Winterton: Over the past few months, the acting chief dental officer has met a number of dentists who have been awaiting further information about the contract values and the regulations that will accompany the contract. I think that there has been a certain amount of misinformation about exactly what is expected. For instance, dentists thought that they would no longer be able to have children only or exempt only lists.
The aim of the regulations that we have submitted for consultation is to ban an unacceptable practice that has been raised by many Members in the House. Dentists were saying "We will treat your children if you will register as a private patient." It will be perfectly possible in future for PCTs to say to dentists "Yes, you can have a children only list." PCTs should be able to look at what is happening locally and say whether it is acceptable. We have tried to tackle a position that we considered unacceptable. Dentists thought that none of them would be able to have those lists under the new contract, which was not the case.
One of the other issues that came up was a feeling that dentists would no longer be able to do some private work and some NHS work. Again, that is not the case. They will be able to mix the two. We must be clear that
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we are offering a contract under which if NHS dentists give a reasonable commitment to the NHS, they will be able to earn about £80,000 a year, and up to another £60,000 can go towards the expenses of their practice. That is guaranteed for three years, for something like 5 per cent. less activity. We are anxious to ensure that if there is room for expansion, the units of dental activity would cover it. I do not think that that is an unfair deal. Nor do I think that it is bad that we are simplifying the system of patient charges.
My hon. Friend suggested that preventive care might not be possible, but the new system of banded charges specifically allows for preventive oral health advice. That is clearly covered as part of the treatment provided, which is exactly what dentists have been asking us to do.
My hon. Friend asked about the current provision of orthodontic services in Durham, which I accept is not ideal. The strategic health authority is looking into the matter and there has been a big increase in the number of orthodontic treatments over the past few years, although there is no doubt that there are problems in some areas.
Today, the Department has issued guidance on commissioning specialist services, with particular reference to orthodontics. There is clear guidance on determining need, on targeting resources and on how to use the new contract arrangements both for general dentist practitioners and dentists with specialist orthodontic expertise. We hope that that will go some way towards relieving the problem.
I hope that my hon. Friend will be assured that we are moving forward very quickly. I accept the fact that some of her local dentists may have been anxious to know the details of the new contract and what their own contract values were, but I hope that in the coming period we will be able to show them exactly what the benefits are.
I reiterate that this is all about making the charging system simpler and taking dentists off the drill and fill treadmill. I think that it is a good deal in return for a good commitment to the NHS, and will ensure that dentists can do preventive work. That is built into the contract and the charging system. It is guaranteed for three years and it replaces the 400 current charges and the way in which dentists have been paid for those, with fixed monthly income.
I feel that that is a good deal and it goes alongside the increases in training that we have already started and the fact that we will increase dental schools. Altogether, I hope that dentists in my hon. Friend's constituency, while recognising that there are still concerns, will be able to benefit from the changes, and that patients in her area will be able to benefit as well. It is a good deal, it will be good for patients and I think that it will put an end to some of the problems that my hon. Friend has experienced in her constituency.
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