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Ms Winterton: The way in which the contracts were calculated involved a reference period that ran from October 2004 to September 2005. During that time, the activity of the dentists was measured, along with the amount that they were paid during the period. The calculation should reflect those two figures, and produce the amount that the dentist would be offered, which would be guaranteed for three years. If a dentist has a problem with the calculation, they should pursue the dispute resolution procedure. However, the primary care trust might be able to identify the reason for the problem—the dentist might have taken on an associate during the year, for example. It is difficult for me to comment on individual cases, but there is a dispute resolution procedure to deal with problems with the amount in the contract.
Mr. James Gray (North Wiltshire) (Con): Is there not a problem for practices such as the Caledonia practice in my constituency, which is expanding fast and has taken on two dentists since the end of the base-line period last September, but is now having to lay off those dentists because it cannot afford to pay them, given the amount that it is being offered? Will the Minister also confirm that a PCT is required by law to use any funds made available through the closure of a dental practice for dentistry and for no other purpose?
Ms Winterton:
Yes, I will. The way in which the budgets have been given out is quite complicated, but I will try to explain it. During the reference period that I mentioned, an overall measurement was taken of the activity in a particular area. It is possible that, during that time, certain dentists might have worked for only half the year, because they had started up half-way through the reference period. Others might have closed during the period. The calculation took into account the
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balance between those that had opened and those that had closed, so that a dental practice that had opened half-way through the year would be able to use the money that had become available from one that had closed. So that would have added up. If, however, it did not add up in that way, extra money would be allocated, but it would not be able to meet every local circumstance. The instance that the hon. Gentleman has cited involves a dental practice expanding after the reference period. We had to have a cut-off point—[Hon. Members: "Why?"] Otherwise, it would not have been fair in terms of allocating the funds. The PCTs wanted to know the size of their budgets. We had that reference period so that we could make that calculation. On top of that I should say that £65 million has gone out to PCTs to ensure that there can be expansion. That is the difficulty that the hon. Gentleman might be facing. However, I should also say in relation to 31 March that the PCT will retain all its money locally. If there are dentists who decide that they do not want to stay with the NHS, the PCT will have the absolute right to go back to dentists such as those the hon. Gentleman has mentioned to say, "This is how we can replace the NHS dentistry that may have been lost." I am sorry if that is a rather long and complicated explanation, but that is basically how things work.
Ms Winterton: May I move on? I am conscious that we are getting towards the time when Back-Bench Members will want to contribute.
Today's debate has shown that concerns have been voiced by some dentists about the changes, but that is not altogether surprising, because they are quite radical. New ways of working have proved popular in the personal dental services pilots, which cover some 30 per cent. of dentists.
To return to a point made by the hon. Member for South Cambridgeshire about a system of payment per head for those registered, we considered that suggestion during the piloting and found a lot of problems, not least because in some areas the number of treatments carried out fell by about 50 per cent., but without an equivalent increase in the number of people seen. Such a system also has a bias towards people with good oral health who would be taken on under it.
I quite understand why the hon. Gentleman is making that suggestion and I am more than happy to send him the data—[Interruption.] If he wants to intervene, I am perfectly happy to give way.
Mr. Lansley: The National Audit Office report was very clear. Yes, there was a reduction in the number of treatments, because the drill-and-fill system had an incentive to overtreat. Of course the number of treatments reduced. We have to measure outcomes—that is what we should be doing—and the NAO was clear about the fact that the 10 per cent. reduction in treatments, on average, was none the less associated with no deterioration in the oral health of people on those patient lists.
Ms Winterton:
But that is not the point about the system that the hon. Gentleman is suggesting. He is
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suggesting that each dentist be paid per patient. The difficulty with that, as I have said, is that we tried it in the pilot schemes and it effectively contained a bias towards taking on people with good oral health as opposed to those with a variety of types of oral health. I am perfectly happy to send him the data from those pilots so that he can look at them. All I am saying is that I can assure him that we considered and piloted that suggestion, but the evidence that came back suggested that it is not the right system.
Ms Winterton: I give way to the right hon. Member for Wokingham (Mr. Redwood).
Mr. John Redwood (Wokingham) (Con): Can the Minister explain why we do not have enough NHS dentists? Is it something to do with the extremely elaborate remuneration method, which seems to be freezing the system in aspic when we need a dynamic system that allows growth for new dentists?
Ms Winterton: That is quite astonishing, coming from the right hon. Gentleman. We have a lot of these problems—this is very well recognised—because of the contract changes and fee cuts made in the 1990s, as well as the closure of two dental schools. We are turning round the system that we inherited and introducing some changes.
Ms Winterton: I shall move on, because I want to make some remarks that I hope will help the House.
As I have said, I know that, for some dentists, the changes are a fundamental shift from the traditional way of working. Understandably, they are quite nervous about that, so I have decided to set up an implementation group with representation from the profession, patients and the NHS to review the impact of the reforms and ensure that they are delivering their intended benefits, for patients and for dentists. I have invited representatives from the British Dental Association to join the group, and I hope that that is a way to reassure dentists that we are looking closely at the implementation of the reforms and ensuring that if any adjustments need to be made, they can be.
Mr. David Drew (Stroud) (Lab/Co-op): Will my hon. Friend include orthodontists in the group? As has been mentioned, there seem to be specific problems with how the lists will be compiled for orthodontists. It is only fair that those valuable servants be included.
Ms Winterton:
I will certainly consider the point my hon. Friend raises, particularly perhaps with reference to the British Orthodontic Society, which we have been in discussions with recently. He is right to say that there have been problems with orthodontics, because obviously such services are offered over a number of years. If new practices have been set up, which we have been able to do because of the increased investment that we have put in, they might have had a short contract value during the reference period. Recently, we have again issued guidance to PCTs including principles such
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as current treatment having to be completed. They need to look at orthodontic requirements locally and ensure that there is proper commissioning. I acknowledge that this has been a problem, but we have tried to clarify it.
Ms Winterton: If I may, I shall move on, because it is important to say that we will not know until the end of this month precisely how many dentists are taking up the new contracts. However, the current view from PCTs is that the vast majority of contracts will be signed by 31 March.
I should stress that, in the minority of cases where dentists choose not to take up the new contracts, the NHS will use the same funding to commission replacement services from other dentists. I am extremely confident that the NHS will generally be able to bring in new capacity very quickly. In the small number of cases where people say that they no longer want to remain with the NHS, we are finding that other dentists are coming forward to say that they want to expand their NHS provision.
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