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Mr. Lansley: Would the Minister like to tell us whether this alternative commissioning will be like the dental access centres? The average cost per patient episode, according to the Government's own figures, is £141 compared with £41 for high street dentists.
Ms Winterton: I am not sure that the hon. Gentleman has quite understood exactly how the new commissioning will take place. If a dentist chooses to leave the NHS, that money can be used by the PCT to provide what it feels is appropriate in the local area. If it feels it is appropriate to have a dental access centre, it can have one. However, it is more likely to want to commission dentistry from the existing dentists in the area.
Ann Winterton: I rather suspect that the name has something to do with the Minister's giving way. Will she estimate the number of new dentists who will be appointed? How many of those will be directly employed by the NHS and not work for traditional NHS practices? As my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) said a moment ago, the cost of providing treatment in that way is about twice the normal cost at present.
May I explain? Most dentists are independent contractors anyway. They are paid by the NHS. Some have greater commitments to the NHS than others, but there are no private NHS dentists, as it were. At the same time, some dental access centres often provide emergency treatment, which we would necessarily expect to be more expensive, and do not always charge fees as well.
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We would expect there to be a range of providers who might want to come in. It would be for the PCT to decide which kind of provider it wanted to use, whether a direct one, one through the salaried service, or an independent contractor in the normal way. As I have said, large numbers of NHS dentists are keen to expand their commitment. We know that, because that is what local PCT dental representatives have been telling us. Something like 1,000 overseas dentists are currently sitting the international qualifying examination, and a number of dental corporate bodies, which have a track record in areas such as the constituency of my hon. Friend the Member for Carlisle (Mr. Martlew) in Cumbria, have expressed an interest in establishing new practices, and are already taking up new NHS contracts.
Mr. Roger Gale (North Thanet) (Con): The East Kent Coastal primary care trust has repeated the Minister's mantra that money "saved" by dentists leaving the national health service will be used to buy other dentists. The fact is that those other dentists do not exist. Existing dentists' lists are already full and have a backlog. Dentists in east Kent are closing or leaving the NHS. There is a gap, and children in particular are waiting for dentists. Where will those dentists come from?
Ms Winterton: I think that I just explained what the PCT is entitled to do, and probably will do, if there are not dentists in the area. For example, dental corporate bodies are keen to establish NHS dentistry, making use of some of the 1,000 dentists currently sitting the international qualifying examination. The hon. Gentleman must recognise that the money remains at local level so that the PCT can commission dentistry. There is no reason why it would not be able to do so. It has happened in other parts of the country, and I am confident that it could happen in his area, too.
Ms Winterton: I have explained how budgets were to be spent. The budgets that will be devolved to PCTs next year are around £315 million more than in 200304. As I have said, all existing NHS dentists are guaranteed contract values based on their NHS earnings during the reference period.
Ms Winterton: First, I am afraid that the British Dental Association, among others, has persisted in alleging that the reforms do not promote preventive dentistry. That goes against the clear evidence from personal dental services pilots showing that abolishing the fee-per-item system enables dentists to carry out simpler courses of treatment, with far fewer interventions and far more time to focus on preventive care.
Secondly, the new system of patient charges has been based on the recommendations of a working group chaired by Harry Cayton, National Director for Patients and the Public, including representatives from the British Dental Association among other stakeholders. The working group unanimously recommended a system
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based on three simple charge bands. At present, there are more than 400 separate charges for different items of treatment. [Interruption.]
Mr. Lansley: I am grateful to the Minister. Will she therefore explain why the Cayton review recommended £11 for band 1, and she has £15.50; £27.50 for band 2, and she has £42.40; and £127.50 for band 3, and she has £189?
Ms Winterton: It is because the recommendations of the Cayton review on cost per band were meant to reflect the patient charges that would be raised during the time that it was producedaround January 2004, I think. Obviously, when we published it, we had to take into account the increased expenditure on NHS dentistry, and we wanted to raise the same amount in proportion in terms of NHS dentistry. The hon. Gentleman fails to mention over and over again that the maximum that can now be paid for NHS dentistry has been cut from £384 to £189, which particularly affects older and poorer people.
Steve McCabe: Surely there is something less than sincere about the position of the hon. Member for South Cambridgeshire (Mr. Lansley). He talks about his concern for NHS charges, but earlier today was happy to support unscrupulous dentists who are exploiting elderly, vulnerable people. Where is the consistency?
Ms Winterton: Consistency has not been a hallmark of the contribution from the hon. Member for South Cambridgeshire today. As I have said, the new system makes it much easier for patients to distinguish between what they are paying for under the NHS and what they are paying for privately.
I want to finish by reminding the House of the broader objectives to which the reforms are designed to contribute. We want to support further improvements in oral health and reduce inequalities in oral health. We want to promote high-quality dentistry throughout the NHS. We want to improve access to services for NHS patients. I agree that the full benefits will not arise immediately.
Mark Pritchard: Will the Minister confirm that her Department will allow primary care trusts the freedom to procure dental health services from anywhere in England if, for instance, my constituents were waiting an intolerable amount of time?
I want the hon. Gentleman's primary care trust to ensure that there is appropriate provision locally. We can help support primary care trusts by providing them with extra money, which we have done, and a contract worked out with dentists that reduces bureaucracy and allows better care for patients, which
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we have done; and through measures such as the international qualifying exam to ensure that NHS dentistry can be provided locally The improvements in access will rely in part on the growing use that primary care trusts make of their new flexibilities under local commissioning. They will also rely on dentists adapting to new ways of working, which free up time, as we have seen from the pilots, and increase capacity to enable a greater number of patients to be seen.
Mr. Hurd: A specific concern of dentists in my constituency is that devolved budgets appear to be ring-fenced for only three years. Hillingdon PCT is wrestling with a deficit of £25 million, and dentists are concerned that in time funds will simply be siphoned off from dentistry into other medical priorities. Does the Minister understand those concerns, and what reassurance can she give?
Ms Winterton: I am sure that the hon. Gentleman is pleased that there is ring-fencing for three years. Beyond that, I cannot predict or give guarantees. We have, however, ensured the ability to ring-fence, and introduced a duty on PCTs to provide dentistry to meet local needs. I hope that that is some reassurance.
I hope that right hon. and hon. Members will recognise the scale of what we have achieved, both in growing the dental work force and tackling some deep-rooted access problems. I hope that the House will welcome the reforms as providing a hugely more secure basis on which the NHS can build on improvements, working in partnership with patients and members of the dental profession. It would be irresponsible to halt the changes as the Opposition motion suggests. It would cause immense confusion to dentists, patients and the NHS, and take us right back to the bureaucratic drill-and-fill treadmill so disliked by the dental profession. The Opposition have offered no new ideas, only carping at the sidelines. I urge the House to reject their motion and to support the Government amendment.
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