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Julia Goldsworthy (Falmouth and Camborne) (LD): D-day for NHS dental patients is rapidly approaching. The new financial year will bring many changes to dentistry—a new contract, new charges, and a new way of measuring dental activity—but the key question is, are patients really aware of the bombshell that could drop on them in the new financial year? For them, D-day will be deregistration day. On 1 April NHS dentists will be subject to the new contract, but how many dentists will decide that because of it, the NHS is no longer for them? How many patients will find themselves deregistered, with a choice between paying for the same dentist and taking a gamble, and trying to find another NHS dentist with vacancies on his list? Has the Minister or her Department made any estimate of the number of dentists who will refuse to sign a contract that the British Dental Association has called, among other things, "a shambles", given that yesterday was the last day on which NHS dentists could sign and guarantee payment on time?
How many dentists does the Minister estimate will not have signed the new contract by the deadline at the end of this month? How many does she believe will sign the contract, but at the same time formally enter into
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dispute proceedings? The Minister talks of "the vast majority", but a more specific figure would be appreciated.
In addition to their initial contract agreement, 75 per cent. of dentists in the constituency of my hon. Friend the Member for Birmingham, Yardley (John Hemming) have signed a letter stating:
"We wish to clarify that the figures referred to in that memorandum are not accepted as being a definitive correct representation of our earnings . . . in relation to the provision of NHS dental care . . . and that they represent only a provisional representation of our earnings and activity. For the avoidance of doubt, we reserve our right to initiate the statutory dispute procedures in respect of either the figures provided, or the basis on which those figures have been calculated."
How many dentists does the Minister estimate will enter into dispute proceedings at the same time as signing the initial agreement?
Paul Rowen : Is my hon. Friend aware that in Heywood and Middleton, the constituency next to mine, every dental practice is refusing to sign the contract? That will leave Heywood and Middleton with no NHS dentists, which is already virtually the case in Rochdale.
Julia Goldsworthy: The position is similar in many parts of the country.
Linda Gilroy : The hon. Lady represents an area with some of the lowest wages in the United Kingdom. Does she not think her constituents will find it a little strange that she appears to support the position of people who consider £80,000 a year to be an income not worth working very hard for?
Julia Goldsworthy: I am sure that patients of NHS dentists will be more interested in the fact that the cost of check-ups and band 2 treatments will increase, and the fact that they may not be able to find an NHS dentist at all.
For 9,000 patients in my constituency, D-day—deregistration day—has already arrived. Last week, one of the biggest NHS dental surgeries in the constituency announced that its 9,000 adult NHS patients would either have to go elsewhere for NHS treatment, or have one week in which to decide whether to sign up for a direct debit plan and private treatment.
Mr. Redwood : Will the hon. Lady tell us what is the Liberal Democrat plan for recruiting more dentists, and how much it would cost?
Julia Goldsworthy: We would of course continue to negotiate the contract, which the British Dental Association has clearly rejected but which the Government seem to be pushing relentlessly, although it appears that many dentists will not sign it. According to the Minister, the vast majority may be signing. That could mean thousands of patients per dentist being denied access to NHS treatment.
The dental surgery that I mentioned has three dentists. They gave their reasons for withdrawing from the NHS, which were very specific. They said that
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"a new NHS system is being proposed by the government and we have been unable to negotiate terms that we feel are in the best interests of our adult patients. We will therefore not be able to treat patients in the NHS from 1 April 2006."
My constituents who are affected are understandably shocked, and do not know what to do next. I have been inundated with correspondence from them, asking what they should do. For many, the choices are stark. One wrote:
"We are shocked that we had no previous knowledge and had not been consulted about this closure, and we are being forced into signing up within a week to a costly private scheme or losing all further treatment".
Those people do not feel that there will suddenly be a magic alternative.
Mr. Martlew : Will the hon. Lady condemn the dentists who have caused so much suffering to her constituents?
Julia Goldsworthy: Many of the dentists to whom I have spoken feel that they cannot offer their patients the level of service that they deserve under the current contract.
All over the country, as other Members have said, thousands of NHS patients are hearing similar bad news. Many of them do not realise that the Government's policy is creating the problem, at a time when NHS dentistry is already in crisis. Another of my constituents wrote:
"We do not know about the new government proposals mentioned in their letter that they are using as an excuse".
They clearly have not had time to read the new leaflet explaining the changes.
Ultimately, however, the patients do not care what is causing the problem. They may not know that dentistry's woes started with the Conservative Government's creation of the drill-and-fill treadmill, and the closure of two dental schools. They may not know that the breakdown in negotiations over the new contract has proved to be the final straw for many dentists. All they know is that they face losing their NHS provision, and it is not clear how they will find an affordable alternative.
Alison Seabeck (Plymouth, Devonport) (Lab): Will the hon. Lady at least acknowledge that the new dental school that is coming to Plymouth will provide new dentists not only in Plymouth but in the wider south-west, including Cornwall?
Julia Goldsworthy: In five years' time, once it is up and running, the dental school will provide new dentists, but there is no guarantee that they will enter the NHS. Moreover, if the current funding is based on levels of activity, there will be no vacancies for them in Cornwall even if they want to enter the NHS.
Linda Gilroy: Will the hon. Lady give way?
Julia Goldsworthy:
I am afraid I must make some progress.
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Yet another horde of dentists look set to abandon the NHS, as they did in the early 1990s. The only difference is that a different political party is in power. The new contract does not mean more dentists for the NHS. Primary care trusts may have access to funds for alternative NHS dental surgery provision when existing dentists leave the NHS, but how does the Minister estimate that PCTs will be able to recruit enough dentists to fill the vacancies? In Cornwall 9,000 patients are being deregistered, while 14,000 are being deregistered in Cheltenham. How will those vacancies be filled? Where is the capacity for all the dentists who are so desperate to sign the new contract? Stockton-on-Tees already has eight vacancies. If more dentists refuse to sign the contract, the number of vacancies will increase.
The new contract does not automatically mean that more people will be treated in the NHS, because it is based on the existing number of dentists and their budgets. No assessment or investment has been made with a view to meeting previously unmet demand, and it is not clear how the Government will fulfil their 1999 pledge to give everyone access to an NHS dentist. That means that even in my constituency, which ought to benefit from a dental school, more cannot be spent on a net increase in the number of dentists or in NHS provision unless the Government are prepared to ensure that extra funds are available, and unless more dentists feel that the NHS offers a contract that is attractive to them.
There are plenty of new circumstances, but there is no improvement in the current dire situation. Millions of people are not registered with a dentist at all, and three quarters of those who are not registered with an NHS dentist say that they wish they were. Demand continues to outstrip supply by a significant amount, and the new contract will not change that fundamentally. The contract will also fail to provide patients who are lucky enough to receive treatment with better standards of treatment, and a stronger focus on preventive work.
The personal dental services pilot was popular because it allowed dentists to spend more time with their patients, and to focus on preventive advice as much as on treatment. It ended the drill-and-fill treadmill. Most of the dentists who are refusing to sign the new contract took part in the pilot, although it has been much vaunted as a reason for the contract. They feel that flexibility has been lost in the new general dental services contract because a new treadmill has been introduced: units of dental activity. It is another target-driven system that does not appear to be well understood on the ground either by dentists or primary care trusts, and it is essentially untested. It was not in the initial pilot.
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