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Mark Pritchard : The hon. Gentleman and I share a concern about animal welfare issues, and I want to make the serious point that, unfortunately, because of these changes, it is easier for my constituents' pet dogs to get dental treatment in Shropshire than it is for my constituents to get such treatment.
Mr. Martlew: I do not know about the situation in the hon. Gentleman's constituency, but the reality is that in most casesleaving aside the valuable work done by the Royal Society for the Prevention of Cruelty to Animalsthose of us who take our animals to the vet have to pay for such treatment. I presume that pets in the hon. Gentleman's constituency are not treated on the NHS; if they are, there should perhaps be an inquiry.
The dental practice to which I was referring offered the caveat whereby the children of patients who signed up and set up a direct debit would be treated for free. That is an absolute disgrace. Unfortunately, neither the hon. Member for South Cambridgeshire nor the hon. Member for Falmouth and Camborne (Julia Goldsworthy) condemned such practice; hopefully, they can put that right during the wind-ups.
Let us not be too concerned about dentists' earnings. Back Benchers are paid about £60,000 a year and most of us manage to live quite well on that. As the Minister said, an independent dentist with a good commitment to the NHSand who probably does a little private work as wellearns in excess of £80,000 a year and gets a further £60,000 toward practice costs. A dentist who works for the NHS, but not as an independent contractor, could expect, after two years, to earn more than a Back-Bench MPsome £65,000but with no practice costs. So dentists in my area, which is a low-wage area, are not badly paid.
Mrs. Nadine Dorries (Mid-Bedfordshire) (Con): The hon. Gentleman is very lucky that only four dentists in his constituency are refusing to take on NHS work. The NHS Direct website has a list of all the dentists in Bedfordshire and, as of today, 20 of those 41 dentists are refusing to accept any new NHS patients for treatment; of the remaining 21, only 11 will register children. So many of my constituents will be unable to find NHS treatment.
The hon. Lady is obviously a very good MP but I am sure that she does not represent all of Bedfordshire. To compare my constituency to Bedfordshire is to compare apples and pears, which is what the Conservatives usually do.
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Let us look at why dentists are saying that they want to leave the NHS. They say that they do not understand the new contract and that they are concerned about the loss of independence, but the reality is that they realise that it is a question of supply and demand. They realise that they can make more in the private sector, and that they can probably work less hard for that money. AlsoMembers have yet to pick up on this pointthey are being targeted by the insurance industry. They are being asked, "Don't you realise how much you could make if you use our particular plan?" Let us never forget that the insurance industry is the enemy of the NHS. Those who want to see where the big money in insurance is should go to America. We must treat with caution the private insurance companies working in this field.
The dental reforms are welcome. An extra £360 million or more is being spent on improving dental services, and when a dentist leaves the NHS, the primary care trust in question will retain the relevant funding. At this point, I should congratulate my local PCTOpposition Members have offered little thanks to PCTswhich has worked hard to ensure that people can access NHS dentistry. In particular, I congratulate the senior manager, Michael Smillie, on the tremendous work that he has done. Last week, we announced the provision of eight new dentists in Carlisle and Penrith. They will take on 20,000 patients and in doing so will probably clear the waiting list. Extra dentists will also be provided in Workington and WhitehavenI note that my hon. Friend the Member for Copeland (Mr. Reed) is in his placeso we are tackling the problem. It will not be solved in a day, and I am not saying that all dentists are happy with the contract, but the vast majority are working with it and people will see the difference.
The Minister has announced a new dental schoolshe kindly sent me a copy of the press releasefor north Lancashire and Cumbria. That brand new facility, to be located at the Cumberland infirmary, will add to the excellent work already being done by its education centre. In training new dentists, it will thereby make up the shortfall. Be it dentists or doctors, the view is that, where they are trained is where they stay, so in four or five years' time we will have new dentists in our region. That said, I have no problem with dentists coming over from, for example, other parts of Europe. Patients tend not to have big conversations with their dentist.
I congratulate the Minister on the points that she made about the contract and I am glad that she has decided to review it. The Conservatives failed dentists when they were last in power, and they have failed to cost their current proposals. I doubt whether the people of this country, even if they are concerned about dentistry, will turn to the Conservatives.
Sir Paul Beresford (Mole Valley) (Con): It is fairly well known that I have a slight interest in this subject. The Conservative Whips certainly know that, and they took the risk that I might not be entirely on message.
I want to congratulate the Minister on two things. First, she has managedalmost, if not entirely, on her ownto upset just about every NHS dentist in general
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practice in the country. Secondly, the implementation group that she has set up sounds really positive. It is a mark of recognition, finally, that there are problems with the contract. Those problems may have more to do with perception, but they need to be looked at.
Most general dental practitioners doing NHS dentistry or offering a mixture of NHS and private treatment want to continue to provide that service. Earlier, we got an inkling of the degree of willingness on the part of the Government in that respect, and that is what is needed to make progress. The hon. Member for Carlisle (Mr. Martlew) said that there were some sharp dentists out there, but that is true of every profession. However, they are a minority: most dentists are straightforward people who want to provide a mixed service because they have to face their patients, to whom it is virtually impossible to say no.
I want to dodge most of the complaints usually raised in a debate such as this, and concentrate on a slightly different matter. The hon. Member for Carlisle spoke about what happened 10, 20 or 30 years ago, but there has been a dramatic change in the quality of dentistry on offer in this country. The teaching that dentists receive is vastly better, as is the quality of the materials that are available. Dentists are able to do much more for patients, but even more dramatic are the changes in what patients now demand. The things that people ask for are more the province of private dentistry than the NHS, and that means that dentists must be able to offer choice. That is the burden of my contribution, and it is something that I hope that the Minister will reflect on.
In that connection, I want to touch on two mattersthe treadmill, and mixed provision. The Minister said that the treadmill had disappeared these days. Like everyone else, I expect that she will have received a letter from Dr. Adrian Kinnear-King, in Norfolk. In his very bitter letter, Dr. Kinnear-King says that he is a socialist, a long-standing member of the Labour party, and an NHS dentist. Although he seemed to be asking me for my personal help with the Labour party, I thought that I would telephone him anyway.
Dr. Kinnear-King has not signed his contract so far. In fact, he has not received one yet, but he has looked at some of its contents. He may decide not to sign it at all, but he says that there is no real treadmill under the present system. If he wants a break, he can take one, and he can also work a bit harder if that is what he wants to do. However, the introduction of targets that he has to meet means that he will get a phone call from the local PCT if he falls behind. He does not like the new contractual treadmill, or the way in which it has been introduced.
If Dr. Kinnear-King fails to meet his monthly UDA target, the PCT will want an explanation. Technically, it can claw back money from him, or take other action. I hope that most PCTs will wake up to reality and not be so draconian. They need to work with dentists who fail to meet their targets and find out why that has happened, as sometimes the fault lies with the proportions assigned in a mixed service.
I listened with care to the Liberal Democrat spokesperson, the hon. Member for Falmouth and Camborne (Julia Goldsworthy). This may upset her, but
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I can tell her that what she said is guaranteed to get dentists walking out of the NHS in droves. Dentists have some difficulties with the present system, as negotiating a change in the size of the contract or the mixture of services that it covers can take two or three months. I am sure that we can do better than that.
I have something else for the hon. Member for Falmouth and Camborne to think about. A patient who presents to an NHS or mixed dentist suffering from pain in her lower-left third molar, for instance, will be offered a choice of treatmentsNHS amalgam, for example, or the latest treatments using bonded composites, or a gold inlay, or an inlay-overlay in porcelain. Those might be her options, but what is important in the end is that the treatment gets done: that is what counts, not whether the treatment is NHS or private.
Under the new contract, the NHS amalgam option means that the dentist will achieve more UDAs. If he does not perform that treatment, he has fewer UDAs. As Dr. Kinnear-King notes in his letter, those UDAs have to be made up with other patients.
Nowadays, patients want choice. The more choice that they get, the more private dentists' fees will come down. If the fees are too high, the dentists will not fill their appointment books. That shows that the market can also work to the advantage of patients.
Dr. Kinnear-King offers a better example of that. He says that a patient who comes in with teeth that are intact but badly stainedperhaps by tetracycline, for exampleis likely to give him a big, broad, ugly smile. When I asked him what he would do as treatment, he said that he would get out his screaming diamond burr and apply it at 500,000 revs. He would use it to tear around the tooth enamel and put on 16 sparkling new NHS porcelain veneers
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