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Mr. Mark Lancaster (North-East Milton Keynes) (Con): I realise that time is marching on, so I will keep my comments as short as possible.
I empathise with the hon. Member for North-East Derbyshire (Natascha Engel). I, too, have lost my two front teeth, although I did so by failing to obey the first rule of cricket: "Always keep your eye on the ball."
I am unsure where in this country the Government are fulfilling their pledge of access for all to an NHS dentist—perhaps in Liverpool or Doncaster, but certainly not in Milton Keynes. Indeed, in an answer to a question posed back in June by my hon. Friend the Member for Isle of Wight (Mr. Turner), who is not in his place, we discovered that just 62 per cent. of children
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and 39 per cent. of adults—an overall rate of just 45 per cent. of people—are registered with a dentist in Milton Keynes. The figure is down considerably—in fact, 10 per cent. or some 20,000 people—since 1997. That is an extraordinarily low figure. If just 45 per cent. of the population of Milton Keynes is registered with a dentist, about 122,000 people in my city are not.
Perhaps the Minister believes—I am sure that she does not—that my constituents simply do not want to register with a dentist. If so, I point her to a recent survey carried out by Milton Keynes PCT showing that 79 per cent. of people who are not registered with an NHS dentist would like to do so—a fact that is backed up by my overflowing postbag of correspondence from many constituents who have written to me on the issue. For example, my constituent, Mrs. Byrne, who wrote to me only this week, is representative of many young mothers when she says:
"I have a 9 month old son and I am 7 months pregnant, I have been advised to go to the dentist for a check up but unfortunately cannot find one in Milton Keynes. My son's first teeth are now through and I need a dentist for him too. I am quite disgusted that I have an NHS maternity exemption certificate so that I can go to the dentist but the NHS are not providing the dentists for myself and many other people in my situation to attend."
Perhaps the Minister, who seems to suggest that training dentists is one, if not the main solution to the problem, believes that my constituents are simply not looking hard enough for a dentist. If so, perhaps she would like to meet my constituent, Mrs. Carter, who in an e-mail this week says:
"I desperately need an NHS dentist who will accept my two children, my husband and myself as new patients and I have phoned every number on the list provided by the PCT and none of them are taking on new NHS patients. I refuse to go private as my husband and I have paid far too much in National Insurance to have to pay for it again."
That raises an interesting question about national insurance contributions to which I will return in a moment, but is it really that hard to get a dentist in Milton Keynes?
Like many people in Milton Keynes, I am not registered with a dentist. Indeed, I am tempted to ask my hon. Friend the Member for Mole Valley (Sir Paul Beresford), who is no longer in his place, whether he will start accepting NHS patients, but I sense that that would probably be unfair. I was able to find just one practice that was happy to accept new patients, but there is a catch: they must be under the age of 18 and they would qualify only if both parents were involved. However, I accept that that has been addressed.
As a Back-Bench Conservative MP who may feel that we have absolutely no influence in the House, I am delighted that my very first question in the House was to the Minister on this subject. I asked her back in June whether, effectively, she had replaced the access-for-all-to-an-NHS-dentist policy with a buy-two-get-one-free policy. So I am delighted—I am sure that the people of Milton Keynes are, too—that I seem to have had some impact on the House.
If I were a cynic, I would ask whether, in reality, the Government are pursuing their policy in the hope that people will perhaps get used to going private and therefore not want an NHS dentist, with possible effects on funding dentistry in the future. So who is to blame? I am sure the Government are keen to blame dentists,
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but I am afraid that I do not blame them. Having talked to my local dentists, it is clear to me that they are doing the very best that they can in extremely difficult circumstances. They do not want to turn away NHS patients, but seem to have little choice.
Dentists have serious concerns, some of which have already been raised by my hon. Friends, so I will focus on just two—first, the time scale for the new contracts. Certainly, in Milton Keynes at least, they were given their contracts just eight days ago, yet they were expected to return the first draft by yesterday. The second concern is the security of the new contracts. Although they will last for three years initially and have been ring-fenced, there appears to be little security beyond that point. For example, if an associate leaves a practice, there is absolutely no guarantee that the PCT must award a contract to the same practice. It is therefore very difficult for dentists to plan the expansion of their practices beyond the three-year period. I should be grateful to the Minister if she considered that issue.
Perhaps we should blame our local primary care trusts, but to be fair to Milton Keynes primary care trust, which is being forced to swim against the tide because of an ever-increasing population, it is at least trying to address the problem, although the early signs are that the results of its efforts are, at best, mixed. It sent out a mixture of practice and individual contracts, but 20 per cent. of dentists have so far refused to accept a contract. As of yesterday, 40 per cent. of dentists had not returned their contracts, and at least a third of the dentists who had returned and accepted their contracts had done so in dispute while waiting for further negotiations with the PCT. Those statistics are hardly encouraging. Given the rapidly growing population of Milton Keynes, Milton Keynes PCT is one of the hardest pressed primary care trusts in the country, although I am confident that it will try to do the right thing when funding dentistry in Milton Keynes.
Stephen Hammond (Wimbledon) (Con): My hon. Friend has obviously had extensive conversations with his primary care trust. Has it given him any indication of the possible implications of the 12-monthly block payments that are coming through on its funding and deficit next year?
Mr. Lancaster: My hon. Friend makes a valuable point. There is deep concern about that matter in Milton Keynes, as I am sure there is in his constituency. Although I am confident that my primary care trust, which is staffed by excellent people, will try to do the right thing, I am worried that once we get beyond the three-year ring-fenced period, there will be a temptation to divert funds for dentistry elsewhere. I hope that the Minister will ensure that that does not happen.
Finally, may I pass on a question that many of my constituents are keen that I should ask the Minister? Given that they have paid their national insurance contributions yet failed to get an NHS dentist, will she give them their money back?
3.1 pm
Mr. David Burrowes (Enfield, Southgate) (Con):
It is a pleasure to follow my hon. Friend the Member for North-East Milton Keynes (Mr. Lancaster), who gave
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us several examples of problems in his constituency that are reflected in mine. The Government's proposals on NHS dentistry are characterised by being target driven, centralised and shambolic, although perhaps we should not be surprised because that is a description of their general approach to the NHS. Several Labour Members focused their comments on the relatively high salaries of dentists, but it should be noted that Conservative Members are worried about access for patients, which should be the focus of the Government.
I want to talk especially about younger dentists because the proposals have been presented as representing a bright future for NHS dentistry. However, is that the case? I suggest that they are yet another nail in the coffin for NHS dentists, especially young dentists. I concede that funding, recruitment and the number of training places have increased, which is welcome, but how will that affect in practice young dentists who want to be part of the supposed bright future? Will my constituents get proper access to a dentist? I suggest that the contract is an obstacle to any of the relatively good progress that has been made and a road block for young dentists.
Let us consider the situation for young women dentists, especially those who are young mothers. One of my constituents, Mrs. Surabaskaran, has told me about her experiences, which are no doubt replicated throughout the country. She is an NHS dentist who graduated in dentistry in 1998 from Kings college school of medicine and dentistry and looked forward to a future in the NHS. She was on maternity leave for five months during the relevant period over which her contract value was calculated, and has been in negotiation with the PCT to get an appropriate contract value. However, her maternity leave has been wholly discounted, so she has effectively been left with a contract that would be worth half her salary. Although she has 2,000 patients on her list, there is a risk that she will be forced out of the NHS because the PCT has stonewalled by saying that it has insufficient funds to address the situation.
The Minister might well point out that the framework proposals said:
for example, due to maternity leave. It was suggested that allowances could be made for dentists who were
during the relevant period. However, despite all the good intentions in "Framework proposals for primary dental services in England in 2005", the reality is that a young dentist such as Mrs. Surabaskaran is being left short when negotiating her contract because the local PCT refuses to award a contract with the value that she should properly have.
As the PCT has said no to Mrs. Surabaskaran, she must use the dispute resolution procedure for the contract and go to the Secretary of State. However, where will that leave her? Will she be guaranteed a better value than that which she has been offered? Given that the contract should have been signed yesterday, she faces the precarious predicament of endangering not only her future career in the NHS, but the 2,000 patients who are on her list. Is the process for dispute resolution
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appropriate? Should the Secretary of State be the binding determinant of a contract? Such a procedure might be appropriate in different parts of the NHS, but should the Secretary of State make decisions about a party who is a sub-contractor risking private capital? Again, the controlling hand—the dead hand—of the Government is at the heart of the proposals. We have heard that D-day has passed, so many NHS dentists, especially young dentists, face chaos.
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