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The Minister of State, Department of Health (Jane Kennedy): The Department's director of access wrote to all PCT chief executives in July 2005. The letter stated that referrals to community-based clinical assessment services and other such centres should happen only where that adds genuine clinical value for patients.
Tony Baldry: How on earth can it make sense for GPs who have not seen the patient to be paid £60 an hour to second-guess and vet the referral letters of GPs who have seen the patient and who know their patients? How can it make sense for every referral letter from every GP in Oxfordshire to be sent to some central lubyanka in the middle of Oxford in some Stalinist process to be second-guessed? What on earth does that say about the system's confidence in GPs to make appropriate referrals and the integrity of GP commissioning?
Jane Kennedy: The hon. Gentleman opened his question with the phrase, "How on earth". He must be on a different planet, because the description that he just gave is not what I recognise. If he is referring to the concerns that the British Medical Association has raised recently, I should say that even the BMA acknowledges that there is real benefit to be had in a different way of managing referrals, so that the patient goes to the person whom they need, depending on the nature of their complaint.
The Minister of State, Department of Health (Ms Rosie Winterton):
The most recent assessment of dentists' numbers was the 2004 "Report of the Primary Care Dental Workforce Review". Since April 2004, we have recruited the equivalent of an extra 1,100 dentists in the NHS. Last year, we announced that we would
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increase dental training places by 170 each year, and in January we announced the opening of a new dental school at the Peninsula medical school.
Linda Gilroy: I welcome the resources that my hon. Friend and her Department have found for the new dental school in Plymouth, especially as it will bring 150 jobs and capacity equivalent to about 20 dentists even in the early years. However, does she agree that preventive health care will make the biggest difference to dental treatment and the availability of dental health care to our constituents? Will she urge the new dental school to consider what it can do to drive that agenda forward?
Ms Winterton: I congratulate my hon. Friend on her assiduousness in pressing for the dental school in her constituency. She is absolutely right to say that that preventive care is extremely important. Not only do we have a public health strategy for oral health, but an important part of the new contract is that it allows dentists to spend time on preventive health care, as well as other treatments.
Sir Paul Beresford (Mole Valley) (Con): I declare an interestit is becoming a habit. I am fascinated by the Minister's reply. She will be aware that dental students need academic clinical teachers. Does she agree that the 6 per cent. reduction in the number of academic clinical teachers over the past year could present a problem? Some 20 per cent. of those teachers are over 55, and 33 per cent. of them are aged 45 to 55. Does she agree that we must face the fact that there is a possible problem with a new school, more places and more students, but fewer teachers?
Ms Winterton: The hon. Gentleman raises an important point, which we have been looking at in relation to the way that we deliver dental training. As well as training to recruit more academics, we can consider other things, such as outreach schools, where students spend more time perfecting their skills in the community, as well as in the school. He is absolutely right to suggest that this issue is important, and I can assure him that we are looking at it.
Mr. Paul Truswell (Pudsey) (Lab): Is not one of the immediate problems about the supply of NHS dentists the fact that those who opt out of the service are writing to patients inviting them to opt into a Denplan contract on a first-come, first-served basis, before those patients know whether there will be any NHS re-provision in the area? Would that not have been prevented if the cut-off date for agreeing the contract had been somewhat earlier?
We had the cut-off date for the contract fit in with the financial year, which also gave the NHS time to prepare for it. My hon. Friend is absolutely right, however, to say that some patients have found the position misleading, which has angered many people in the primary care trusts. The impression has been given that NHS dentistry is not going to continue if a dentist withdraws, but the fact is that the PCT will, under the new system, have money locally. Whether a dentist decides to take up a new contract is up to the dentist, but
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the primary care trust will re-provide dentistry from elsewhere, and many NHS dentists are coming forward to say that they want to do that where others do not.
Mr. Douglas Hogg (Sleaford and North Hykeham) (Con): Given that NHS dentistry is largely unavailable in Lincolnshire, and given further that there is a precedent for the national health service paying for operations that cannot be performed within it within a stated time, why is the same principle not applied to private dental fees incurred by patients who cannot get NHS dentistry because it is not available? Why, in those circumstances, does not the NHS pay those private dental fees?
Ms Winterton: Most NHS dentists are, in fact, independent contractors. The NHS contracts with them, and in future that will be done in an improved way. We have had no control: if a dentist left the NHS, there was no way in which the local primary care trust had the money to recommission local dentistry. The reforms that we are introducing change all that.
I am aware that there are particular problems in Lincolnshire, which has received substantial access money to increase availability. As I have said, however, that money will be available locally. Meanwhile, it would be interesting to know whether purchasing in the way that the right hon. and learned Gentleman outlined is now Conservative party policy.
The Minister of State, Department of Health (Ms Rosie Winterton): Under the new contract, a highly committed NHS dentist can expect to earn, on average, around £80,000 per year, with additional money for practice expenses. That will be guaranteed for three years, along with a 5 per cent. reduction in work load.
Steve McCabe (Birmingham, Hall Green) (Lab): Eighty thousand plus! Given that figure, is it right for dentists in Birmingham to claim that they are being ripped off by the Government? In some cases, like doorstep cowboys, they have been attempting to blackmail elderly people into purchasing private insurance that they do not need and cannot afford. Surely that is no way for professional people to conduct what is essentially a trade dispute.
My hon. Friend is right to point out that we are offering £80,000, plus practice expenses, guaranteed for three years, and a 5 per cent. reduction in work loadwhich seems to me to be a fair offer to dentistsas well as introducing a system that will greatly benefit patients. He is quite right, too, to say that many primary care trusts have been worried by some of the information disseminated to patients, which quite frankly has been unnecessarily alarmist. Patients should not feel that they must be driven into private insurance. If a dentist decides not to come with us but to leave the NHS, the money will be available locally to recommission dentistry from other dentists.
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Mr. Mark Lancaster (North-East Milton Keynes) (Con): I understand why the Minister does not allow dentists to use 0870 telephone numbers, but why has she allowed the practice to persist in the NHS as a whole, particularly for patient hotlines?
Ms Winterton: I am not sure whether I understand the hon. Gentleman's point. Is he saying that patients have to use a different number to make an appointment? That is not current practice. Most people contact their dentist by ringing an ordinary number.
Mr. David S. Borrow (South Ribble) (Lab): Does my hon. Friend agree that it is totally unacceptable for dentists who have rejected the contract and who have moved into the private sector to tell elderly patients with false teeth that they must sign up to Denplan, which costs £200 a year? They do not need their teeth cleaned or examined; all they need is access to a dentist when their false teeth need repairing or upgrading.
Ms Winterton: My hon. Friend is right to say that that practice is unacceptable. We are making changes to the registration of denturists, who can undertake some of the work that he has mentioned; with appropriate training, they can undertake some of those tasks separately, too.
Tim Loughton (East Worthing and Shoreham) (Con): Given that the Government are making an offer that dentists apparently cannot refuse, and that the deadline passed at the end of last month, will the Minister tell us whether more NHS dentists will be providing services after 1 April? Has there not been a distinct lack of dentists signing up to the new contract in the Minister's Doncaster constituency? As a result, more patients will pay more for treatment, if they can get it, while dentists who do sign up will be paid less for performing the same work.
Ms Winterton: All the indications suggest that the vast majority of dentists will sign up to the new contract. As I have said, if dentists do not want to sign up, local primary care trusts now have the money to recommission dentistry.
Ms Winterton: Some NHS dentists say that they will expand their lists if other local dentists do not want to sign up. Over and above that, international recruitment has taken place, and 1,000 recruits are going through the international qualifying examination. In addition, there are corporate bodies that want to undertake NHS dentistry. An extra £315 million is going into NHS dentistry compared with two years ago, so we can increase capacity and access for patients. The deal is good for dentists, but, importantly, it is good for patients, too.
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