Supplementary memoranda from the Minister
1. I am writing to follow up some of the
points that we discussed in relation to NHS dentistry at your
hearing on 26 January.
ORAL HEALTH
AND FLUORIDATION
2. The Committee asked if I could set out
in writing the Department's position on the use of fluoride and
fluoridation.
3. Experience of oral health promotion initiatives
shows that interventions to put fluoride on people's teeth are
more effective than campaigns to change behaviour in respect of
diet or oral hygiene practice. There have been major improvements
in oral health since the introduction of fluoride toothpaste in
the 1970s. However, there remain inequalities in oral health,
which are strongly associated with economic and social deprivation.
This is likely to be linked to toothbrushing regimes with fluoride
toothpaste.
4. In October 2005, we issued a new oral
health plan for England, setting out a range of actions that the
NHS, dentists and other stakeholders can take to build on improvements
in oral health and further reduce inequalities. This includes
action to encourage the use of fluoride toothpastes, especially
for young children in disadvantaged areas, and action to promote
water fluoridation where local communities support this action.
5. The Government has reformed the legislative
framework governing fluoridation to give communities with high
levels of tooth decay a real option of having their water fluoridated.
In September 2005, the Department issued guidance to Strategic
Health Authorities on the consultations they would need to undertake
to assess the feasibility of a fluoridation scheme and assess
public opinion towards fluoridation. The feasibility of schemes
depends largely on the organisation of the water distribution
system of the area. We are therefore encouraging SHAs to consult
the water companies which serve their areas before deciding whether
they should proceed with a public consultation.
NUMBERS OF
DENTISTS AND
RELATIONSHIP BETWEEN
NHS AND PRIVATE
WORK
6. The Committee asked for information about
the ratio of dentists to population. The position on this is that:
— the total number of primary care
dentists practising in England is about 21,000; and
— there are about 2,400 persons per
primary care dentist (based on an England population of around
50 million).
7. In terms of the split between NHS and
private work, the Office of Fair Trading's 2003 report, The private
dentistry market in the UK, included an estimate that about 2%
of dental practices offer exclusively private care. The report
also contained estimates that NHS patients make up around 94%
of all child patients and around 67% of adult patients.
8. We do not have data on the comparative
number of courses of treatment in the NHS and private sectors.
However, information collected in a 2000 workforce survey found
that, on average, dentists spent about three-quarters of their
time on NHS work. Almost 60% of dentists spent 90% or more of
their time on NHS work, and 70% of dentists spent 70% or more
of their time on NHS work.
9. In terms of the value of NHS and private
work, we estimate that in 2003-04 dentists working in the NHS
derived on average about 54% of their gross earnings from the
NHS and 46% from private work. About a third of dentists had an
NHS commitment of a third or less (measured by comparative earnings);
about 20% had an NHS commitment of about a half; and about a half
of dentists had an NHS commitment of two-thirds or more.
NHS REGISTRATIONS
10. I indicated at the hearing that around
46% of adults and around 60% of children are currently registered
with an NHS dentist. "Registration" in this context
measures (for adults) the number of patients who have seen their
dentist at least once in the last 15 months.
11. The concept of NHS dental registration
was only officially introduced in 1990. The highest recorded level
of NHS registration in 1993 was 57% for adults and 60% for adults
and children, at a time when the adult registration period was
two years as opposed to 15 months now and when the figures were
inflated by some duplicate registrations. (In other words, these
figures would now be lower if measured against the 15-month period.)
Registration numbers and rates have been relatively stable since
1998 when the figures first reflected the new 15-month registration
period.
12. The Committee expressed surprise that
these figures were not higher—and asked for further information
about the Department's estimate that around two million patients
were unable to access regular NHS dental care.
13. The first point to emphasise is that
NHS dental registration is (unlike GP registration) a time-limited
measure. The figures exclude a number of patients who attend less
regularly than every 15 months. Under the new NICE guidelines,
recommended recall intervals range from three months to two years,
depending on a patient's oral health. The figures also exclude
patients who do not seek routine dental care, but who are nonetheless
likely to receive urgent NHS treatment when they need it.
14. The figures also of course exclude patients
who do not wish to attend a dentist, or who have chosen to attend
privately. In 2003, the Commission for Health Improvement report
on access and NHS dental patients found that, for those patients
who had not been to an NHS dentist in the past year, the two most
common reasons given were that they did not think they needed
to go (because their teeth were all right) or because they preferred
to have a private dentist.
15. The Department's estimate (in September
2000) of two million people being unable to register with an NHS
dentist was based on extrapolating from the position in 1993,
when (two-year) registration levels were at 60% but there were
no significant problems of access to NHS dentistry. We therefore
calculated:
— the fall since 1993 in the number
of adults registered with a dentist (adjusted for changes in the
measurement of registration) (1 million);
— an allowance for increases in demand
arising from the increase since 1993 in the number of adults with
natural teeth (0.75 million, or half of this increase);
— an allowance for additional demand
for NHS services by virtue of measures to improve access and promote
better oral health (0.25 million).
16. We will of course continue to monitor
the number of patients who see primary care dentists, so that
we can assess the impact of the forthcoming reforms in improving
access to NHS dentistry.
COMMISSIONING DATA
17. The Committee asked what information
will in future be available to the Department (to influence decisions
about resource allocation) and to Primary Care Trusts (to inform
decisions on local commissioning of primary care dental services).
18. Both we and the NHS will have access
to data on:
— the numbers of patients seeing an
NHS dentist (within a specified period);
— the numbers of courses of treatment
carried out, broken down between the three main bands under the
new system (examination/diagnosis, treatment, and advanced treatment),
between adults and children, and between charge-exempt and charge-paying
patients;
— measures of oral health.
19. In terms of oral health, the Department
commissions decennial surveys of adult and child dental health.
The most recent adult survey was conducted in 1998 and the most
recent children's survey in 2003. In addition, the British Association
for the Study of Community Dentistry, which includes many dentists
working in schools among its membership, conducts more frequent
surveys of children's dental health. These surveys provide figures
on levels of tooth decay by Primary Care Trust.
TRENDS IN
REGISTRATIONS AND
ACTIVITY
20. It may also be helpful if I clarify
some of the information I gave on trends in registrations and
activity.
21. In terms of adult courses of treatment,
there has been a steady increase over the last 10 years. In 1996-97,
there were around 24.6 million courses of treatment; in 2004-05,
there were some 26.6 million.
22. In order to allow more time for preventative
work, General Dental Services (GDS) dentists transferring to the
new contract will have a 5% reduction in the courses of treatment
they are required to carry out (after weighting for the relative
complexity of the three new bands).
23. For registrations, there has been an
increase between November 2004 and November 2005 of 1.8%. For
a number of PDS schemes (which do not use a formal registration
system), these figures are based on the number of patients seen
in the previous 15 months). As set out above (para 11), registrations
have been relatively stable since 1998.
24. I hope that this further information
is helpful.
Rosie Winterton MP
Minister of State for Health Services
3 February 2006
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