Memorandum by The London Regional Group
of Local Dental Committees (DS 07)
1.1 The London Regional Group of LDCs agrees
with the London Assembly's findings that "only half of Londoners
regularly visit an NHS dentist, meaning that oral disease and
decay are common".
1.2 The LRG also agrees with the London
Assembly that "much more work is needed to ensure Londoners
are well-informed and able to access dental care that meets their
1.3 The LRG agrees with the London Assembly
that "Low uptake of dental care is an important public health
issue for London, as people who do not attend a dentist regularly
are more likely to have untreated dental problems and disease,
which can impact on other aspects of their health."
1.4 The LRG agrees with the London Assembly
that "The reforms have introduced measures that could actually
reduce access to NHS dentistry" and "Some dentists .
. ..because no new money was available . . . . . . had to close
their doors to NHS patients . . ..."
1.5 The LRG agrees with the London Assembly
that "in future, the Department of Health should base PCTs'
funding allocations on local needs assessments, rather than historical
1.6 The LRG maintains that to improve quality
dental services for Londoners, it is essential to address the
limiting factors listed in this paper. Dentists feel that when
they raise these issues "nobody is listening".
2. Who we are
The London Regional Group of Local Dental Committees
includes representation from Local Dental Committees throughout
the whole of London, ie the NHS London Strategic Health Authority
area. Each Local Dental Committee represents the dentists in their
3. Low morale of dentists
Local Dental Committee representatives throughout
London hear constantly and consistently that dentists are demotivated
and disheartened by the new dental contract.
They feel that the new contract was imposed
with no meaningful consultation. The "Units of Dental Activity"
scheme was not piloted.
4. Uncomfortable pressure to perform Units
of Dental Activity
We hear every day comments from dentists such
as "I used to enjoy my job, but now when I arrive at work
I feel under pressure to carry out the requisite number of Units
of Dental Activity and I feel this distracts me from concentrating
on looking after my patients and doing what is best for them."
5. Threat of money being "clawed back"
Dentists call us in distress because their PCT
insists on part of their earnings from the past year being repaid
to the PCT, if they have not carried out the requisite number
of fillings and other treatments. It was never explained to dentists
prior to the introduction of the new contract that the relationship
between their earnings and their dental interventions would be
so strictly linked.
We are aware of many examples of dentists falling
short of their UDA (units of dental activity) targets through
no fault of their own (eg changing patterns of patient attendance)
yet the PCTs have no sympathy for such circumstances. This creates
a demotivating and depressing culture for dentists.
6. Dentists who are able to walk away from
the NHS are doing so
We have many examples of this. There are young
recently qualified dentists who have decided to change career
because of the new contracts; some dentists nearing retirement
have chosen to retire early because of it, and some have decided
to reduce their time in NHS dentistry because they have become
7. Dentists are feeling overwhelmed by the
extent and duplication of "monitoring" of their professional
PCTs are sending ever increasing numbers of
compulsory questionnaires, systems of monitoring quality and quantity
of dental work, statistical record-keeping, and audits etc. Whilst
most of these are not unreasonable in themselves, the cumulative
effect becomes too heavy a burden on dentists, and often requires
them to spend their evenings and weekends completing paper work,
which is a further demotivating factor.
8. Additional regulatory responsibilities
are not resourced
Dentists are supportive of high standards of
infection control, radiation protection, control of substances
hazardous to health, etc. However when more onerous requirements
are imposed, the increased cost represents an effective decrease
in dentists' earnings, unless properly resourced. For example,
the latest infection control requirements necessitate the purchase
of additional equipment, and longer times spent by staff that
is not recognised by Units of Dental Activity.
These additional costs represent a pressure
on dentist's personal income.
9. Primary Care Trusts wish dentists to treat
more patients for the same money
We are aware of situations where dentists have
withdrawn from working within the NHS, and where PCTs have recommissioned
the resultant shortfall in activity at a much lower cost.
Whilst we recognise PCTs have an obligation
to achieve value for money, this is often emphasised above the
need for high quality patient care.
10. The new contract's intention to "improve
the working lives of dentists" has not figured highly in
We are not aware of many, or any dentists who
feel that the new contracts have improved their working lives,
despite this being one of its stated intentions.
11. Preventative dental work not recognised
by the new contract
The incentive within the new dental contract
is to achieve the correct number of Units of Dental Activity,
which do not emphasise preventative work, nor oral health education,
nor general health improvement. Whilst dentists embrace a preventative
approach, this is not recognised in their contracts. The London
Regional Group of LDCs agrees with the London Assembly in concluding
that "The Department of Health should look at including preventive
care in the way PCTs manage and monitor dental contracts and consider
whether dentists should be financially rewarded for providing
12. Restrictions on dental activity
The Regional Group of LDCs is concerned to read
in the London Assembly's report that 205,000 adults in the capital
may never visit a dentist.
Whilst only 51% of Londoners went to an NHS
dentist in the two years to March 2007, dentists are consistently
being told by their PCTs that there is no scope for growth, and
practices with imaginative ideas to increase access are being
actively discouraged from implementing them, as PCTs wish to contain
dental activity within the limits of the year before last.
Dentists who carry out dental activity in excess
of their allocated target are not being funded for this.
Some PCTs (notably Bexley) used funding intended
for Access Quality and Choice in dentistry for other purposes,
without public consultation. The Secretary of State for Health
and the Department of Health were asked to intervene but refused.
The London Regional Group of LDCs agrees with
the London Assembly in its conclusion that "The Department
of Health should base PCT's dental funding allocations on what
local people need, rather than basing it on what has been provided
in that area in the past".
13. Dentists are being pressurised by PCTs
not to prioritise the most needy patients
Children and adults who are exempt from NHS
charges are among the most in need of dental help.
Yet PCTs require dentists to ensure that a certain
proportion of the patients they treat are sufficiently well off
to pay for their own NHS treatment, in order to maintain the PCT's
financial balance. We know of dentists who have been told that
unless they see a higher proportion of paying NHS patients, they
will have their contract capacity curtailed. This attitude tends
to increase rather than reduce socio-economic inequalities.
14. UDA targets are being imposed too rigidly
Dentists find it almost impossible to ensure
that they achieve exactly the required number of fillings and
other interventions over a 12-month period. We maintain that providing
dentists achieve within 10% of this target, they should be allowed
to address the under or over achievement during the following
year. But this is not happening.
15. Dentists are being financially disadvantaged
by patients who fail to attend appointments
Prior to the introduction of the new contracts,
dentists were allowed to make a small charge to patients who failed
to keep appointments. This was an excellent incentive to remind
patients of their appointments, and avoided them having to be
"struck off" for non-attendance. Since the new contract
dentists have been prevented from carrying out such incentive
programmes, and as a result many appointments are unused, which
in turn affects the achievement of UDAs, and can lead to financial
penalties to dentists. We maintain that it is often the patients
from the most deprived backgrounds who find it hardest to remember
appointments, and dentists should not be disallowed from running
an incentive scheme to discourage "Did not Attends".
16. Dentists are out of work because of the
financial limitations on NHS dentistry in London
For example, when dentists finish their vocational
training, there are no NHS dental jobs for them.
Dr Henrik Overgaard-Nielsen