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EDITORIALS: Ruth Freeman Reforming NHS dentistry BMJ 2008; 336: 1202-1203 [Full text]

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Failures in the new NHS contract

Elizabeth Carstairs, Simon D McLaughlin, Research Fellow, Department of Biosurgery and Surgical Technology, Imperial College, London, W2 1NY   (1 June 2008)

Failures in the new NHS contract 1 June 2008
Elizabeth Carstairs, Dental Associate Harvestfield Dental practice, London Road, East Grinstead, RH19 1QD, Simon D McLaughlin, Research Fellow, Department of Biosurgery and Surgical Technology, Imperial College, London, W2 1NY Send response to journal: Re: Failures in the new NHS contract	Dear Editor, we read with interest the editorial, “Reforming NHS dentistry”. One of us is a full-time NHS dentist who has worked both the new and old NHS contracts. We agree with many points in the article, but feel it is important to make clarify some of the issues. The new contract was perceived as a way of removing the “treadmill” effect of dentistry and allowing more time for preventative work. This has failed. In our experience the new contract has placed dentists on a faster treadmill, creating a much more stressful target-driven environment and encouraging dentists to leave the NHS because for many these targets cannot be met. Recently one of the authors (EC) has increased her working hours to achieve her NHS targets (and is still failing). The new contract was meant to promote oral health, but complex restoration of decayed teeth is discouraged in favour of extraction because the financial reward is the same whether the tooth is extracted (20 minutes) or root canal treatment completed (1 hour). Regular dental attendance to achieve good oral health is discouraged because this is costly and patients are charged (and dentists paid) the same for one filling or five fillings (irrespective of the number of visits required). Is this promoting oral health? The article states that the new NHS contract is more affordable for patients, this is not always the case. A single molar root filling is now cheaper; however a crown is twice the old contract price. Dentures are also more expensive. The new contract was designed to cap NHS dental funding. Therefore whilst we admire the optimism of Professor Freeman, we fear it would not be in the Government’s interest to change a system which for them is working possibly just as they planned. Competing interests: None declared