Preparations for the most far-reaching reforms of NHS dentistry since 1948, founded on the delegation of new contractual arrangements to primary care trusts, are proceeding on time for introduction from
Given that many dentists have said that they might still go private in spite of the new contract, and that many people in constituencies such as mine are facing increasing difficulty in accessing an NHS dentist, what specific steps is the Minister taking to engage dentists in the new contract to encourage more of them to undertake NHS work?
We are continuing our discussions with the British Dental Association on the new contract, the principles of which were drawn up after years of discussions with the BDA, following the fiasco that took place under the Conservatives. In fact, dentists are voting with their feet. About 2,500 have now moved over to the new way of working, at about 1,000 sites around the country. We are also continuing with international recruitment; we shall recruit another 1,000 dentists into the NHS by next October, and increase the number of dentists in training. All this is sending a clear message to NHS dentists that we are increasing investment and training, and providing the new way of working for which they have been asking for many years.
I congratulate my hon. Friend on her work so far with the new contract arrangements. Will she join me in congratulating Doncaster health care services, which has just opened a brand new, state-of-the-art dental access centre with a same-day phone and go service? May I ask her to do one thing more and put further pressure on dentists to let people know that they are being de-registered? Usually, the first time that constituents get to know about it is when they turn up for emergency treatment and are told that they cannot have it.
My hon. Friend is right to congratulate our local health services on opening the new centre in Mexborough. It represents £3 million of new investment and is one of the first facilities in the country to bring family dentists and hospital dentists together under one roof, so it is very innovative. Naturally, it will benefit some of my constituents as well as some of his.
My hon. Friend is right on his wider point about dentists who de-register patients: they are supposed to give notice to the PCT and to their patients. We are working with PCTs to ensure that they are in regular touch with their local dentists and encouraging them to move to the new system, but if they are not, they should ensure that we can consider a system whereby we have knowledge of the whereabouts of those who are de-registered, so that when we increase the number of NHS dentists we can ensure that they have access to them.
Clearly, I have a slight interest in this subject. At a recent press conference, the Secretary of State, in announcing the last White Paper, said to the BDA representative, "Dentistry's sorted." That certainly is not the feeling of the dentists, the BDA, the dental organisations or even the National Audit Office. If it is sorted, will the Minister tell us when the draft contract will be available for dentists and the dental organisations?
I am sure that the hon. Gentleman recognises that the NAO report said clearly that we are moving in the right direction. It identified some risks associated with that, but to address those risks we have dental advisers in every PCT, talking with local dentists about moving to the new way of working. As I have said, we are continuing discussions with the BDA and will publish contractual guidance to PCTs in due course.
The experience of Mr. Gill is different from that of my constituents in Hartlepool PCT. Under all the key performance indicators, the number of registered patients, the changes in the number of registered patients and the number of practices that are allowing NHS patients to be registered are all massively above the average for England—but I am not complacent. What will my hon. Friend the Minister do to ensure that all those patients in Hartlepool who are registered and who want to be registered get the resources needed to ensure that they receive a full dental service from the NHS?
My hon. Friend is right to say that in his area about 75 per cent. of dentists are taking on new NHS patients—but we would not want to be complacent about that. There is sometimes an issue, as he says, about people who may not be registering but whom we want to register. There have been a number of initiatives around the country, most particularly in London, where people have been encouraged to come forward to register so that, in general, the oral health of the population can improve. We will certainly consider such initiatives in his constituency.
Is the Minister aware that the National Audit Office reported recently that primary care trusts may not have the capacity or capability to manage the new dental contract? Is she confident that, as the Prime Minister said in 1999, the new contract will ensure that everyone has access to an NHS dentist within two years?
The hon. Lady may not have noted what I said to Sir Paul Beresford, which was that the NAO report recognised that we were moving in the right direction. It identified some risks, and as she said, one of the priorities was ensuring that primary care trusts were able to implement the new contract. She may recall that we announced some months ago that, after discussions with the British Dental Association, we had agreed to delay implementation of the contract until October 2005, to ensure that PCTs were able to implement it by that date. On top of that, in the run-up to that date, we have been organising training sessions with every PCT and issuing guidance about how to do that. As I have said previously, on the ground, many dentists are already moving over to the new way of working—2,500 are doing so in about 1,000 sites around the country, with others wanting to do so. That indicates that dentists recognise that we are moving in the right direction, as did the NAO, and that we will be able to implement the new contract by October.
Unfortunately, the experience of my dentist, whom I visited yesterday morning, is slightly different. While he was messing around inside my mouth, he wanted to inform me that his practice is going to move into the private sector rather than remain in the national health service. One of the problems was the delay in the contract and the uncertainty that that has caused. Can the Minister reassure me, so that I can go back and convince him not to take that course of action, that the contract will be in place by October, and that it will provide certainty to dentists across the country that there is a future for NHS dentistry, not just for me but for every constituent whom I represent?
Of course, my hon. Friend is right to be concerned if his dentist says that he plans to move into the private sector. What I would say is that his dentist could already move to the new way of working. I am prepared to talk with the local PCT and suggest that the dental adviser there contacts him and offers him the opportunity to move to the new personal dental services system immediately, if that is what he would prefer to do.
The NAO and the chief executive of the Dental Laboratories Association, Mr. Richard Daniels, whom I had the pleasure of meeting this morning, both fear that the new contract will give dentists a perverse incentive to abandon some costly dental work that they currently give to dental laboratories. Indeed, a dental technician from Oldham, where the new contract is being piloted, has written to say that between 80 and 90 per cent. of the work that he gets from NHS practices in his area has disappeared. Why is the Minister diverting money for high-quality crown, denture and orthodontic work from dental laboratories to dental practices? Is that the way to make an unpopular dental services contract more acceptable to dentists?
There will not be such a diversion away from dental technicians. It will be possible to do anything that is clinically necessary under the NHS under the new contract. Some research has been done on patterns of treatment under the new way of working, and there was a slight decrease in the initial stages, but there is no firm evidence that dental technicians and laboratories will suffer. It is the clinical decision of the dentist as to whether the work needs to be done. I hope that the hon. Gentleman is not saying that NHS or other dentists would not act in a clinically professional manner.