Motion made, and Question proposed, That this House do now adjourn.—[Mr. Roy.]

I am grateful to have obtained the Adjournment debate for which I asked because I am concerned about the present and future availability of national health service dental services in Durham.

Twenty dentists in Durham provide NHS care but some of them do so only for the under-18s and other exempt cases under a personal dental services contract. All practices in my City of Durham constituency have currently closed their lists to new NHS patients. I understand that the nearest open list is at Chester-le-Street community hospital.

Problems with the availability of NHS dental care in Durham are unfortunately not new. In response to previous representations from me and my predecessor, the primary care trust agreed to employ a salaried dentist directly. That appointment was made but that NHS list is also closed, albeit temporarily.

The PCT intended to take on another salaried dentist and confirmed that in a meeting with me in the summer. In the event, that did not happen for a variety of practical reasons and the PCT does not currently have the financial resources to support it. Discussions with dentists about expanding their NHS provision are currently being held up until further details of the new general dental services contact are known.

Durham, like many commuter towns, faces a problem of the demand for dental services being higher than the size of its population base would suggest was necessary because many people who work in the city but do not live there register with a dentist. The PCT argues that that makes planning for the correct amount of dental services difficult. It also has the effect of pricing local, low-income people out of dental care because many of those who come into the city for employment can afford to be private patients.

The problem of "privatisation" has been happening for some years, with several dentists "encouraging" or forcing their NHS patients to become private ones. Sometimes lists are completely closed to NHS patients.

I am glad that the hon. Lady has secured such an important debate. When I listen to her speaking about Durham, I realise that her comments apply to Wellingborough, which suffers from exactly the same problem of dentists opting to go private. My constituents have to leave the constituency to find an NHS dentist.

Order. We cannot widen the debate by intervention. The debate, which the hon. Lady has won, is about dentistry in Durham.

I thank you, Mr. Deputy Speaker, but I have enormous sympathy for Mr. Bone.

As I said, several patients are forced to register as private patients. There was an unfortunate example in the summer, when a dentist gave two weeks' notice to his patients, did not inform the PCT, and told his patients that if they wished to re-register with him, they would have to do that on a private basis.

I would like the Minister of State for Health, my hon. Friend Ms Winterton, to make some comments about how we can encourage dentists to take their social responsibilities to provide NHS care more seriously, especially as they are trained and supported by the NHS. I know that that applies only to some dentists, but I would welcome her comments on that.

I can see that the Government have taken action to try to address the problem of a shortage of NHS dentists by employing more dentists, setting and recently achieving a target of 1,000 new dentists, and I know that there are 170 extra training places this year in dental schools—a 25 per cent. increase on 2004–05. I also understand that additional capital money is being made available, and discussions are taking place about a new dental school. But those measures, welcome though they are, are not delivering on the ground for the people in Durham.

In addition to the extra resources now being put into NHS dental services, I understand that the Government are placing a great deal of faith in the general dental services contract being introduced from April 2006, which they say is a large part of the solution to current problems. Feedback from the Durham and Chester-le-Street PCT, however, does not fill me with optimism. Already the PCT has received one letter of resignation giving the reason as the introduction of the new contact. The primary care development manager has stated that she has had many discussions with dentists over the past few months and she has yet to hear a positive view of the contract.

Orthodontists are also very unhappy with the proposals relating to them. Incidentally, Durham has only one orthodontist practice, and the waiting time for treatment is currently 20 months, which is also very unsatisfactory. Anecdotal evidence suggests that once dentists receive their contract values and activity levels from the Dental Practice Board, which I understand is happening soon, most will not wish to renegotiate their NHS contracts. The majority are unwilling to commit themselves without that information.

Obviously, I find this information very worrying. Faced with a potential sudden large reduction in the amount of dental capacity available on the NHS, the PCT will need to provide a direct PCT service, but currently the PCT does not have the capacity either in terms of dentists or surgeries to be able to re-provide that service.

Patients involved in a PCT consultation exercise also had some difficulties with the new contracts. They seemed to be concerned that dentists would no longer hold lists of registered patients as there would be no long-term responsibility for the quality of care provided. They were concerned that patients might not be able to receive continuity of care.

Patients also feel that the way that charges are structured in the new contract—with a fixed price for fillings, for example, no matter how many they have—would encourage people to wait until they require a large number of fillings before visiting the dentist. That would probably apply more to those on lower incomes, creating inequality in dental care. That sentiment was also reflected in consultations with the professionals.

The PCT and the British Dental Association acknowledge that the new charging system is simpler, and that there will be winners and losers in terms of cost—those requiring one-off, more intensive treatment are likely to be the winners, and those needing regular lower-level treatment are likely to be the losers. The British Dental Association maintains that we shall need to train yet more dentists and other dental team members. It notes that demand for dentists is outstripping supply, which is why dentists are closing their books.

According to the BDA, in 2005, 15 per cent. of general dental practitioners were not taking on new child patients, 37 per cent. were not taking on new exempt adults, and 15 per cent. were not taking on new paying adults—a significant rise since 2000. It is also concerned that additional funding might not reach front-line dental services when PCTs become responsible for commissioning from April 2006.

The BDA acknowledges that the value of the private market has grown rapidly over the past 10 years and that NHS care still outstrips private practice, but it suggests that the move towards private care is prompted by a lack of investment in NHS dentistry. Evidence shows that dentists do not typically earn more in private practice than in the NHS, but that they can earn similar amounts of money while being able to spend longer with patients.

I think that it is fair to say that reaction to the new general dental services and personal dental services contracts has been mixed. More than anything, dentists appear to want a break from the treadmill so that the link is broken between treatments provided and remuneration received. The view being expressed by the BDA, however, is that under the new contracts dentists will lose the flexibility to work at their own pace but will be unable to get off the treadmill. The basis of the new system is that the contractor will complete a number of units of dental activity, set by the local PCT, in return for a set monthly payment.

Dentists are also concerned because the new proposals do not encourage disease prevention or the maintenance of good oral hygiene, as preventive care does not specifically attract units of dental activity. They are also of the view that the new system has not been sufficiently piloted before being rolled out across the country. They note that although one or two aspects of the new GDS contract proposals have been tested in the PDS agreements, the UDA output system is, they contend, as yet entirely untested. The BDA maintains that the shortage of dentists is likely to continue for some time.

I raised those more general points about the contract and work force planning matters because I should like reassurance from the Minister about the likely impact of the new contracts in terms of improving access to NHS dental services in Durham. I should like her to comment on the steps that she might take to alleviate the current unacceptable problem in Durham—that no NHS facility is available to new patients. What support will be given to PCTs directly to employ dentists if the mixed economy of dental care does not deliver enough NHS capacity post-April 2006 and they need to employ salaried dentists to achieve NHS output?

I hope that the Minister will accept that my overriding concern is to ensure that the people of Durham have a first-class NHS dental service, which reflects the Government's commitment to the NHS.

I congratulate my hon. Friend Dr. Blackman-Woods on securing the debate. The topic is not only important but timely. As we speak, general dental services dentists' individual contract values are being sent to them and details of the new system of charges for patients and the regulations governing the new GDS and personal dental services contracts will be released shortly. My hon. Friend pointed out that many dentists were waiting for some of that information before committing themselves. They will now be able to see exactly what the new contract means for them. I hope that that will address many of the issues that she raised.

My hon. Friend referred to the situation in Durham and I want to touch on some of the improvements that have been made there, bearing in mind that there are still some difficulties, as she pointed out. I want also to talk about how local commissioning will give all primary care trusts assistance in developing local dental services.

As my hon. Friend rightly said, there have been severe access problems. We have tried to address them through a variety of means, including domestic and international recruitment and the expansion of personal dental services. In Durham, the PCT took various steps to deal with the problems. It appointed two salaried dentists a year ago and expanded personal dental services. In Durham and Chester-le-Street, six of the 23 practices—about 26 per cent.—are in PDS, which is close to the national average of about 28 per cent.

Will the Minister give some further clarification about the two dentists directly employed by the PCT? Only one of them is employed in City of Durham. The PCT had intended to employ two salaried dentists in my constituency, but for the reasons I gave earlier it was unable to do so.

The PCT area may be wider than that of the constituency.

The PDS practices have a combined contract value of £1.78 million, which includes growth funding of £558,000. That is new money, and it has been made available by the Department of Health to my hon. Friend's local PCT. As she said, there are problems, but those practices were treating almost 24,000 patients at the end of October. The roll-out of the new dental contracts will provide an opportunity for the PCT to look at the PDS agreements and make sure that the units of dental activity agreed with the practice reflect significant recent growth. May I emphasise the fact that the PDS contracts are pilots from which lessons have been learned? In the next few months, we will sit down with dentists to look at levels of activity under PDS contracts to see whether there is room for growth in certain areas. The PDS pilots, combined with the new guidelines from the National Institute for Health and Clinical Excellence, provide greater flexibility. For example, patients do not necessarily need to see their dentist every six months—the time between check-ups can be up to 24 months. The lesson of the PDS pilots is that there is flexibility and room for growth in certain areas. That is one of the benefits of the new system, and it gives PCTs local flexibility.

My hon. Friend's PCT received £65,000 from the £50 million that the Government made available to improve access last year. That sum funded 1,300 additional patient contracts across 10 local practices in the area. The PCT must await details of next year's budget before it makes further NHS dentistry commitments. However, I can assure my hon. Friend that those details will be released shortly, allowing the PCT and local dentists to look at the way in which local commissioning can be used for local investments. They can look at local priorities to ensure that dental services meet all local oral health needs.

I have a slight interest in our debate, although it is becoming slighter and slighter as I continue my parliamentary career. I hope that we can apply a little lateral thinking. At the moment, we look at the number of patients who are seen, contacts and so on. However, we have a mixed dental service, and patients can be treated on the national health service or privately. Dentists can offer different treatments for the same disease, but most of those treatments are available only outside the NHS. It is important that dentists remain with the NHS, because patients should have a choice as to whether they receive treatment on the NHS or privately. A treadmill system has been introduced—I know that the Minister does not entirely agree—and I urge her to reconsider the proposals and provide flexibility so that more patients can approach more dentists for NHS treatment if they wish to receive it.

I contest the notion that this is another treadmill. It is important that, under the new system, dentists can continue to undertake a mix of private, public and NHS work. The new contracts will reflect the way in which they have previously worked. We expect dentists who have recently undertaken units of activity or interventions to make a reasonable commitment to the same level of activity with the same cohort of patients, although we accept that they may undertake a mixture of private and NHS work.

My hon. Friend is concerned about access problems caused by the fact that people outside the city are registered with local dentists. That has been the case for many years, and we have no plans to replace the system because doing so would require many people to find different dentists from those to whom they have become accustomed. It is true that the system is not based on residency, but changing it could affect continuity of care for existing patients.

My hon. Friend asked what would happen if dentists did not take up the new contract. The point of the changes that we are making is this: in the past, when a dentist has left the NHS the money has returned to the centre; now, the primary care trust will retain it locally. That money must be spent on NHS dentistry, which means that more dentists can be brought into the area if there is a shortage. It can be spent on salaried dental services if the PCT thinks that appropriate, although such services usually involve community dental access centres and the like. PCTs can also commission additional services from existing dentists. The money will be there to meet local needs.

As my hon. Friend said, in the longer term we are reversing the closure of two dental schools. The British Dental Association has spoken of the need to increase the number of dentists, and there is such a need—although more dentists are registered, fewer of them work for the NHS.

My hon. Friend is right about what we hope to achieve with the new system. We have discussed with dentists the need to move away from the drill and fill treadmill and to introduce a much simpler charging system. I hope that that will result in a commitment to NHS dentistry. We want to rectify many of the problems that dentists say they have experienced with earlier contracts. Our recruitment of some 1,400 more dentists over the past year demonstrates that there are dentists out there who wish to work for the NHS, but we will continue the programme if some dentists do not want to join in our reforms.

Will my hon. Friend give way?

I will, although my hon. Friend made many points with which I want to deal.

I am grateful to the Minister. Will she say a little more about why she and her Department are so confident that the dentists will be happy with the contract? The consultation in Durham revealed that no dentists were in favour of it.

Over the past few months, the acting chief dental officer has met a number of dentists who have been awaiting further information about the contract values and the regulations that will accompany the contract. I think that there has been a certain amount of misinformation about exactly what is expected. For instance, dentists thought that they would no longer be able to have children only or exempt only lists.

The aim of the regulations that we have submitted for consultation is to ban an unacceptable practice that has been raised by many Members in the House. Dentists were saying "We will treat your children if you will register as a private patient." It will be perfectly possible in future for PCTs to say to dentists "Yes, you can have a children only list." PCTs should be able to look at what is happening locally and say whether it is acceptable. We have tried to tackle a position that we considered unacceptable. Dentists thought that none of them would be able to have those lists under the new contract, which was not the case.

One of the other issues that came up was a feeling that dentists would no longer be able to do some private work and some NHS work. Again, that is not the case. They will be able to mix the two. We must be clear that we are offering a contract under which if NHS dentists give a reasonable commitment to the NHS, they will be able to earn about £80,000 a year, and up to another £60,000 can go towards the expenses of their practice. That is guaranteed for three years, for something like 5 per cent. less activity. We are anxious to ensure that if there is room for expansion, the units of dental activity would cover it. I do not think that that is an unfair deal. Nor do I think that it is bad that we are simplifying the system of patient charges.

My hon. Friend suggested that preventive care might not be possible, but the new system of banded charges specifically allows for preventive oral health advice. That is clearly covered as part of the treatment provided, which is exactly what dentists have been asking us to do.

My hon. Friend asked about the current provision of orthodontic services in Durham, which I accept is not ideal. The strategic health authority is looking into the matter and there has been a big increase in the number of orthodontic treatments over the past few years, although there is no doubt that there are problems in some areas.

Today, the Department has issued guidance on commissioning specialist services, with particular reference to orthodontics. There is clear guidance on determining need, on targeting resources and on how to use the new contract arrangements both for general dentist practitioners and dentists with specialist orthodontic expertise. We hope that that will go some way towards relieving the problem.

I hope that my hon. Friend will be assured that we are moving forward very quickly. I accept the fact that some of her local dentists may have been anxious to know the details of the new contract and what their own contract values were, but I hope that in the coming period we will be able to show them exactly what the benefits are.

I reiterate that this is all about making the charging system simpler and taking dentists off the drill and fill treadmill. I think that it is a good deal in return for a good commitment to the NHS, and will ensure that dentists can do preventive work. That is built into the contract and the charging system. It is guaranteed for three years and it replaces the 400 current charges and the way in which dentists have been paid for those, with fixed monthly income.

I feel that that is a good deal and it goes alongside the increases in training that we have already started and the fact that we will increase dental schools. Altogether, I hope that dentists in my hon. Friend's constituency, while recognising that there are still concerns, will be able to benefit from the changes, and that patients in her area will be able to benefit as well. It is a good deal, it will be good for patients and I think that it will put an end to some of the problems that my hon. Friend has experienced in her constituency.

Question put and agreed to.

Adjourned accordingly at twenty-nine minutes past Six o'clock.