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Last Updated: Monday, 29 November, 2004, 16:52 GMT
Can NHS dental access be improved?
Government plans to improve access to NHS dentistry are in danger of making matters worse according to the National Audit Office.

The reforms which are due to come into force next October are set to see a move from "drill and fill" treatments towards more preventative work.

However, the watchdog is concerned that primary care trusts, which will commission services, do not have the expertise required.

It has also warned that some dentists may end up cutting their commitment to the NHS due to a lack of detail about the changes.

What do you think? Can anything be done to improve the NHS dental service? Have you had problems registering with a dentist?

This debate is now closed. Read a selection of your comments below.

The following comments reflect the balance of opinion we have received so far:

There is a national shortage of dentists regardless of any moving to private only treatment
Jan Taylor, Glasgow, UK
My father is a dentist, and has worked solidly for the NHS since graduating some 30 years ago. What many of the general public don't realise is that several years ago the government drastically cut the number of dentistry places at universities, to the point where there is a national shortage of dentists regardless of any moving to private only treatment. Dentists also, unlike GPs - who are paid per capita from their lists - only receive payment for the treatment they provide, meaning they have to work constantly to ensure any income. My father, and many other NHS dentists, have lists of 3,4 or even 6000 patients to see - when 1500 is a realistic number to treat appropriately. Many work ridiculous hours, including 24 hour 365-day emergency cover for a relatively small wage.
Jan Taylor, Glasgow, UK

My dentist has been a pilot practice for a year now. I used to get an appointment about 2 weeks after phoning- it has just taken 12 weeks to get a check up and they are no longer accepting new NHS patients, so my girlfriend can't join the practice. Thankfully I am on the list and he's a good dentist!
David, Crosby

"I'm a dentist get me out off here" this is the latest catchphrase doing the rounds. Dentists are being delayed from entering into schemes to provide NHS care by the PCT's.
Dave the dentist,

NHS dentistry in this part of the world (Northeast Scotland) effectively does not exist. My wife travels to Glasgow to get dental treatment from our previous NHS dentist there. I myself have to use a private dentist but it can take a sizeable chunk out of my monthly income. The Government will undoubtedly lose many votes on this matter.
Thomas Masson, Aberdeen Scotland

The new contract will do nothing to help those poor souls who don't have a dentist
Donna Jackson, North Wales
I have worked as an NHS dentist all my career. In North Wales we have been told there is no more money available for dental contracts unless more practitioners go private leaving less of us to "share the pot". There is no-one left taking on patients and those of us left have waiting lists months long. We cannot take on any more patients ourselves and we cannot attract new dentists to the area. The new contract will do nothing to help those poor souls who don't have a dentist and may very well kill the last of the NHS dentistry and the little pride and goodwill that NHS dentists have left. We do not want to go private but we are being frogmarched down that road by a system that doesn't care for patient or practitioner.
Donna Jackson, North Wales

8 months ago I went to my dentist to find out why I hadn't received my usual 6 month check-up appointment. The practice had closed down without informing anyone, with a sign on the door informing me of the fact. Since then I've been searching high and low for a NHS dentist, with no luck. Luckily I've got good teeth so they're not a problem at the moment but what happens if I do have a problem with them? Looks like a trip to the local A+E.
Joe, UK

Could there be a means testing system in place? I recently registered at an NHS dentist in South East London without any bother whatsoever, perhaps because my husband has been on their books for his whole life. I do feel a bit guilty however because I could afford private dental treatment and I don't want to think that I am depriving someone less fortunate of NHS treatment. It seems to be completely random as to whether there is NHS treatment available or not.
Katherine, London, UK

They should work in the public sector for a few years at least. After all, it is our money who trained them.
Gerry Noble, Salisbury, UK

When a local dentist did advertise vacant NHS spaces the queue to register was about 1/4 mile long!
Lyn Edwards, UK

Unless you are on benefits - an asylum seeker or in prison - you have about as much chance of having NHS dentist treatment as pigs flying! I think that anybody who trains in this country should be made to work at least 10 years on the NHS to put back in some that they have taken out. When a local dentist did advertise vacant NHS spaces the queue to register was about 1/4 mile long! This country is going backwards I'm afraid, in more ways than one.
Lyn Edwards, UK

The dentists where I used to live all became private and I was therefore forced to go private. The care has been of a much higher standard and I am not keen to look for an NHS dentist now that I have moved. In terms of cost the private dentist is not really much more expensive and there is always plenty of time available for treatment during my appointment. Then again I do contribute to the NHS which is supposed to be free at the point of delivery... yeah sure.
Mark, Swindon, Wilts

I've just returned from a trip to my dentist. I earn 14k a year, and have just paid out nearly two hundred pounds to repair a tooth that broke during a fall on my way to work. I've got to go back for more treatment for preventative reasons and to replace some old fillings, so my final bill is going to be nearly five hundred pounds. I may be earning, but I just can't pluck five hundred pounds out of thin air. It'll have to go on my credit card, then I'll spend the next year paying it off, at a hefty interest rate.
Jennifer, UK

I think it is about time to move away from state dentistry and instead to move to fully privatized dentistry. We have got to the state now where subsiding the cost of a private operation in full is cheaper than providing it on the NHS. So surely we can benefit more people by fully subsidising in full all of those people who cannot afford treatment to get it on the private sector.
Nathan James, Liverpool

As I've not been to my old dentists for more than the prescribed time - so many months, I believe - I'm off their list, and have heard rumours of people travelling from York to Harrogate to find a dentist with space on their roll. I've never been able to understand why the NHS dental service isn't run along the same lines as the GP service - free at the point of need etc. Certainly, I can't afford the costs of a private dentist, since things like raising a family have priority in my budget.
Steve Brereton, York, UK

Thankfully painkillers are less expensive than the trip to the dentist
Sue, Tewkesbury, Glos
I have not seen a dentist for 10 years. I have at last managed to get on a waiting list for emergency treatment, I have 2 broken teeth, but have been informed the wait will be 12-18 months. Thankfully painkillers are less expensive than the trip to the dentist.
Sue, Tewkesbury, Glos

If you work and pay for the service you cannot use it. The only way I can get to use the service I pay for is to become unemployed and stop paying! I have been unable to register with a dentist for the past 18 months, I have need of dental work. All I get is told to ring back in 6 months. I have now resigned myself to the fact that now I will just have to take pain-killers when the pain gets too much to bear. Calling it the National Health Service is a joke. You ask if anything can be done to improve the NHS dental service, before it can be improved we actually need one.
Rob, Northants

There are plenty of NHS dentists in Bath but they will only take on people on benefits. Whilst it is right that the poorest citizens who can't afford to go private should be given priority, this policy is dangerous long term because it undermines support for the NHS among the middle class and wealthy people who are paying for the NHS. I personally resent the fact that I pay over 15,000 per year in tax, but can't get a dental check up on the NHS. I can afford to go private but that is not the point. If people like me could get the NHS treatment that we have paid for, we wouldn't resent paying for other people who were equally in need of treatment getting it as well.
Tim, Bath, England

If the government wants to provide an assured level of service under the NHS they should either buy existing practices, or set up their own, and employ the dentists just as they would hospital doctors and nurses. The fact is that they tried this, with the dental access centres, and found that it cost four to five times as much to provide care this way as it was costing to pay sub-contracting self-employed dentists.
Audoen Healy, High Wycombe, Bucks

I have lived in Kendal for 4 years now and I still have not been able to register myself and children with an NHS Dentist. I think it is appalling that there is no dental care for NHS patients in this area. I have approached virtually all the dentists registered in this area to no avail. I worry about this as my daughter has not had a check up for 4 years now - I just cannot afford to pay for private treatment - I have not had a check up since I had to go to the local hospital for an emergency appointment to have an abscess treated. That was 3 years ago. These reforms will just add to the problems, when more dentists will just turn their back on the poorer people of this country.
Kathy , Kendal, England

Near us, all the dentists in town sent letters to customers withdrawing NHS dentistry. This is nothing more than a cartel. In response a new NHS dentist opened, he was swamped with demand and has been cold-shouldered by the other private dentists. What price choice?
Peter Hitchmough, Disley, England

What NHS service. All dentists in my area have gone private, with no option but to go on the Denplan scheme where the charges vary according to the condition of your teeth. If you don't join their scheme they may reluctantly register you as a private patient and will be charged accordingly. But they won't tell you up front what these charges are.
P Samuel, Llanelli, Wales

There are already no NHS dentists in my neighbourhood which is a major area in London. More and more people will simply not go to the dentist because even with NHS costs the price of a visit is already expensive so to go private is not an option. On my last visit to my dentist before he went private he explained that teeth he treats are the worst they have been for 30 years because people can't get or afford "preventative" or corrective treatment. This is scandalous for such a tax-rich country.
Martin Clarkson, Croydon England

I grew up in the west country but now live in London. I have had to keep my dentist in the South-West because it has proved near-impossible to register as a new patient in London, meaning that twice a year I have to take a day off work to travel two and a half hours to see the dentist! If I can't make the appointment they send me, and have to re-arrange too many times, they threaten to strike me off their lists. How on earth can this possibly be a sensible way of doing things?
Allie, London

NHS dentists are now a very rare species. So rare, in fact, that many people go abroad for their dental treatment. On a recent trip overseas I needed dental treatment and was seen and treated quickly. The skill and care was as good as in this country and the dentist was amazed when she saw that I had a metal filling, saying that she would never give metal fillings. The cost of the treatment was also a lot less than in this country. I think my next dental appointment will be overseas.
James Dowling, Birmingham, England

I'd pay for treatment if I received a refund of the NI/tax I've already paid
Mike, Kendal Cumbria
At least one surgery here now refuses to do NHS work and all patients have been told to go private or find another dentist. However none of the local dentists are taking on new patients so they effectively have nowhere to go. My dentist is probably going to follow suit. Apparently a dental plan costs around 15-20 per month which a lot of people can't afford. I'd pay for treatment if I received a refund of the NI/tax I've already paid since they can't provide a NHS service anymore. I'm certainly not going to pay twice for it.
Mike, Kendal Cumbria

Aren't dentists trained at the taxpayers' expense? How can they expect to continue to receive state subsidised training if they don't accept NHS patients? By all means, let them set up private shop and get rich, but not at the taxpayers' expense. It's obscene that dentists receive training for a fraction of the costs incurred in other countries and then refuse to treat patients on the NHS.
Andy, Sheffield

I'm fortunate to be registered on my dentist's NHS book. For check-ups, scrapes, polishes and basic fillings it makes sense for me to have him do this work. More complicated cosmetic procedures, as we all know too well, often aren't covered and if needed I would, therefore, be tempted to go over to eastern Europe where I would get a comparable standard of treatment for a small fraction of the cost of private work here.
Patrick V. Staton, Guildford, UK

I am one of the few fortunate people still to have an NHS dentist but I am slightly nervous when I go to see him. This anxiety has nothing to do with the treatment. It's because he is always so angry with the Government and the NHS for the confusion, pettiness and what he sees as double-dealing. He is committed to providing a public service but feels driven to go private. Is this the same Government that claimed the NHS was safe in its hands!
Denzil, Devon

They should make it compulsory for all newly Graduated Dentist's to do at least 5 years of NHS dentistry before they go private. They get enough experience from the NHS when they are training, why can't they give something back?
Clive Rowlands, Chepstow

The government should either abolish National Insurance, or cover dental health for free on the NHS. Instead, NI has increased to a massive 10% super-income tax, and the NHS doesn't support the needs of the vast majority of the population - particularly those who have teeth. That many have to use (and pay for) private health-care, despite paying thousands of pounds a year for the NHS, which might treat some health problems within 4 or 5 years, is utterly wrong and the minister for health should be brought to book.
Gordon, Manchester

It is quite right that people who are earning should pay privately. The NHS should be reserved for life threatening illnesses. I can't understand why people would expect dentistry to be free except in some rare emergency cases. The idea of a 'free' check-up on the tax payer is simply bizarre.
Mike, Ipswich, UK

We now have a journey of 66 miles each way to visit our NHS dentist
Phil Cash, Sleaford, Lincs
My wife and I moved to Lincolnshire 2 years ago, and hunted high and low for a NHS dentist. Eventually we managed to find one in Bourne (Only 26 miles away). However, he went private last year, and we again started searching. There is no way I could even consider a private dentist, charging 30+xrays etc for a check up on my wage for us both. We now have a new dentist in Shepshed. This was the nearest one to us. We now have a journey of 66 miles each way to visit our NHS dentist. We went last month for a check up. Is this really acceptable in this day and age?
Phil Cash, Sleaford, Lincs

Well, it seems inevitable that soon the vast majority of UK tax payers will be having to cough up for private dentist fees. Already over 50% of those in England and Wales don't have access to an NHS dentist. I thought the recent hike in NI which gave several extra billion to the NHS was in part meant to resolve the dental crisis... I would like to see a map of where acute shortages lie as I suspect that in general, the Northern part of the UK is suffering the most - another example of the postcode lottery?
Tim Stevens, Aberdeen, Scotland

In the USA if your not a sports star or a pop star or maybe a lottery winner, then you can't afford to have your teeth fixed... thought you might like to know that.
Kev, USA

Being a resident of north Worcestershire I find that to all intents and purposes our local dental service has been privatised. It seems we have enough money to fund dubious wars abroad yet not enough to keep our population at home healthy - it's a crying shame!
Martin, Bromsgrove

There are no NHS dentists taking on new patients in the Fareham, Gosport and Portsmouth area. This has been the case for several years and is steadily getting worse. Until a year ago I was registered with an NHS dentist who hired dentists temporarily from overseas, this meant you saw a different often newly qualified dentist every visit. This has now stopped and I have to pay privately - the treatment is better but that should not be the case. We have all paid and in many cases still are paying with our national insurance contributions for dental treatment to be available on the National Health, it now seems that the new contracts the government intended to improve the system will make things worse.
Viv Muscroft, Fareham Hants

When I moved here over 12 years ago I was unable to register for an NHS dentist due to a disagreement between the dentists and the then Conservative government. I have had to go private since then. However the quality of service as a private patient is so much better and it has not cost me that much more. As a consequence I now wonder at the alleged purpose of the entire NHS. I strongly support socialised medicine but question whether it is being conducted in Britain in the best way for the patient.
Nigel Wilson, Buckingham UK

It's a poor reflection on the society of today that making more money by going private is more important than providing an essential service to everybody. Dentists, like doctors, should still be free to all patients.
Rob, Bristol

Somehow, they are expected to see more patients than at present
David Hazel, Fareham, UK
I had my regular 6-monthly check-up last week, and my dentist has absolutely no idea of any of the details of the proposed changes to the system, apart from the bare fact of it being administered by the PCTs and each individual dentist having to negotiate their contract directly. Somehow, they are expected to see more patients than at present, but in a more relaxed and less time-pressured environment and focussing primarily on those people who have greatest need of treatment. The two requirements are a flat contradiction of each other. Secondly, what is going to happen when, five years down the line, we ALL have greater need of dental treatment because of not having regular 6-month check-ups any longer?
David Hazel, Fareham, UK

I have been unable to register with a local NHS dentist since I moved to North Yorkshire over a year and a half ago. If this continues, I will soon be as toothless as the Government themselves!
Carl, Scarborough, England

All very well but, where I live you can't get an NHS dentist unless you are on benefits. There aren't any new ones opening, which is what we need. So, I've had to pay privately for nearly 10 years now
Mags, Newbury, UK

I think that a fundamental move away from a state provided health service to a privately run one, with benefits support for those on lower tier incomes would better serve our country in the long run.
Ben Hodgkinson, York, England

To Ben Hodgkinson - have a close look at the USA and what private healthcare can do. Millions of people with no healthcare, others afraid to lose their healthcare supplied by their employers. Nevertheless, your wish will come true. This and other governments are on a long road to privatising the health service. They learned from other countries who did it too quickly (New Zealand) and run scared of the taxes required to have an excellent system (Sweden). A state run system is the only one that stands a chance of being fair but it doesn't fit in our increasingly 'me-first' society.
David, Manchester, UK.

The main problem is that a dentist can make 3 times as much money working privately as they can in the NHS. Who would work for 20,000 when they could get 60,000 for doing exactly the same job? Dental students have 5 years worth of loans and tuition fees to clear...I can't blame them for doing it as quickly as they can.
Peter, Nottingham, UK

I had National Health treatment with a dentist in Basildon for 42 years and was then told that he would no longer treat me on the National Health as he was going to treat private patients only. I had always paid the National Health prices and he had made plenty from my treatment. I felt very hurt by his letter and that my loyalty to him for all these years had meant nothing.
Dorothy, England

NHS dentists 'may get scarcer'
25 Nov 04 |  Health
Q&A: Dentist reforms
25 Nov 04 |  Health

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