Why are some dentists reducing their NHS work just when the Government is promising great things for the future of the profession? Health Correspondent Barry Nelson talks to one North-East practice.

PEOPLE have been reading about the growing crisis in UK dentistry for years. With not enough dentists to go around, increasing numbers of patients are having difficulties in finding an NHS dentist. And continuing uncertainty over still undisclosed reforms for dentistry is not helping profession's morale.

Most of us in the North-East still take our local NHS dentist for granted but in some parts of the region, this cosy assumption has taken a serious knock. In February, hundreds of people queued for hours in Scarborough in the hope of registering with an NHS dentist. Elsewhere in the region, shortages of NHS dentists in Durham City, York and Easington have been reported.

In the last few weeks around 6,000 people in Darlington, previously a stronghold of NHS dentistry, have received letters explaining that one of the largest dental practices has decided to treat a majority of its adult patients privately. For many of those people, the letter will have come as an unpleasant shock. But the practice says that the overall response to the decision to switch to a private care plan to pay for treatment for all but children and exempt adults has had a good response from patients.

Jon Henley, one of three principals at the Cleveland Terrace Dental Practice, says: "In general we have had a positive response from our patients, who appreciate our reasons and what we are trying to achieve. Obviously, the changes will not suit everybody, which we can understand, but on the whole the response has been a very encouraging one."

Mr Henley says the practice has thought long and hard over the last 18 months about making the changes. Overwhelmingly, the main reason for deciding to change is the wish to get off the "treadmill" of NHS dentistry, to enable the practice to spend longer with patients to maintain high standards of care, he says.

Also driving the change is the relatively modest level of fees NHS dentists can charge for their services. These fees are set out in a 90-page list of permitted treatments, starting at around £7 for a check-up and going up to a maximum of £376. Patients usually pay 80 per cent of their charges with the rest topped up by the State.

According to the British Dental Association, this compels many dentists to see up to 40 patients in a single eight-hour working day. "Current NHS funding for dentistry is not keeping pace with the cost of running a well-equipped modern dental practice," says Mr Henley, who points out that other local practices have also moved into the private sector in recent years.

"The level of fees at present leads to a treadmill effect where we are working at such a busy pace, which makes it more difficult for us to give patients the length of time for their appointments that we would like. This leads to a very pressurised working day and is the primary reason for the change."

Although most adults who pay NHS fees for treatment will shift to a private dental care plan under the practice's changes, Mr Henley stresses that they are not going wholly private, with an associate dentist still treating adult patients on the NHS.

"We are still seeing children and exempt adults on the NHS. Our associate at the practice has taken on a considerable number of patients who still wish to receive their dental care on the NHS."

Details of the new Government dental reforms are still under wraps, despite plans to bring in wholesale changes from next year. The Government has said it wants to move away from paying dentists on a piecemeal basis to providing a guaranteed income in exchange for a commitment to providing a range of services to X numbers of local people.

But the Cleveland Terrace practice dentists remain sceptical. "The newly proposed funding for NHS dentistry, which plans for a locally negotiated salary, still raises more questions than it answers and there are many issues which we are still in the dark about. The proposal has also just recently been delayed from April 2005 to October 2005 and we still do not know exactly what it will offer," says Mr Henley.

What they find particularly frustrating is the claim that the new contract will help get dentists off the treadmill way of working. "It does not give explanations as to how this will happen. It proposes that dentists see a similar number of patients, or even an increased number of patients and do a similar amount of treatment. This would actually increase waiting lists," says Mr Henley. There is also concern at plans to increase check-up intervals for adult patients from six months to possibly two years. "This would only be suitable for a small percentage of patients," says Mr Henley, who believes the NHS could possibly become more of a core service, providing a restricted range of treatments with more complex work done in the private sector.

When asked whether there is anything that Health Secretary Dr John Reid can do to bring the practice back into the NHS fold, Mr Henley says: "It would be very difficult to find a system that would provide adequate funding to allow the time with each patient that we would like. Basically, funding would need to be increased to allow increased time with each patient, which would mean we would see fewer patients daily than we do under the current system. This would still lead to a manpower shortage." While many of the practice's patients have decided to go along with the plans to go private, dentists who take the independent road are not popular with some politicians.

Recently Durham MP Gerry Steinberg criticised dentists who leave the NHS, accusing them of being more interested in making money than providing a service for all.

Mr Henley and his colleagues reject this view. "We are not leaving the NHS to see adults who pay for their treatment privately in order to make more money; we are making the move to work at a more sensible pace to allow us to spend more time with patients. This will help us to continue to maintain high standards of care."

Despite moves to the private sector, most dentists in the North-East remain within the NHS, and the British Dental Association believes that will still be the case after the Government implements its reforms. "The devil will be in the detail. We will be working very closely with the Department of Health to hammer out the best deal for dentists and patients," says Jo Tanner, spokeswoman for the BDA.

But for David Hewlett, group head of primary care dental services with the Department of Health, this is the worst possible time to leave the NHS. He claims that hundreds of dentists around the country have already embraced a new pilot contract and found it to their liking.

Recently Dr Reid announced an extra £368m for NHS dentistry to allow extra dentists to be appointed and a plan to recruit 1,000 extra dentists by the end of October. "I would say to the practice in Darlington, 'for goodness sake think twice, come and talk to the NHS and give the reforms a chance,'" he says.

But after attending a series of meetings about the proposed NHS changes, Mr Henley says he and his partners still feel they have not been given the answers they need.