NHS dentistry chaos

Dentists are extracting patients' teeth rather than carrying out more complex repair work because NHS reforms have failed, an influential MPs' committee says today. The Government's overhaul of dentists' contracts, which promised to increase preventive treatments, has had the opposite effect, the Commons Health Select Committee says. The changes were designed to improve the quality of dental care and end a perceived "drill and fill" culture, in which dentists sought to slash waiting lists with quick fixes. Instead, the committee has suggested that a new payment system had made dentists even more prone to avoiding time-consuming repair work.

The number of tooth extractions, many of them unnecessary, experts say, has risen since the new contract was introduced, according to evidence presented to the committee. At the same time, the volume of more complex work such as crowns, bridges and dentures has fallen by more than half.

Dentists used to be paid a fee for each item of treatment they provided, but they now receive an annual income in return for carrying out an agreed amount of work, known as units of dental activity (UDAs).

The MPs' report, published today, said it was extraordinary that the Department of Health did not carry out pilot studies on the new payment system before introducing it across England.

Data published this month also high-lighted failings in the reforms, which were introduced in April 2006. Almost a million fewer people are now seeing an NHS dentist than before the changes, a report from the NHS Information Centre said. Less than half the population was found to have seen a dentist in the previous two years.

Setting out today's report, Kevin Barron, MP, the chairman of the committee, said that the failure of the reforms was compounded by the department's astonishing oversight in not conducting pilot tests. "While we readily accept that in some areas of the country, provision of NHS dentistry is good, overall provision is patchy," he said. "Fewer patients are visiting an NHS dentist than before the contracts were introduced in April 2006, we heard little evidence that preventive care has increased, and patients seem less likely to receive complex treatments they might require within the NHS."

The British Dental Association said: "This is a damning report which high-lights the failure of a farcical contract that has alienated the profession and caused uncertainty to patients." The new contract was introduced in 2006 with the aim of reversing the decline in NHS dentistry. It eliminated the need to register with a particular dentist, and introduced the "unit of dental activity". But the department's financial estimates were hopelessly adrift. It predicted that payments by patients in 2006-07 would be 159 million pounds higher than they actually were. The shortfall meant that primary care trusts, which are responsible for dental services, found themselves short of cash to pay for them.

In addition, targets for the UDAs were in many cases unachievable, dentists found. Nearly half of all dentists failed to meet their UDA targets in the first year, according to the British Dental Association. Some were forced to pay back money that they had already been paid.

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Australia: Overstretched doctors turning away 'chronic' patients

When there are heaps of people wanting to get into medical schools, a doctor shortage is just plain government negligence. Why is money being spent on useless "postmodern" courses when funds for medical education are so limited?

STATE capitals are feeling the brunt of the nation's doctor shortage, with GPs in these previously well-served areas shutting their doors to new patients due to overwhelming demand. In some cases, patients are having to travel 20-30km from their homes to find a doctor who can see them. Some GPs are using fees to dampen demand, charging as much as $100 for an in-surgery consultation after 6pm.

Although governments for years deemed the doctor shortage to be a largely rural phenomenon, an analysis of GP statistics shows doctor headcounts are falling hardest in metropolitan areas, which have so far been largely overlooked by medical recruitment incentive programs. Workforce data for Australia's 115 locally based divisions of general practice shows that in at least parts of all mainland state capitals, the number of GPs and the number of services they provide annually have both fallen between 1995-96 and 2005-06.

At the same time, there has in almost all cases been a huge jump in the proportion of GPs in each division aged over 55, raising the prospect that the doctor shortages in the affected areas will worsen when large numbers of GPs start to retire.

In the Central Sydney division, the GP headcount fell from 680 in 1995-96 to 590 nine years later, while the population grew. The number of services provided by GPs in those years also fell, from 2.7 million to 2.4 million. Similar patterns were seen in at least six other Sydney divisions, while headcounts in many rural NSW divisions rose. Headcount falls were also seen in the ACT, at least eight divisions in Melbourne, two in Brisbane, four in Adelaide and three in Perth.

The real impact on the workforce would be bigger, because the trend towards more women qualifying as doctors has led to a reduction in the overall numbers of hours worked, as women are more likely to work part-time.

Perth GP Tim Lipscombe closed his books to new patients seven months ago, as have about half the doctors in his nine-GP practice. "I wasn't able to service my own patients and I was being inundated by patients with relatively complex chronic diseases who were coming from other practices that had closed," Dr Lipscombe said. "There are a lot of doctors around here near retirement age, who I have heard on the grapevine will be retiring soon. I'm not sure what's going to happen - it's pretty scary."

A practice in Indooroopilly, Brisbane, said some patients came from as far away as Ipswich or after ringing "six other centres and are unable to get in". "I know a couple of practices whose standard consultation is about $65 - and certainly out of hours, anything after 6pm is a lot dearer, around $100," said the reception supervisor, who asked not to be named.

Federal Health Minister Nicola Roxon said the shortage of GPs was "a real issue right around Australia". "This is an issue we're determined to tackle," she said. "The increasing number of doctors coming on-line over the next few years should make a difference, but we need to do more."

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