HL Deb 01 November 1989 vol 512 cc244-6

2.58 p.m.

Baroness Gardner of Parkes asked Her Majesty's Government:

What provision is made in the proposed new NHS contract for general dental practitioners to ensure that NHS dental treatment will continue to be available to patients in high-cost areas such as the major cities.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)

My Lords, the new contract, with its emphasis on continuing care, will generally reinforce the profession's commitment to the National Health Service. The proposals have been welcomed by the General Dental Services Committee as better for dentists, patients and dentistry. The proposed pay structure will reward dentists who attract more National Health Service patients. We believe that that will be just as effective in the major cities as elsewhere.

Baroness Gardner of Parkes

My Lords, I thank my noble friend for that Answer. I know that she is aware that I retire just before the new contract comes into force, so this is not personal pleading.

Is she not aware that throughout the country in the high-cost areas other jobs and professions normally attract some form of weighting? I speak for London which I know best. Is my noble friend aware that in areas such as London, where rents and rates are so high and staff often have to be paid at a much higher rate because they want a form of weighting, dentists will find it impossible to accept those conditions? When she says that the profession has accepted the contract, is she aware that at a major meeting of the metropolitan section of the British Dental Association great concern was expressed about how dentists could possibly afford the additional overheads while still giving a proper service to patients?

Baroness Hooper

My Lords, there is nothing in the new contract that will make the problem of major city and London costs in particular any worse. The contract will enable legitimate mixing of private and National Health Service care. But we shall of course monitor the effect of the proposals and see how they work in practice.

Lord Ennals

My Lords, does the Minister accept that the last intervention by the Government in the dental price mechanism —namely, the imposition of charges for sight tests —was very damaging to patients' interests and to dental health? Will she now give an assurance that, whatever new formula is worked out between her department and the British Dental Association, it will not impose new burdens on the public in terms of charges?

Baroness Hooper

My Lords, the present pay system was introduced in 1948 when the main need was to encourage dentists to carry out as many fillings and other treatments as they could. Nowadays there is general agreement that we need a more preventive approach, a more even coverage of the population and to improve the service to the patient. Hence the proposed new contract. About 20 per cent. of dentists' earnings will be for all-round care, including preventive work, rather than individual pieces of work. Dentists have long argued that the fee scales should be less work-related, and they welcomed this change.

Lord Ennals

My Lords, with respect, I asked whether the Minister can give an assurance that that will not lead to higher charges for patients.

Baroness Hooper

My Lords, I see no reason why it should.

Baroness Gardner of Parkes

My Lords, I am sure that the Minister will be able to confirm the fact that 75 per cent. of the charge is now paid by patients. Will she confirm that she is aware that a practice, which is not considered desirable, of selective treatment is now carried out in high-cost areas whereby dentists carry out only profitable forms of treatment on the health service? Will she also confirm that, under the new contract, the selective system which has been used by dentists to survive in those high-cost areas will no longer be available, and that patients will have to have either fully national health treatment or fully private treatment; or will she tell us whether the Government are considering salaried community dentists, for example, particularly in deprived areas?

Baroness Hooper

My Lords, the new contract will not reduce the scope for private practice. Indeed, it includes proposals to liberalise the rules which limit the circumstances in which private treatment may be mixed with National Health Service treatment. If patients wish to receive private treatment from a dentist who previously cared for them under the National Health Service, they will, as now, be free to do so. The contract will ensure, however, that patients understand the options open to them and that, if they are accepted as National Health Service patients, they will have access to the full range of NHS treatment if they need it. I am sure that noble Lords will welcome this removal of any possible confusion to patients on their entitlements under the National Health Service. I must emphasise that in these proposals it is the interests of patients which come first.

Baroness Gardner of Parkes

My Lords, is the Minister aware that her last statement will put back the whole situation? We know, as she said, that patients will have the right to continue with private treatment, but we also know that dentists will not have a right to refuse any one treatment, whatever it may be. Therefore, my fear is that they may refuse all treatment. That is my point. Is the Minister aware of that problem?

Baroness Hooper

My Lords, as I said previously, the profession welcomed the opportunity to negotiate a new contract which it felt was long overdue. The new contract offers benefits for dentists which they welcome, in particular, greater clinical freedom and a stable flow of income. The contract is unlikely to have the effect of driving dentists away from the National Health Service. There is a strong feeling among many members of the profession that demand will increase and that people will be attracted as a result of the new proposals.