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 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.

Diagnosing the pain

21,111 NHS dentists were registered on March 31, 2007. There were 20,887 at the end of 2006

46% of adults are registered with a dentist

62.9% of children are registered with a dentist

500,000 fewer patients were seen by dentists in the two years after the introduction of the 2006 contract than in the two years before it came into force

45% of dentists in a 2007 survey said that they would not be accepting any more patients

£16.20 the basic NHS dental charge, which includes an examination, diagnosis and preventive care

80% of the cost of treatment is met by NHS patients who are not exempt

50% proportion of an average dentist’s income from private work. In 1993 it was 6 per cent

Source: Times database

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