I welcome your inquiry into NHS dental and orthodontic services, because I feel very demoralised by the current state of affairs. I qualified in 1981 and I have always worked in general practice providing care for NHS patients. Until this new contract was imposed I had considered my work to be appreciated and well rewarded. Now I feel there are major problems with the service and the remuneration.

  The reforms were sold to us as a means of improving work balance by removing the "treadmill" of piece work, and to improve our ability to practice preventive dentistry, ie; advising to improve dental health rather than just treating disease. As far as I am concerned the connection between "work done" and "pay earned" is just as close yet not as fair, and there is a negative incentive to practice preventive dentistry.

1.  Under the old contract some dentists provided large volumes of complex work attracting huge gross payments which translated to 12 UDA's per course. Under the new contract they were allocated the same gross but can now provide just one crown per course and easily achieve their target UDA's. And more annoyingly they now have a reduced laboratory bill and thus are earning more money for doing less work. Why did no-one think to make laboratory bills part of the equation?

2.  We were told how many UDA's we were to provide for the same gross earned the previous year, yet there was no way we could check if that figure was correct. Now we are striving to achieve a target which is totally unrealistic, and for which the goals keep changing. Our interpretation of the rules differs from those of the PCT and the Practice Board in Eastbourne. We do not know how the Bands were allocated historically, whether the difference between Band 2 and 4 could be applied accurately by someone looking at old claims, not knowing the circumstances under which the patient attended on each individual visit. Over a year the accumulated score can alter considerably if more courses were allocated as Band 2 rather than as Band 4. Now we are committed to achieving an inflated target.

3.  I feel the target is also inflated because under the old contract we were able to make a separate claim for each child we saw who required an orthodontic examination. Thus our historical gross included this value but now under the new contract there is no possible way to earn the equivalent UDA value, so to make-up for this discrepancy we have to squeeze more patients into the time available.

4.  Achieving Band 3 for most regular patients is quite easy but they are subsidising those patients who have neglected their teeth. If a patient needs a number of fillings we have to try and squeeze as much treatment as possible into each visit, as each visit after the first means no UDA's are being earned for that time. Doing a lot of work in one visit is not ideal. Historically treatment could be split, for example extracting a tooth, waiting for healing then adding onto a denture. This would have given two Band 3 courses, however now the patient pays for a Band rather than for the actual treatment we have to hold the first course open and only gain one Band 3 for the same work undertaken. Again making it harder to achieve targets.

5.  There is a considerable problem with patients not keeping appointments. Under the old system we were able to make a charge, this helped encourage patients to attend and made up for loss of earnings. Now we are told there is no loss of earnings as a result of a patient failing to attend, but there is a potential for claw back at the end of the year if targets are not met. It is impossible to make-up lost time in a day, once an appointment is not used it is wasted time. A no show means no UDA and reduced earnings indirectly.

6.  I have had to reduce my target of UDA's ( hence my gross) to make the target reasonable, or rather to make my daily workload manageable. I have to earn 25 UDA's per day, this doesn't sound a lot about 4/hour. But if most patients are in the middle of a course on some days my total could be as little as 8, so I have to make the rest up on other days. The pressure is immense. I can afford to give a patient just 15 minutes for a full examination, scale and give advice. Where is the time for prevention?

Mrs H Diane Martin

12 November 2007