Children at risk in dentist funding row

Key quote "The result of this [change to the quota of NHS patients in a practice] means that your approach to measuring NHS commitment will result in patients, particularly children, being deprived of access to NHS dental services" - Colin Crawford, chair of the Scottish Dental Practice Committee

Story in full DENTISTS in Scotland are threatening to withdraw free NHS treatment to children in a row over the way allowances are handed out by ministers.

Dental practices currently earn tens of thousands of pounds in extra payments if they have enough NHS patients on their books.

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But the British Dental Association (BDA) says the definition of who qualifies for these payments is flawed and could mean that dentists do not treat as many children on the NHS in the future.

The Scottish Executive said last night it was "deplorable" to threaten to deprive children of dental care, but dental leaders said they were only pointing out the reality of the crisis facing the service.

Around 712,000 children - 66 per cent of all youngsters in Scotland - are registered with an NHS dentist.

Despite this, Scotland has one of the worst child dental records in western Europe. Figures in 2003 estimated that the level of tooth decay among five-year-olds in Scotland was 2.76 teeth per child - compared to 1.47 per child in England.

This could get worse if more children are denied access to dental care.

To receive their allowances from the Scottish Executive, dental practices must have at least 500 NHS-registered patients per dentist; of these, at least 100 must be NHS fee-paying adults. Children, pregnant women and those on benefits do not have to pay.

The Executive said the aim of the definition was to stop practices de-registering NHS patients and forcing them to pay more for private treatment.

But the BDA said the conditions for the commitment were "flawed" because dentists might practice in poor areas with few fee-paying patients, meaning they did not qualify for the payments.

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Because they did not receive the extra cash, dentists might have to rethink the balance of their practices, ditching NHS patients, including children, to make room on their lists for more private patients.

Colin Crawford, chair of the Scottish Dental Practice Committee, expressed his concerns in a letter to Lewis Macdonald, the deputy health minister.

Of Scotland's 836 NHS dental practices, 270 do not qualify for the extra money.

"The combined number of children and exempt adults these practices are seeing will be substantial," Mr Crawford said.

He said if practices did not get extra funding they would have to charge private patients more to subsidise improvements to NHS treatment or reduce the number of NHS patients.

"The result of this means that your approach to measuring NHS commitment will result in patients, particularly children, being deprived of access to NHS dental services," he said.

The Executive responded angrily, insisting there was a system in place to deal with practices with good reasons for not meeting the criteria, such as those in disadvantaged areas.

"What is unacceptable is for the BDA, or any individual dentist, to threaten to deny dental care to children as a means of extracting money for themselves from the NHS or from parents," Mr Macdonald said.

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"I hope the BDA will withdraw this deplorable threat to NHS dental services for children."

The minister said the main problem with access to NHS dentistry was for adults who were de-registered and then forced to pay privately.

He said this was why it was necessary to set a threshold for fee-paying NHS patients.

Andrew Lamb, the BDA's director for Scotland, said: "The BDA is not threatening to deny treatment to children.

"We are pointing out the reality of the situation if the minister does not reconsider the measures he has put in place.

"Dentists have to make business decisions.

"They are not trying to make money for their own pockets.

"They want to make money to invest in their service, to modernise the services they offer and give more preventive care."

Dr Nanette Milne, the Scottish Conservatives' health spokeswoman, said there was a "total breakdown of trust" between the BDA and the Executive.

She said: "Lewis Macdonald needs to explain how the Executive has let things deteriorate into a public slanging match."

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The SNP's health spokeswoman, Shona Robison, said: "Labour and the Lib Dems announced their plan for the future of NHS dentistry almost a year ago, but it appears a solution to this growing problem is no nearer."