Dentists say service at risk: Government pledges to safeguard NHS treatment as pay row vote may force patients to 'go private'

DENTISTS yesterday warned of a rapid decline in British dental health which would push standards back fifty years as members of the two professional bodies voted not to accept new patients for treatment on the National Health Service.

The action means that thousands of people not registered with a dentist - just under half the population is registered - will have to pay for private treatment, or have an increasingly difficult search for a dentist willing to take on NHS work. Millions of others face uncertainty about treatment.

The dentists' decision to confront the Government reflects their anger at an imposed fee cut which comes into effect tomorrow, the day the Secretary of State for Health, Virginia Bottomley, launches the White Paper, Health of the Nation.

She appealed yesterday for dentists to 'think long and hard' before taking any action that would harm NHS patients. She pledged to take 'all necessary steps' to safeguard NHS treatment, providing salaried dentists in areas where people could not register with an NHS dentist.

However, Robin Cook, Labour's health spokesman, accused the Government of risking the NHS dental services' future. If dental services were not saved, 'no part of the NHS was safe'.

Some Tory backbenchers privately accused ministers of 'mishandling' the confrontation - ducking the issue before the general election rather than setting up a fundamental review of dentists' contracts as promised. Health ministers said yesterday they hoped to announce details of the pay review within a week.

Members of the British Dental Association, and the General Dental Practitioners' Association, were balloted separately on possible action after the Government imposed a cut of 7 per cent in the fees for NHS work.

The cut is necessary, it says, because dentists are earning about pounds 8,000 more than the intended target salaries set by their pay review body. Dentists claim it would reduce the average salary of pounds 35,000 by between pounds 6,000 and pounds 7,000, adding that they are now doing 15 per cent more work. They argue that they cannot afford to practice at the proposed level of remuneration. The Government says the average salary is pounds 41,000.

The 16,000-member BDA voted by a majority (58-42) to stop taking all new NHS patients, whatever their age. They decided by a small margin (45-55) not to remove existing adult patients from their lists. An accompanying survey found that two-thirds of BDA members intend to expand their private practices. The more militant GDPA, which has 4,000 members, mainly from high street practices, voted to refuse NHS treatment to all existing patients and new ones not entitled to free care. More than 70 per cent of members were in favour of deregistering existing non-exempt NHS patients; more than 90 per cent voted to refuse treatment to new non-exempt patients.

The turnout in both ballots was about two thirds. However, dentists are under no obligation to take the action recommended.

The BDA said yesterday that the future for NHS dentistry was bleak and the drift of its members to private practice looked set to become a flood. Hundreds have left the NHS because they say fees are too low, and in parts of the South-east it is impossible to find an NHS dentist.

Joe Rich, chairman of the general dental services committee, said that unless the Government reversed its decision, it would be 'turning the clock back to the 1940s' when about 12 per cent of those under 19 had no teeth of their own. He said that he would appeal directly to the Prime Minister as a last resort to 'avert what will inevitably be a serious reversal of the improvement of the dental health of the nation'.

While advising members not to take new patients, the BDA said it would emphasise that a lower majority of its members were in favour when such action affected children and people exempt from charges. Now most patients pay 75 per cent towards the cost of care up to a pounds 225 maximum, with the remainder being paid by the state. Pregnant women, nursing mothers, children, students under 19 and those on low income are exempt from all charges.

Ministers remain phlegmatic and see a 58 per cent vote for action on a 68 per cent turn out as 'flag waving' - a warning of serious trouble to come if a better and more sensitive payment system cannot be found - rather than a full-blown crisis.

Dentists' dilemma, page 3