Contract changes that have seen more than 1,000 dentists leave the health service threaten to bring about the end of NHS dentistry, MPs will be warned next week.
The introduction of financial penalties for missing targets has already seen twice as many dentists leave the NHS as the Government estimated.
Thousands more are questioning their future in the NHS because of the uncertainty surrounding their earnings, the British Dental Association (BDA) said.
Already, the changes have left an estimated one million extra patients without access to a dentist. Almost one in three children do not receive any form of dental care.
The BDA will warn the influential Commons health committee that the future of NHS dentistry is “at risk” unless ministers scrap the system.
The new contracts, introduced in April 2006, were designed to provide better access to dentists, and to simplify charges for treatment.
But the BDA said they had driven more than 1,000 dentists – not the official figure of 57 – to concentrate solely on private practice because of the “financial penalties and uncertainty they face”.
Under the new system dentists are forced to pay back money, often thousands of pounds, to their primary care trust if they do not meet a target for the number of NHS treatments provided.
Dentists say the system is patently unfair and does not properly measure the amount of work carried out. For example, they receive the same fee for giving a patient one filling as for giving that patient five fillings.
In addition, the targets are based on the number of patients each dentist saw in 2005, meaning those with expanding or shrinking practices face having to pay back part of their salary.
Dentists also complain that they have less time to advise patients on how to prevent future dental problems because of the “treadmill” conditions they are forced to work under.
The future of NHS dentistry is “at risk”, the BDA says in written evidence to the committee, because “dentists are facing financial penalties derived from untested targets”.
The BDA also accuses the government of “chronically underfunding” dental services. Spending on dentistry in the NHS is now just 2.8 per cent of the overall budget, less than in 2002.
Dr Anthony Halperin, the chairman of the Patients Association and a dentist himself, said: “Dentists are concerned that they are going to be even more squeezed and have to do more work for less money. Whereas many before saw the NHS as a career they are now beginning to question whether that is really the case.”
“Initially their places will be taken by patients travelling abroad. But as they become more established those dentists will also begin to look for more salary and move away from the NHS.”
Peter Ward, the chief executive of the British Dental Association, said the new contracts would drive increasing numbers of dentists from the NHS every year.
He added: “This situation is only going to get worse. Dentists who miss their targets by small amounts are not fined if they agree to make up the shortfall the following year. But if dentists are struggling to carry out enough treatments one year it will be harder to hit a higher target the next.”
A spokesman for the Department of Health said it was “fully committed” to expanding dentistry services. He added: “We have made it very clear to primary care trusts that they must deliver year-on-year improvements.”
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