EARLIER this month health minister Rosie Winterton said East Lancashire would see an extra 70,000 NHS dentist places by this time next year to ease the region's dental crisis. Reporter ANDREW TAYLOR talks to two East Lancashire dentists - one NHS, one private - to look at why so many dentists decided to go private and what still appeals about the NHS?

OVER the last two years dentists have been deserting the NHS in their droves, leading to a massive shortage of places.

East Lancashire has been particularly hard hit because of its poor dental health record and the number of people wanting to access NHS treatment.

When a dentist in Rawtenstall opened to NHS patients earlier this year hundreds of people queued around the block for hours to register.

And when an NHS dentist in Chorley announced it was extending its practice last month around 5,000 people turned up for the two-hour open day. Needless to say people have been left disappointed.

There have been tales of people being told to travel to practices as far away as Greater Manchester to receive NHS treatment.

The other option is to register for a private plan where patients pay a monthly fee to register and receive free or cut price treatments, depending on their premium.

But why did so many dentists leave the NHS? The exodus has been blamed on old working practices which have seen little change since the 1940s.

Dentists dub it the 'treadmill' because they get paid per treatment and the time they spend on paperwork means they have less time to spend with the patient.

But the Government is now hoping to tempt dentists back to the NHS through modernisation.

Their provision has been handed to local Primary Care Trusts who will receive government money to employ dentists, a system called Personal Dental Services (PDS).

It means they will receive a monthly salary, rather than being paid per treatment.

East Lancashire's PCT's are to get seven extra dentists from abroad between them.

NHS changes 'in right direction'

NHS dentist Hitesh Nayer, of Baxenden Dental Practice, Manchester Road, Baxenden, had considered turning his practice private because of the old system of working but decided to stay after warming to modernisation proposals. His practice is one of 15 in East Lancashire piloting the new Personal Dental Services (PDS) approach, due to be introduced nationwide next year when NHS contracts are scrapped. He said:

WE used to get paid per item and would charge the patient for the treatment and then get reimbursed from the Government. To earn a living we had to do as many treatments as we could but it meant we were never sure what our monthly income would be and we wouldn't get paid for work we did at the end of the month until the following month.

That is why dentists call it the treadmill because it's exactly that. You have to get people in and out to get paid, but for every item you charge for there is all the associated paperwork. You were so worried about chasing money off patients and the Government that you were unable to give the patient the attention they needed.

Private practices need around 1,000 patients per dentist to function whereas we needed three times that. I considered going private, but decided to wait and see how PDS would work.

Under PDS, which we started at the beginning of September, we have a contract with the local primary care trust and get a base line sum for the year from them. We charge the same, but get more time with patients and provide them with better care. This will enable us to start seeing patients that don't need to be seen every six months every 12 months instead.

PDS has given me the time to dedicate Wednesday afternoons to emergency treatments with patients being referred by NHS Direct from across the region. Before people would have to sit in a surgery for hours just to get seen.

It's at an early stage but I have definitely noticed a difference.

Hopefully it will keep dentists in the NHS.

Private practice 'benefits patients'

COLIN Cromie, of Cromie and Associates, Blackburn, has owned his Accrington Road surgery for the last 15 years and has been NHS contracted in that time.

However, in April he decided to introduce Practice Plan, a private dental plan in which a monthly fee is paid and the patient receives free or reduced price treatments. He said:

A LOT of dentists are going independent because they think it offers a more secure future than the NHS. The changes being made to the NHS system started two years ago, but dentists have been kept unaware of detail about what is happening and that made a lot of them worried about their future.

The changes are being made for the right reasons but as an individual dentist I would be working more for the same or maybe less money. It's not that dentists do not want to do health service work -it's just become very unattractive to them.

Since we went independent I've been able to see my patients when they need to be seen. If they phone up in the morning with toothache I can see them within 10 to 15 minutes. I want to do that for patients, otherwise what are they paying for?

The public have a misconception about dentists. All dentists are private sub-contractors and are not employed by the NHS, they just have a contract with them.

These contracts are being scrapped next year by the Government anyway and a dentist will either have to be employed by the Primary Care Trust or be independent. That is going to be very much a 'suck it and see' exercise.

When I was with the NHS I was seeing 60-70 patients a day and now I'm seeing 30-40. I've taken a slight pay cut but our working lives and patient service have been massively improved. Before I was going home every night feeling ill and dizzy - reducing my workload was essential.

People still want their treatment on NHS and it's not the health service's fault, they just can't get enough people doing the work for them.