Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by Mr Stephen Day (D 16)

  I am a dental practitioner in general NHS practice with a special interest in endodontic treatment and I receive referrals in this field to my practice. Consequently I see and treat failures of endodontic treatment, mainly from the NHS sector, many of which could have been avoided with suitable initial treatment.

  My feeling shared by many others is that the present Statement of Remuneration allows substandard endodontic treatment in the NHS that has to be corrected later on with more unnecessary expense involved. That Committee was circulated with copies of a report published in two parts in 1997 and 1998 in the Dental Practice Board magazine, Dental Profile[1] which showed very low success rates for this treatment, in the order of 10 per cent. 4.6 per cent of the claims had no discernible root-filling present at all yet fees had been paid for this. The present monitoring system by the Dental Reference Service is ineffective in assessing claims for endodontic treatment since no post root-filling x-ray film is asked for nor copies of the notes. An x-ray film is the only way of assessing a root filling satisfactorily.

  Access to Dental Services requires money and dentists. Presently money is being wasted on ineffective root filling treatments as the present Statement of Dental Remuneration allows ineffective and outdated techniques and materials to be used. This incurs more expenditure for the NHS when later corrective treatment is needed to treat the failures. Dentists are reducing their NHS commitment to be able to carry out this sort of treatment effectively. It requires more time and the use of adequate equipment that is expensive, neither of which are funded by the very low NHS fees. In addition the medico-legal concerns at providing inadequate treatment are becoming more apparent. To continue working in the NHS doing this treatment will expose the dentist to possible erasure if compromise treatment techniques are forced on them by virtue of the economics of low NHS fees.

  Questions should be asked of the Department of Health why they have not changed the Narrative of the Statement of Dental Remuneration to insist on the use of materials and methods of treatment in line with current teaching practice. They were asked on 7 December 1998 by the Narrative Sub-Committee of the GDSC of The British Dental Association to remove silver points from the Narrative but they refused to do this in spite of the fact that this technique is ineffective, outdated and not taught anywhere in the Western World. The Dental Practice Board should be asked why the monitoring system allows claims for inadequate treatment to be made. Over £40 million a year is spent on root canal treatments in England and Wales yet no x-ray film is routinely asked for to check on the treatment carried out. This would not be difficult to organise with the use of double film packets for the final film, for which incidentally there is incredibly no requirement in the Narrative.

  Dentists are leaving the NHS because it is increasingly impossible to maintain treatment standards with the present fee scale and so there is an increased risk of medico-legal compromise. Many want to stay within the NHS as I do but we are being forced out by the poor economics of the present system if we are to maintain our professional integrity.

January 2001

1   Not printed. Back

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