Access to specialist dental services for children have been cut by up to 50% in some parts of the country.
An investigation by the British Orthodontic Society says the new NHS contracts for dentists in England and Wales is leading to longer waiting lists, and could put some new practices out of business.
The new contract was introduced in April to improve the quality and availability of dental care.
Orthodontists say it is having the opposite effect on specialist services.
We can increase our work level back to 400 children a year, but we’re stuck at 200 a year and we can’t do any more
Colin Purkis, orthodontist
Orthodontic treatment is needed for children with crooked or overcrowded teeth.
Patients are referred by a general dentist to have braces fitted. This can relieve pressure on the jaw and improve appearance.
But orthodontists say the new contract is effectively rationing treatment. It was based on workload during a reference period in 2005.
Orthodontic work takes one to two years, so payments during this reference period covered work started as far back as 2003.
Many practices have since expanded their service at the request of their local health trust. Orthodontists say that this increase in work was not taken into account.
The result is that practices all over the country have had to cut their case load.
In Shropshire, orthodontist Colin Purkis has had to reduce the number of children he sees by half.
They were seeing 400 cases a year. They were encouraged to expand their practice because Shropshire is recognised as an area of high need.
“We’re frustrated sitting here wanting to do work, and able to do the work. We can increase our work level back to 400 children a year, but we’re stuck at 200 a year and we can’t do any more.”
The Department of Health acknowledges that some orthodontic practices have expanded since the reference period for working out contract levels.
It adds that it remains up to local primary care trusts to decide whether to fund all these cases.
But Colin Purkis is angry with that response. He says the local primary care trust cannot afford it, when it has so many conflicting priorities for it’s limited funding.
He believes the government should change the contract values, not shift responsibility to a local level.
Like many orthodontists, Mr Purkis only signed his contract in dispute.
Michael Cheung believes the process has been a whitewash
They are waiting to hear back from the litigation authority. If this doesn’t increase the value of their contract, he is willing to take the department of health to court.
Mr Purkis explains that there was a statutory document stating that an increase in workload should be taken into account.
In Slough, another orthodontist, Michael Cheung has heard back from the litigation authority already.
He is one of the first to do so. Mr Cheung recently set up a new practice. He treated 1,000 children last year. This year, his contract only allows him to treat 100.
The litigation authority sent him a letter to say they could not force the local health trust to increase his funding. He calls the whole process a “whitewash”.
As for what he can do now, Mr Cheung is not happy about putting the children he can’t treat on a long waiting list.
He says he feels compelled to ask parents to pay for the treatment, rather than have them wait for years before it can start.
“I now have to persuade parents for the first time since the inception of the NHS 60 years ago that they have to pay for their children’s orthodontic treatment.”
But parents are not happy with this idea. Mike James has a 16-year-old son who has recently been referred.
He has checked his son’s position on the waiting list, and his treatment will not start for more than two years.
“To be told it will be two years before he’s even seen is just totally unacceptable.
“If he turns 18 then the NHS treatment that he could have now wouldn’t be possible. We could be faced with a bill of £2,000 to £3,000.”