NHS DENTISTS In High Wycombe are facing a critical decision; whether to sign up to a new contract, or jump ship and join the growing number of private dentists in Bucks.

In this week's Focus reporter SITALA PEEK looks at the supporters and opponents of the contracts from the perspective of a practice in Loudwater that has been piloting the forerunner to the new system which comes into effect in a fortnight.

MILLHOUSE Dental Surgery, in London Road, Loudwater, was established last year and serves 5,000 NHS patients.

For the past 12 months it has been trialling the Personal Dental Service, a fore-runner to the new NHS contracts, which partner Carlos Clark says has worked very well.

The main difference between the new contract and the PDS scheme are the types of quality control checks.

Under the PDS, the practice was given a fixed amount of money to treat 5,000 patients for a year.

Dr Clark said: "We had a fixed income and there was no pressure.

"We worked the same hours and had more time to treat patients. It meant we could get off the conveyor belt system, that NHS dentists always complain about and budget and plan ahead to run more efficiently."

The downfall was there was no way to measure productivity or efficiency and ensure tax payers were receiving value for money.

Instead the Department of Health (DOH) chose to measure the practice's success according to how many NHS patients it served and by monitoring its standards of care and levels of customer satisfaction.

Inspectors from the DOH visited the practice to check standards were being maintained and patients were satisfied with the level of care and attention they were receiving.

The practice scored one of the inspector's highest rankings and is now in a position to take on 1,000 more NHS patients in the next 12 months, because it has effectively managed its existing patients' needs through treatment and prevention advice. Other dentists are more sceptical though.

The British Dental Association, which represents dentists nationwide, is opposed to the new contracts. The DOH says they will increase NHS dentist availability and simplify patient charging.

Michael Dods, of Conway House Dental Surgery, in West Wycombe Road, High Wycombe, used to treat children on the NHS but has recently opted out of the system because he believes the new contract is unworkable in the long term, will reduce dentists' independence and result in worse patient care.

He said: "Many dentists, including myself, have found the constant changes in the NHS contract have just made it more and more difficult to provide a good standard of clinical care and at the same time maintain a comfortable working relationship with our patients.

"This has resulted in more dentists jumping ship and allows the Government and DOH to turn round and blame dentists for the gradual collapse of NHS dentistry.

"It would be more honest of politicians to admit that it is impossible to fund a fully comprehensive NHS dental service for everyone when there are so many other demands on the health budget.

"They could then concentrate on providing a satisfactory core service for children, the elderly and other needy or disadvantaged sections of society."

To some extent Dr Clark agrees with Michael Dods that productivity targets (UDAs) are simply itemised payment in disguise.

He said: "Yes we are still on the treadmill, under a new name, but I can see the other side too.

"Taxpayers want a good value service. Measuring productivity allows you to show tangible value."

In the new contract, the practice has a target of five UDAs per hour, which amounts to two routine 15 minute check ups, worth one UDA each and a half hour filling and check up worth three UDAs.

"I think most dentists would agree that sounds very reasonable and is what we would expect to achieve at the moment. But it only takes one person who needs ten fillings, which is at least four 30 minute visits, to put you behind," he said.

Nevertheless Millhouse Dental Surgery signed up for the new contract this week.

"We have two choices," Dr Clark added: "Either to accept the new contract system and try to make the best of it or to opt out and go private.

"The previous system needed an overhaul and the way the PDS was heading seemed an ideal solution.

"In my view the new contract is a compromise. I hope it works but we shall see."