Sir, I am writing in response to a letter about the new fees structure (BDJ 2005; 199: 249).

From an altruistic standpoint I am personally inclined to stay within the NHS, however, and I may be being a little too cynical here, I cannot help but see the whole PDS/new contract and the revised fees structure as a very well crafted method of removing dentistry from the NHS.

The PDS/new contract will have the dentist considering the treatment they provide from a 'how much will it cost me to treat this patient?' point of view, as the salary that they receive is predetermined and the laboratory bills will actually reduce their take home pay. I know that in theory we will have been paid for all of the work that we are anticipated to carry out within the salary, but human nature is inevitably going to lead to the pushing of private work to supplement that basic salary. Essentially why do an NHS crown and reduce your income when you can provide a private one and raise it?

Similarly the banding options for patient charges will almost certainly result in the provision of more private work. In dealing with a basic example, an examination and scaling costs £15 but when you add a single amalgam, no matter what the size, the price is boosted to £41

What then, is the response of your patient going to be when offered the provision of a private composite for only £25, for example? Not only is the overall cost going to be lower for the patient but they will have a nice tooth coloured filling as well! As for the dentist, they have gained £25 but have also been paid in anticipation for the NHS amalgam. This means that we can make more money short term and gain patient approval for our actions as they too will benefit, but the NHS will lose money as a result.

The long term effect of this will be that dental salaries will be renegotiated downward as productivity levels will have fallen, and then it will be necessary to maintain that private income to retain the current level of your salary. In short, unless we place ourselves on a self imposed treadmill maintaining our GDS productivity levels, then NHS dentistry has just been given a death sentence by the government.

The government has effectively shot NHS dentistry and managed to pass us the smoking gun, as it will be us who receive the bad publicity for electing to move over to private practice, while they have merely engineered a situation where the conditions are perfect for us to do so. How much money will they be able to claw from the dental budget as a result of this to plug a hole elsewhere in their spending? So much for a caring government; it makes a mockery of the promise to provide affordable dentistry for all.