Sir, my native country is Italy, where I have 23 years of experience as a dentist. I recently visited a family friend who is working as a GDP in a deprived part of north west UK. I was horrified to learn and witness the UDA system imposed on dentists in the UK. Any qualified dentist with a few years of experience would have foreseen the catastrophic consequences of this system.

There are pockets of deep deprivation in my friend's town where the majority of people have poor oral status and are in need of extensive treatment. On the contrary, other parts of the same town benefit from an affluent population who will barely need any treatment. It is absolute madness when dentists are required to do almost identical numbers of UDAs in such a system.

The dentist in question, using her dental software, has documented that on average each of her patients requires five fillings. I would expect the probability of periodontal and endodontic complications in the majority of these patients to be very high. Personally I would need approximately 20 minutes for restoring an average cavity. Five fillings including the cross infection procedures would require about two hours of my clinical time. I discussed the same issue with a periodontist who considers 2-3 hours of periodontal treatment/instructions as a minimum. His patients are expected to pay for his time, his staff's time and all other costs on an hourly basis.

Now replicating the same principles in an NHS practice, we could assume that a typical patient in my friend's practice is in need of estimated three hours of treatment. Each typical band 2 patient has been allocated 3 UDAs for all his/her treatment, therefore every UDA will require on average one hour of clinical work. An appropriate UDA allocation for each dentist in such a practice should be about 1,760 UDAs annually (1 UDA x 8 hours x 20 days x 11 months). However, the dentist in question is required by her NHS contract to deliver 6,000 UDAs annually.

The second issue in UK dentistry is the high regulatory regime which has been brutally policed by the GDC. The GDC is by far the most demanding and pedantic regulator in Europe and possibly in the world. Failing to perform an academic periodontal treatment and a periodontal six pocket examination (including all bleeding sites) based on a 6,000-UDA-environment will devastate a dentist's career. I have advised my friend to resign from her post as soon as possible and will question the sanity of any other dentist who has agreed to such conditions.

1. Rome