Sir,- The Office of fair trading report into private dentistry contains some excellent suggestions, the implementation of which should, in broad terms, serve the public interest well. However, one aspect requires very close examination before it is allowed to pass.

The press release from the OFT refers to dental patients as customers. The BDJ has recently hosted correspondence related to the ethical marketing and selling of dental procedures. Columns are related to the 'business of dentistry'. Nevertheless, the financial constraints on public support for provision of dentistry and the OFT examination of the alternative should not cloud the central issue. Dentists are not retailers. They have a professional responsibility for the standard of care and advice offered and unlimited professional liability.

Dentists do not leave, or choose to practice outside the NHS, because they are greedy individuals looking for vast incomes. They make that decision on the basis of the need to be comfortable with a system of professional ethics. They are aware of an exponential growth of litigation against them: litigation which is often generated because they have tried to provide the best care they can in limited time available, only to find that both ethically and legally, lack of time is not a justification for compromise to the standard of care provided.

The OFT has been excited by the cost differential between NHS and private fees. Many individual dentists, specialist societies and organisations have campaigned for years about the pressure on the standards of care that the terms of service available through the NHS imply. The OFT now wishes to introduce an effective system for the monitoring and enforcement of standards in private dentistry. Had there been an effective system for monitoring and enforcing the standard of care delivered through the NHS, then successive governments would have been publicly embarrassed by the woeful under-funding of NHS dentistry. As it is, even the rudimentary controls exercised by the DPB through the DROs are scheduled for the scrap-heap under 04C. There is no rule more simple, either for the retailer or for the customer, than 'You get what you pay for'.

If the election not to practice under the terms of the Health Service is to be pursued by the OFT on the basis of restricting the flexibility to charge a particular fee for a particular service for a particular patient in particular circumstances, it will represent a constraint on the patient to choose to buy the amount of time that an ethical practitioner believes to be necessary to provide a high standard of care.

The glowing reference made by the OFT to terms of service in Holland is particularly interesting in this respect. Private fees are capped in Holland. There is very little scope for variation, irrespective of the variation either in the degree of clinical challenge or in the skill and experience of the operator. There is complexity and diversity in any biological system. Fees scales need to be flexible in order to reflect that variability.

No one could dispute that a patient is entitled to information in advance about the availability or cost of consultations and treatment. Thereafter the decision is up to the patient. It is 'social engineering' of the most patronising and invasive sort to seek to control that professional relationship.

The dentist is a professional and most of us believe that that is greatly in the best interest of the public. Any change in the terms of service which conflicts with or diminishes that professional ethic will not be in the long term interest of patients.