NHS dentistry is moving towards a system of free examinations and payment for treatment, similar to that operated by opticians, a Labour peer has suggested.

Speaking in a Lords debate on NHS dental services last month (April 24), Lord Desai argued that dentistry was taking a similar direction to that of optician services. 'Had John Lennon not made them popular in the mid-1960s, nobody would have chosen an NHS frame if they could afford anything better. Opticians are a combination of NHS and private: we get our eyes examined and then we spend our money buying the frame. Something similar has happened in dentistry, which we have not quite acknowledged.'

Lord Desai pointed out that unlike general medical practice, dentistry and opticians were businesses. 'NHS entitlements to optical care are very basic, and the frames that one gets on the NHS are very basic,' he said. But opticians, he noted, 'have long ceased to be a subject for debate in the press.'

He added that there were 4,000 more dentists in practice than in 1997 and spending on dentistry was increasing.

Opening the debate, Lord Colwyn (Conservative), 'a semi-retired dentist with more than 40 years experience, of which 20 were in the NHS' called for more investment in dentistry and improved support for PCTs.

'If PCTs are to meet the oral health needs of their communities they must have the right resources to commission dental services successfully in terms of funding and expertise,' he said. 'It seems likely some PCTs with access problems may be adopting a narrow interpretation of their duties, focusing on spending at the level of their historic budgets, rather than a comprehensive assessment of local need.'

Lord Colwyn welcomed the decision to extend ring-fenced dentistry funding for PCTs to 2011 but said increased investment was needed. 'For too long investment in NHS dentistry failed to keep up with funding for other parts of the NHS.'

Baroness Gardner of Parkes (Conservative), a retired dentist, described the current situation as 'dire' and said people with disabilities were experiencing particular problems in accessing treatment. The pathway between community dental services and hospitals was not clearly defined, she said.

Dental tourism also needed acknowledgement, she added. 'I was sitting next to someone at breakfast in the House yesterday who was just off to have seven implants done in Hungary. He told me that to have it done here would cost £20,000, but to have it in Hungary would cost £7,000.'

Baroness Thornton (Labour) said increasing access was a priority for the government and the new system was working well. 'Lots of committed NHS dentists have realised, as the reforms have bedded down, that this is a workable system,' she said.

Mainly private dentists might be uncomfortable with the reforms because the resurgence of NHS dentistry challenged their businesses, she suggested. She cited Tower Hamlets PCT's fleet of mobile dental surgeries as particularly successful at improving access.