Progress on improving access to dental services since the introduction of the new contract in April 2006 has been 'disappointing', the government has admitted. But it remains confident that that the contractual arrangements give primary care trusts (PCTs) the power to commission appropriate local services.

The health select committee's report on dental services, published in July, (BDJ 205: 2, 54–65) concluded that access across the country was uneven following the introduction of the new contract, and that the number of patients seen by an NHS dentist had fallen. The report called for PCT dental funding to be allocated on local needs rather than a historic basis, improved PCT commissioning drawing on advice from public health specialists, reinstatement of registration, and a review of the UDA system and an increase in the number of treatment bands.

The government's response to the report, published on October 7, said: 'We accept the committee's view that progress on improving access to date has been disappointing and we will work with professional and patient groups to review how we can achieve the maximum benefits for patients from these reforms. The government fully accepts that more needs to be done.'

'The government is committed to developing a fairer formula for allocating funds,' the response stated. 'However, any new formula is likely to benefit the same areas where there have historically been more NHS dentists, as these tend to be the areas with greater oral health needs.'

In the response, the government agrees that more use should be made of dental public health specialists to improve PCT commissioning and says the NHS Management Board is working with strategic health authorities 'to agree high impact changes that will most rapidly improve access to NHS dentistry'.

'There is currently no shortage of dentists interested in taking up the new contracts being tendered by PCTs and interest in providing vocational training places is higher than ever,' it says. 'That said, we do expect that dentists holding restricted contracts – such as child-only contracts – may decide to leave the NHS as these are phased out. PCTs will need to be proactive in replacing these services as quickly and seamlessly as possible,' the response points out.

The select committee called on the government to investigate why the number of complex treatments carried out had fallen since the introduction of the new contract and suggested an increase in the number of treatment bands from three to five or more.

In its response the government says: 'We will review the bandings as part of our study of how NHS dentistry will develop over the next five years.' But, it adds, 'Any contractual currency has ultimately to rely on dentists delivering care to meet clinical need, and not allowing their judgement to be affected by the degree of remuneration a treatment will attract.'

The response acknowledges that there might be a case for bringing back registration, although it does not see this as essential for continuity of care. 'We recognise, however, the significance still attached to the term “registration” and will examine the scope and options for some form of registration in consultation with the dental profession,' it says.

BDA Executive Board Chair Susie Sanderson said: 'This response acknowledges the many issues facing NHS dentistry in England and Wales. We hope that the positive response to the BDA's call for dialogue with the profession and patient groups signals the start of a more constructive relationship between the government and the profession. We look forward to meeting the Chief Dental Officer to begin this process.'