Sir, those who read the BDJ of 10 March (volume 212 issue 5) will be aware that the British Association for the Study of Community Dentistry (BASCD) has written to the Secretary of State for Health reflecting the concerns of the wider public health community about the impact of the Health & Social Care Act on the NHS and its implications for health improvement and inequalities. The same issue carried an editorial by Paul Batchelor, a past president of BASCD, setting out these concerns in more detail and describing a future NHS that may resemble the system in the USA, with all its costs and shortcomings.

Those readers who have experienced previous English NHS reorganisations may see the latest one as the final step in a sequence aimed at creating a real market for health services in England, with a supporting bureaucracy that includes procurement, commissioning, contracting and performance management. Much of the increased cost of the NHS in recent years could be explained by the creation of this chain of processes.

My reason for writing is to point out a significant omission from the BASCD letter and the BDJ editorial, which is that the Act has much to commend it from a dental point of view. The irony is that the Act goes a long way to remedying the problems of a dental market but condemning the rest of the NHS to a similar learning process.

Dental services have always operated in a real market, albeit with one major purchaser. Dental practices are all private businesses and we have seen the emergence of national dental companies with significant market share. The lessons learnt from the 2006 contract were set out in the Steele report and the Department of Health (DH) has done a great deal to address these problems and create the conditions where dentists can work within a public health approach to dental disease. It has the potential to create a better future for dental services by a single, consistent commissioning model, an emphasis on oral health outcomes and the opportunity for GDPs to practise prevention, without the perverse incentives of the current (2006) contract. We have learnt the lessons of a private market in dental services and the 'commodification' of treatment and dental access with a heavy emphasis on activity and intervention where clinical decisions are influenced by the reward system.

The wider NHS could learn a great deal from our experiences. However, we are moving back from 'marketisation' where dental treatment, oral health and previously registration became commodities, often in short supply.

The last time BASCD expressed serious concerns about DH policy on dental services was in 2005, with a reversal of direction and the introduction of Units of Dental Activity (UDAs) as the contract currency. BASCD wrote to the minister at the time setting out their concerns about the effects of the new contract on access to services, oral health and the lost opportunity to move to a preventive approach. The outcome was an agreement to work together. Delivering better oral health was the result and it has become a major component of preventive practice.

I hope that once again BASCD will be able to work with the dental team at the DH on developing the preventive potential of a new dental contract.

1. BASCD President 2005-2006