Thousands of NHS dental places are being created across Selby and York in a bid to crack a chronic shortage in the region. But how will this work? LUCY STEPHENS talked to the Selby and York Primary Care Trust to find out.

This April dental services across Britain will go through their biggest shake-up in nearly 15 years, as contracts devolve from the Department of Health to Primary Care Trusts.

But the new system has come in for heavy criticism from the British Dental Association, which has said dentists need more time to spend with patients.

The changes mean the 46 dental practices across Selby and York face a choice: either sign up to the new contract or opt out of the NHS.

This week two dental practices in the region announced they were taking the latter path, blaming the new contract for stopping their NHS work.

Last week there was more gloomy news when it emerged hopes of creating a new dental school had been dashed after the Government announced the 62-place school would instead be based in Devon and Cornwall.

It had been hoped the proposal, put forward by the universities of Hull and York, would have expanded the number of dentists in the region - the idea being that many would stay.

But the PCT has confirmed that some 28,000 extra NHS dental places will be delivered over a three year period. To date, 18,000 have already been delivered.

According to the latest figures, that leaves 9,978 dental places still to come - and PCT bosses are confident it will be done, whether dental practices in the region decide to sign up to their new contracts or not.

Kay Goodwin, director of strategic partnerships and localities for the PCT, says the trust can afford to be confident because under the new system it has control of its own dental care budget.

That means that if a dental practice opts to go private, the PCT will have both the responsibility - and, more importantly, the cash - to make sure any lost NHS services are re-provided in areas of most need.

"(Under the current system), if a patient knows that their dentist is going private, there's nowhere for them to go. Now we have a duty to provide alternative NHS dental services," said Kay.

Denise Smith, head of primary care delivery for the trust, said: "Now we have a dental budget, if somebody leaves we can commission another service, it gives us much more control."

The 18,000 NHS places already provided have been achieved because a number of dental practices had already signed up to expanding services with the Primary Care Trust, which has meant increasing provision to register new patients.

Come April, existing contracts will cease and the new regulations will come in - but the trust says if dental practices drop out of the NHS it will be able to commission alternative services for patients.

Despite a negative reaction to the new system from some dentists, Kay says it will bring increased security for patients.

"It's security for patients," said Kay.

"A patient can know that the PCT has a dental budget and the flexibility to commission dental services where there's most need. We can influence what happens and where it happens.

"We are currently working closely with our dental practices to negotiate the new dental contracts. Our main priority is to agree a new contract with each practice but if a practice does decide to leave the NHS we will be able to commission alternative NHS dental services for patients."

Two types of dental contract

Denise Smith explained that there were two new types of contract: Personal Dental Services (PDS) and General Dental Services (GDS).

A PDS contract will be issued for specialist services such as orthodontics. Unlike a GDS contract, which is open-ended, it has a finite finish date. But in either case, a dental practice can give notice to opt out.

At the moment, dentists are paid directly by the Department of Health for each bit of work they do, whether that is cleaning, fillings, or tooth extraction.

But the new PCT contract will say how many patients dentists will have to treat and how many "units of dental activity" - specific kinds of treatment - they undertake.

It will mean dentists get a fixed income rather than piecemeal payments.

SO what happens when you have a dental emergency - and no dentist? STEVE CARROLL reveals all.

THERE is nothing worse than a bout of toothache. You can't talk, eat or sleep. So when I was struck down with a nasty wisdom tooth infection, there was only one place for it - the dentist.

Only, I don't have one. Along with many other city residents, many dentists stopped taking NHS patients long before I thought about getting on their books.

With a swollen jaw and painkillers providing only temporary relief, a search on the internet revealed the worst. There was no one to call.

Most dentists are prepared to treat an emergency, but it's done privately and at a price. But for those of us without bottomless pockets, there is a way forward.

A call to NHS Direct on 0845 46 47 will put you in touch with the dental unit at the Monkgate NHS Walk In centre. Appointments can be booked daily during the week from 8.30am until 9am (it's best to ring at 8.30am to ensure an appointment).

I was saying "aah" on a dentist's couch within 20 minutes of making the call and, two days later, was in the middle of a course of antibiotics and, pain-wise, in a much happier place.

Updated: 09:54 Monday, January 30, 2006