If NHS dentistry is to be restored in England, then it is necessary to understand what has gone wrong.

Before 2006 nearly every practice in England was basically NHS with a private element. Patients held the upper hand, and practitioners had to keep their patients satisfied because if you didn’t, they simply went elsewhere.

A decent NHS income could be made, and dentists could set up a practice wherever they felt there was a need.

The 2006 contract has totally changed the balance of power in basically three ways. Firstly, the dentists have become like hamsters on a never ending treadmill with contracts, targets to meet, dozens of administrative targets to satisfy the Care Quality Commission and the ever growing and demanding faceless civil servants who seem to have their own agenda for dentists.

The straw that has broken the camel’s back is a system where dentists can be expected to do six, seven, or even more items of treatment and only be paid for one. 

Finally, dentists can only open a new practice if approved by the Care Quality Commission, and NHS England, and this can take months with many hoops to jump through with no guarantee of acceptance.

Control is now very firmly in the hands of the private sector in dentistry, and we are left with two main sufferers. Firstly, the patients who can no longer access an NHS dentist or often even a private practitioner.

This huge increase in all private practices allows dentists to see fewer patients for more money. Secondly the dentists who have remained in the NHS because they feel obliged, or the area they are working in does not lend itself to charging the extortionate amounts of money we see and hear about.

The big question is what can be done about it?

The answer if dentists cannot be persuaded voluntarily to return to the NHS, then some degree of force needs to be applied.

The simplest answer would be to make it a condition of remaining on the dental register is that they have a minimum of 1,000 NHS patients who must be kept dentally fit.

There would obviously be a benefit to very many patients who cannot access an NHS dentist, and it should be very easy to look up your local dentist in a computer programme. One could easily be designed for the purpose which would show how many NHS patients were on the register for that surgery.

We must bear in mind that up to 40pc of the population never attend except for emergencies, so when this new system is up and running it should take care of the vast majority.

Dentists should qualify for a cash bonus if 96pc of their NHS practice are dentally fit at year end, rising if the number exceeds 1000, and the financial reward should be considerable enough and tax free.

In addition every hospital, and NHS 111, should know who the on call dentist in their area is, and every dentist would have to take turns to be on a rota. This system was in place when I arrived in Norfolk some 45 years ago, and it certainly works,.

Assuming the pre 2006 contract becomes live again, dentists will once again be able to speak with one voice. What happened in 2006 was dentists in different areas had different value contracts and the principle of divide and rule came into being.

 This would dramatically reduce the pressure on GPs and A & E.

As the contracts from 2006 would now become irrelevant, and so the huge number of civil servants who control NHS dentistry would now not be necessary, saving the Treasury a considerable sum of money.

This would remove the need for practices to employ managers who were employed because of the huge amount of administration required since the 2006 contract. This would lower practice costs dramatically.

Pre-2006 there was a system in place to keep a check on the honesty and standards. This was known as the RDO and every dentist would have work examined annually at least once, and more often if there were shortcomings. This should also be extended to private patients as well to ensure a higher standard of work was being carried out.

Finally, entry to dental school should not be based on exam results but on the likely aptitude of candidates. It is sad to hear of youngsters whose parent and grandparent were dentists but are not accepted because of the unreasonably high standard required academically. Statistically they will make a good dentist, but the profession is being denied this, and we are short of dentists.

In addition research needs to be done looking at the past 30 years of entrants to the profession to find out how long the new dentists were actually in general practice, and did they work full time or part time. This would  have implications when recruiting new undergraduates.

Ian Smith is a retired NHS dentist having practised in Norfolk for 45 years