By Caroline Ryan BBC News Online health staff

Children in the area have a high level of tooth decay

BBC News Online talks to one dentist who is piloting a new way of providing care. Four years ago, dentist Tony Drury-Smith wanted to retire from the NHS.

The stress of trying to care for patients under a system set up in 1948 had led Mr Drury-Smith, then 50, to become depressed and develop high blood pressure.

But he is now working under a new pilot system which he says is better for him and his patients.

These new working arrangements are set to be introduced across England by October 2005.

The money I have is equal to what I had before, but I have got much more freedom over how I want to use it Tony Drury-Smith NHS dentistry set for reform

Mr Drury-Smith's practice in a deprived area of Sheffield provides dental care to around 2,000 people.

He told BBC News Online: "We had a lot of tooth decay amongst children. But we weren't able to provide preventative care; to go out into schools or care homes."

On average, children in the area had eight dental cavities by the age of nine. The national average is 2.4.

Now he is able to spend time offering advice to parents about how to protect their children's teeth.

Fewer fillings

Under the old system, Mr Drury-Smith was unable to treat cavities until they had become serious - because that was the only way to obtain item-of-service payments for the treatment.

But since he began working under the new arrangements, he has had far more freedom over how he spends his budgets - meaning he can treat cavities without having to drill the tooth and put a filling in.

He added: "Also, in the past we had to replace a whole filling if there was a problem with it - because of the system of payment.

"But now, with minimal intervention, we can repair it, often under local anaesthetic."

Mr Drury-Smith added: "The money I have is equal to what I had before, but I have got much more freedom over how I want to use it. That's really marvellous.

He said: "The new system has reduced the amount of physical treatment we do.

"We've also got a lot of heavy smokers here, but we weren't able to offer smoking cessation advice. Now we can."

He is also hoping to be able to prescribe patches and gum to help smokers quit from April next year.

Other future plans include offering blood pressure and diabetes checks, and going into schools to offer dental health advice.

Pressure

Mr Drury-Smith said patients preferred the new system for a number of reasons.

"Before, the six-month check-up was sacrosanct. But now we use oral health assessments to decide when patients need to come back in. That can be in 12 or 18 months time.

"For patients that pay, that's important. And it helps convey the message that it pays to look after teeth and practice preventative care."

He added: "Under the old system, my big anxiety was the fact that you knew you were working under so much pressure that you might make a mistake.

"But now I enjoy my job."

He said a new way of working was desperately needed to keep dentists in the NHS.

"I have a colleague, 10 years younger than me, working under the old system, who is in the same position I was in, suffering health problems and considering retiring.