“As it is at the moment, the situation for patients is getting worse and there doesn’t seem to be much chance of that changing any time soon.”

It is a downward spiral that shows no sign of letting up. As more and more disillusioned dentists opt to go private, resulting in large numbers of patients not having access to dental care, or having that access restricted due to the costs of treatment, the impression of a service on the brink of meltdown becomes increasingly clear.

Drastic measures are needed and fast. The Scottish Executive has proposed a £295 million package to help lure dentists back from the private sector. This has been rejected, however, leading to accusations that dentists are simply demanding too much and are in effect holding the authorities to ransom.

So are dentists being too greedy?

“Despite the common perception, the situation is not at all about money,” said Frank.

“The idea that this is about pay is just wrong. Colleagues I have in the private sector are not earning any more than what they were in the NHS.

“Working as a dentist has always been stressful and it always will be. That has always been the case. It is the reality of our profession. It’s sad to say that Scottish teeth are not good and there has always been lots of people to see and treat.

“The problem with the failed health service approach to dentistry is that it hinges on seeing patients quick. And if they see them quick this year, then they have to see them a little bit quicker the next year and then even quicker the year after.

“We are expected to meet these impossible targets. We are not able to spend enough time looking after our patients and cannot carry out the necessary treatment in the time we are given.

“It is not a case of being greedy or holding the NHS to ransom. This is simply the reality of the way we are having to work today.

“We want to be able to offer better treatments and preventative treatments. At the moment there are not enough hours in the day to do that. We have to just react and treat patients when they have a problem.

“The money that has been offered is dependent on a set number of patients being treated on the NHS. It comes down to having the necessary time to look after our patients and we do not have that.

“The big difference in the private sector is the time dentists have with patients. There is adequate time to do things, while the NHS expects us to do far more in a lot less time.

“It is extremely disheartening. I teach part-time at the Dental Hospital in Dundee and we always tell the students they have to do things properly, but under the current NHS system that is impossible.”

Fife has been particularly badly hit by the crisis, with more than 10,000 patients having their registrations withdrawn this year alone as dentists opt out. Frank himself says he has been left with no choice but to leave the NHS and offer private care.

“I have always had a good relationship with and been committed to the NHS and dentists like myself are not leaving the NHS through choice,” he continued.

“We are being forced to make this decision. I have been telling my patients this is the last round of free treatment they will receive and it is up to them if they opt to stay or try to find another NHS dentist.

“I think NHS Fife is a very good organisation and they are doing their best by setting up access centres for treatment and employing dentists from Poland to relieve some of the pressure. But the fact of the matter is these are not long-term solutions to the overall problems.

“In 2003 the Scottish Executive embarked on a long-term consultation process to look at reforming the dental service, but two years on nothing much seems to be happening. There is talk of improved funding packages, but they are not being implemented.

“The Government needs to stop paying lip-service to dentistry. Dental diseases are the most common diseases in Scotland. The problem is the service is taking a step back instead of a forward step. We are developing better techniques for treatment all the time, but we are unable to use them.”

The Evening Telegraph asked the Scottish Executive if they would like to comment on the story, and Deputy Health Minister Lewis Macdonald said, “It is disappointing that some dentists choose to deregister NHS patients, and patients should feel free to tell dentists what they think about that decision.

“We announced a massive funding package earlier this year that will build up over three years, from £200 million in 2004/05 to £350 million by 2007/08.

“We are increasing the number of salaried dentists employed across the country so that patients will begin to have a real choice of where to access dental treatment.

“We have also responded to the concerns raised by the profession. We will dramatically slash red tape by reducing the ‘item-of-service’ fees from over 400 items to around 50 — freeing up dentists to spend more time caring for their patients.

“Our rent (or rent-equivalent) reimbursement scheme will relieve them of a huge financial burden and is one of several innovative incentives we announced to help NHS dentists out with overheads.

“We have always acknowledged the current difficulties accessing NHS dental services would not be solved overnight.

“However, I am confident that with the measures we are taking people will begin to see a steady improvement in NHS dental services across Scotland in the coming months.”