NHS dentists should be paid according to the number of patients on their list and penalised for shoddy operations that require repeat visits, an independent review has recommended.

The proposals, which have been accepted in principle by the Government, include changes to improve access to NHS dentists and to end the “drill-and-fill” culture of operations. The review said that dentistry had become too preoccupied with treatment rather than prevention over the past 60 years.

The recommendations include rewarding dentists for registering new patients and building up relationships with existing ones, similar to those between GPs and their patients.

Jimmy Steele, the lead author from Newcastle University, said that dentists’ responsibilities must be as much about ensuring that people understand oral health and diet as carrying out fillings.

A series of pilot trials will start in the autumn. Income will be determined on patient list size, quality of care and the number of courses of treatment.

The plans for patient registration have marked the return of a policy scrapped by Labour in its much-criticised dental reforms of 2006 — and which the Government said at the time would end the “drill-and-fill” culture. Figures show that around a million fewer people now have access to an NHS dentist in England than before the contract came into force three years ago.

Andy Burnham, the Health Secretary, said yesterday that he recognised that dentistry was “an area of unfinished business”. He accepted that the contract had been problematic and that some decisions could have been taken differently.

Professor Steele said that dentists would have as much as 50 per cent of their income linked to the number of patients on their books. “It’s an incentive to take more patients on,” he said.

The review also recommends that dentists have greater accountability. This could mean being penalised for faulty work and having to carry out repairs at no extra charge to the NHS. At present, dentists can charge local health trusts for a procedure and then charge again even if they are the reason why a patient has had to return for further treatment. Under the new plans, the points dentists receive for carrying out an operation would not be awarded a second time if restorative work had to be carried out within three years.

Professor Steele said: “It’s a basic principle of quality and warranty. If I think the filling that I’m about to put in, or the crown I’m about to prepare for, is not going to last three years, then I shouldn’t be picking up that handpiece.”

Other plans include a new system of patient charges, replacing the current three-band system with one of between five and 12 bands. This was in response to the view of some patients that they did not always receive value for money.

Professor Steele said that patients should be called in for check-ups based on their individual need between every three and 24 months. “The six-month recall has no basis in science,” he said. “It’s just got a long history.”

The review also calls for more focus on preventative healthcare, with the aim of teaching people how to better look after their teeth. Mr Burnham said this could include looking at people’s diet. He has long been in favour of adding fluoride to the water in deprived areas.

The 2006 contract, which was supposed to allow dentists to spend more time with their patients, was criticised by dentists, while they were accused of playing the system. Yesterday’s report included examples of dentists recalling patients too often, or choosing more profitable treatments for patients when a less lucrative alternative was available.

Professor Steele added: “In the last 60 years, dental services have all been about quantity. We need to make a jump — and it’s a difficult jump — to move on to quality, to accept that less is usually actually better.”

Norman Lamb, the Liberal Democrat health spokesman, said the “near-destruction of NHS dentistry will be one of Labour’s most shameful legacies”.

He added: “The Government has repeatedly botched efforts to reform dentistry services in this country. The NHS must learn from past mistakes and ensure that future reforms are rigorously piloted. It is also vital that the concerns of dentists and patients are listened to.”

Andrew Lansley, the Conservatives’ health spokesman, said that the review confirmed the comprehensive failure of the 2006 reforms.

“It is bad news for the Government that their own independent reviewer has highlighted a string of problems with NHS dentistry and recommended moving to a patient registration systemas Conservatives have proposed.”

John Milne, of the British Dental Association, said: “What is important now is that the Government pilots properly the changes it makes and engages fully with the profession and patient groups as we move forward.”

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