dental association is keen to see reform, having campaigned vigorously against the "flawed, target-driven arrangements" introduced in 2006 that are currently in place. in 2022, nhs england proposed a number of changes to the contract to reflect the increasing number of high need patients caused by the covid-19 pandemic. in scotland and northern ireland, the system works differently and relies upon a mix of capitation payments alongside item of service charges. an examination in scotland is free of charge to the patient, but pays the dentist £8.10. for most other items of treatment, the patient charge is set at 80% of the total fee. the fees paid are approximately one third to one half of what they were in 1948, once adjusted for inflation. performance in june 2015 the consumer group which? contacted 500 dental surgeries listed on the official nhs choices website and found that 31% of them were refusing to take on any new nhs patients. they called for the competition and markets authority to intervene to ensure dentists were complying with rules. the british dental health foundation. healthwatch england said that in some parts of england only a fifth of surgeries were accepting new nhs patients. the chair of the british dental association, said the “byzantine system” had failed dentists and patients. the bda said that the 2006 contract did not meet its purpose of improving access to nhs dentistry and concentrating on prevention, and had been criticised by patient groups, government, the health select committee and the chief dental officers for england and wales. in january 2016, more than 400 dentists signed a letter arguing that the nhs dental system in england is unfit for purpose and are whistleblowing publicly, to warn and expose the centralised failings to develop a proper national dental health and prevention strategy. in may 2022 the association of dental groups, a trade association. published a report on the gaps in nhs dental provision (or “dental deserts”) in england. it indicated that the number of dentists conducting nhs work in january 2022 was the lowest for a decade. it highlighted the areas of england with the lowest number of nhs dentists per 100,000 population and expressed the need for a levelling up of access. a lack of access to nhs dentistry presents risks not only for oral health, but also in relation to early detection of mouth cancers and type two diabetes. in july 2022 the british dental association released an article that the proposed changes to the nhs contract would do little to stop the exodus of dentists from providing nhs treatment, due to the high displeasure in the system.