Fitting the treatment to the words:-NHS Regulations, Bands, Forms and

UDAs

Southway Education CentreFriday 21 September 2012

Richard Elvin

General Practitioner

Chair of Annual Conference of Local Dental Committees GDPC Representative for

Hertfordshire

(General Dental Practice Committee)

Hertfordshire Local Dental Committee

Why is there NHS dentistry

Primary Care Trusts (PCT’s) have an obligation to provide access to NHS

dentistry within their area

How do PCT’s provide NHS dentistry

They commission it

Who do they commission dentistry from

• Individual dentists• Groups of dentists• Corporate bodies• Anyone who can provide the dental services

the PCT is looking for

General Dental Contract

• A fixed amount of money• A fixed amount of Units of dental activity

(UDA’s)

What does contractor have to provide

Mandatory Services

Mandatory servicesThe Contractor must provide to its patients……all proper and necessary dental care which includes

• the care which a dental practitioner usually undertakes for a patient and which the patient is willing to undergo

• treatment, including urgent treatment, and• where appropriate, the referral of the patient for

advanced mandatory services, sedation services or other relevant services

Treatment referred to includes

• Examination• Diagnosis• Advice & planning of

treatment• Preventive care &

treatment• Periodontal treatment• Conservative

treatment

• Surgical treatment• Supply and repair of

dental appliances• The taking of

radiographs• The supply of listed

drugs and listed appliances

• The issue of prescriptions

Contractors must also

Follow NICE guidelines with respect to interval recalls etc

Providers/performers

• A provider is the contractor with the PCT• A performer carries out dentistry• Most providers are also performers• Performers also called associates

Units of dental activityUda’s

• A unit of dental activity is earned/awarded for carrying out dental treatment

• All dental treatment is categorised into ‘bands’(apart from 4 items)

• Uda’s are awarded for each band of treatment

Treatment bands

• Band one• Band two• Band three• Band one - urgent treatment

Band 1

• Examination, case assessment and report, diagnosis and treatment planning

• Orthodontic case assessment and report• Radiographs, including panoral and lateral

headplates and report• Study casts including in association with

occlusal analysis• Taking material for pathological examination

Band 1

• Instruction in the prevention of dental and oral disease including oral hygiene instruction and dietary advice

• Surface application as primary preventive measures of sealants* and topical fluoride preparations

• Scale and polish and marginal correction of fillings.

Band 1

• Adjustment to and easing of dentures and orthodontic appliances

• Treatment of sensitive cementum

Band 2• Fillings - amalgam, composite resin, synthetic

resin glass ionomer, compomers, silicate or silico-phosphate including acid etched retention

• Sealant restorations*• Root fillings* - permanent or retained deciduous

teeth

Band 2

• Extractions• Oral surgery including surgical removal of

cyst, buried root, unerupted tooth, impacted tooth or exostosed tooth and alveolectomy.

• Soft tissue surgery in relation to the buccal cavity and lips.

• Pulpotomy• Apicectomy• Transplantation of teeth

Band 2• Non-surgical periodontal treatment

including root-planing,deep scaling, irrigation of periodontal pockets and subgingival curettage

• Surgical periodontal treatment, including gingivectomy, gingivoplasty or removal of an operculum, raising and replacement of a mucoperiosteal flap, curettage, root planing and bone resection.

• Free gingival grafts

Band 2

• Relining and rebasing dentures including soft linings.

• Addition of tooth, clasp, labial or buccal flange to dentures.

• Splints (other than laboratory fabricated splints) in relation to periodontally compromised teeth and in connection with external trauma.

• Bite raising appliances (other than laboratory fabricated appliances)

Band 3

• Crowns• Inlays*• Veneers• Bridges• Dentures

Band 3 - Crowns

• Full or jacket crowns in alloys containing not less than 33.33% fine gold or platinum or palladium, or alloys containing stainless steel or cobalt chromium or nickel chromium,with thermally bonded porcelain.

• Crowns in porcelain, synthetic resin and other non-metallic crowns.

Band 3 - Crowns

• Full or three quarter crown cast in alloys containing not less than 33.33% fine gold or platinum or palladium

• Full or jacket crown cast in alloys containing stainless steel or cobalt chromium or nickel chromium

Band 3 - Veneers

• Porcelain, composite or acrylic mastique veneers, including acid etch retention

Band 3 - Inlays

• Inlays, pinlays, onlays and palatal veneers, in alloys containing 60% or more fine gold, porcelain, composite resin and ceramics

Band 3 - Bridges

• Bridges in alloys containing 60% or more fine gold with or without thermally bonded facings.

• Bridges cast in alloys containing stainless steel, cobalt chromium or nickel chromium, with or without thermally bonded facings

• Acid etch retained bridges.• Bridges in other materials.

Band 3 - Dentures

• Provision of full or partial dentures, over dentures and obturators in synthetic resin or metal or both synthetic resin and metal, including any cast or wrought metal components or aids to retention

• Orthodontic treatment and appliances.• Other custom made appliances excluding

sports guards

Band 1 Urgent treatment

• A prompt course of treatment is provided because, in the opinion of the Contractor, that person’s oral health is likely to deteriorate significantly, or the person is in severe pain by reason of his oral condition, and

• treatment is provided only to the extent that is necessary to prevent that significant deterioration or address that severe pain

Band 1 Urgent treatment

• Urgent treatment for acute conditions of the gingivae or oral mucosa including treatment for pericoronitis or for ulcers and herpetic lesions,and any necessary oral hygiene instruction in connection with such treatment.

• Incising an abscess• Dressing of teeth and palliative treatment

Band 1 Urgent treatment

• Provision of post-operative care including treatment of infected sockets

• Pulpectomy or vital pulpotomy• Re-implantation of a luxated or sub-luxated

permanent tooth following trauma including any necessary endodontic treatment

• Other treatment immediately necessary as a result of trauma

• Treatment of sensitive cementum or dentine

Band 1Urgent treatment

• Extraction of not more than two teeth• Not more than 1 permanent filling• Repair and refixing of crowns, bridges• Temporary bridges• Adjustment and alteration of dentures or

orthodontic appliances• Examination, assessment and advice.• Radiographic examination and radiological report

Band UDA values

• Band 1 = 1 UDA

• Band 2 = 3 UDA’s

• Band 3 = 12 UDA’s

• Band 1 urgent treatment = 1.2 UDA’s

Patient charge

• Band 1 = £17.50

• Band 2 = £48.00

• Band 3 = £209.00

• Band 1 urgent treatment = £17.50

Band 2 or Band 1 urgent treatment

If you are doing a band 2 then you should show that an examination has taken place

Items exempt from charge

• Issue of a prescription 0.75 UDAs• Repair of a denture 1.0 UDAs• Repair of a bridge 1.2 UDAs• Removal of sutures 1.0 UDAs• Arrest of bleeding 1.2 UDAs

Free replacement• You can replace a restoration without

charge within one year* as long as it is the same provider and the same restoration

• Applies to any filling, root filling, inlay, porcelain veneer or crown

*The relevant period means the 12 month period beginning on the date on which the restoration was provided and ceasing twelve months after that date

Free replacement - not applicable

• If during the relevant period a person other than the Contractor has provided treatment on the tooth in respect of which the restoration was provided

Free replacement - not applicable

The Contractor advised the patient at the time and indicated on the patient record that:

• the restoration was intended to be temporary in nature or

• in the contractors opinion, a different form of restoration was more appropriate to secure oral health but, notwithstanding that advice, the patient nevertheless requested the restoration which was provided

Free replacement - not applicable

• The repair or replacement is required as a result of trauma

Continuation course of treatment

• If a patient needs further treatment within two months of completing a course of treatment, no further charge shall be levied provided the new treatment is in the same band or lower

* * *

Private treatment

• The Contractor may, with the consent of the patient, provide privately any part of a course of treatment for that patient

* * *

But…...

The Contractor shall not, with a view to obtaining the agreement of a patient to undergo services privately:

• Advise a patient that the services which are necessary in his case are not available from the Contractor under the contract

• Seek to mislead the patient about the quality of the services available under the contract

Treatment plans

Where the Contractor agrees to provide a course of treatment to a patient, it shall, at the time of the initial examination and assessment of that patient, ensure that the patient is provided with a treatment plan on a form supplied for that purpose by the PCT

- FP17DC

The treatment plan shall show

• Name of patient• Name of Contractor• Address and telephone number where

services will be supplied• Telephone number where the Contractor

may be contacted during normal surgery hours

Treatment plan

• Details of the services which are, at the date of the examination, considered necessary to secure the oral health of the patient

• The NHS charge• Any proposals the Contractor may have for

private services

Revised Treatment plan

• Where the services included in the treatment need to be varied, the Contractor shall provide the patient with a revised treatment plan

Treatment plan not needed

• No treatment plan need be provided for a Band 1 course of treatment or a charge exempt course of treatment

unless• There is private treatment involved• The patient requests written details of the

course of treatment to be provided

Summary care

• The Contractor shall provide the patient with a summary of the care and treatment provided under the treatment plan where the patient so requests because that patient intends to receive services from another contractor

Who are my patients

• There is no registration• Your patient for that course of treatment

only• No obligation to accept them for a future

course of treatment

Patient preference of dentist

Where a Contractor has agreed to provide services to a patient it shall

• Inform the patient of their right to express a preference from a particular performer, and

• Record in writing any such preference expressed by or on behalf of the patient

Patient preference of dentist

• The Contractor shall endeavor to comply with any reasonable preference expressed but need not do so if the preferred performer has reasonable grounds for refusing to provide services to the patient or does not routinely perform the services required by the patient within the practice

Terminating treatment

A course of treatment may only be terminated by virtue of

• Violent conduct• Refusal by a patient to pay NHS charges

prior to commencement of, or during, treatment

• Irrevocable breakdown in relationship between dentist and patient

Violent patients• Where a patient of the Contractor has

committed an act of violence against, or behaved in such a way against any of the persons specified….as a consequence of which that person has feared for his safety and the Contractor has reported the incident to the police

The Contractor may notify the PCT that it will no longer provide services to that patient under the contract

Refusal to pay charges

• The Contractor may refuse to begin a course of treatment or terminate a course of treatment prior to its completion..

If the Contractor has, in accordance with the charge regulations, requested that the patient pay a charge in respect of that course of treatment and that patient has failed to pay that charge

Breakdown in relationship

• Where in the reasonable opinion of the Contractor, there has been an irrevocable breakdown in the relationship between patient and Contractor and notice of such a breakdown has been given to the patient by the Contractor….

The Contractor may notify the PCT that it will no longer provide services to that patient under the contract

Failed appointments

• Cannot charge for a missed appointment• Send treatment off as incomplete after

reasonable time lapse • Can refuse to accept patient for a further

course of treatment if two failed appointments within designated time span

GiftsThe Contractor shall keep a register of gifts which are given to any dentist or member of staff by or on behalf of:

• A patient• A relative of a patient • Any person who provides or wishes to provide

services to the Contractor or its patients in connection with the contract

and have, in a reasonable opinion, an individual value of more than £100.00

Contract facts

• Contract value is paid monthly net of patients charges

• UDA’s are recorded by the Business Services Authority who send PCT’s regular updates

• Contract cannot be altered except by mutual consent

• Contract can be altered if in breach

Contract monitoring

• Mid year review

• End of year review

• Tolerance of 4% allowed

• Clawback under 96%

• Contract is open ended

BSA monitoring

• Vital signs monitoring• Data sets

PCT Monitoring

• Half yearly reviews• Full year reviews• Vital signs and data set reviews• Practice inspections• CQC visits• External audits of contracts

Additional income

• PCT may tender for additional UDA’s or access slots

• These may be recurring or non recurring• Additional services• Private treatment

Benefits - via Contractor

• Superannuation• Sick pay• Maternity pay• Paternity pay

Clinical Governance

The contractor shall comply with such clinical governance arrangements as the PCT may

establish….

Key points

• Be clear and open about costs• Do not say you cannot get this treatment on

the NHS if you can• Make it clear if any treatment is private• Try and be as open and honest with patients

as you can be

GOOD LUCK!