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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!