NEW GENERAL DENTAL SERVICES REGULATIONS

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NEW GENERAL DENTAL SERVICES REGULATIONS

• Bernard Swithern BDS MFGDP
• Dental Advisor

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AIMS

• To ensure that people dealing with patient
  enquiries have an understanding of the new
  contract regulations
• To ensure that there is a consistent approach to
  patient queries

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OVERVIEW

• Presentation based on currently available
  information
• Information is still being supplemented
• Presentation is a summary of regulations and does
  not claim to be exhaustive
• Expertise will increase with experience
• Will take questions as we go along

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SUMMARY

• Basis of old GDS contract
• Basis of new GDS contract
• DoH Objectives for change
• Units of Dental Activity
• NICE guidelines
• Patients rights
• Standards
• Practice-based considerations
• Reference documents

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Fundamentals of old contract

• Funding held centrally
• Dentists remunerated on item of fee basis
• Limitless amount of work and patients
• Unlimited contract value
• Patients registered with dentist
• Prior approval required for some treatments
• Dentists responsibility for out of hours service

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NEW CONTRACTPCT obligations

• Floor funded budget devolved to PCTs
• Responsibility of PCT to ensure that local
  population has adequate access to NHS dentistry
• PCT to monitor providers activity levels
• PCT responsible for out of hours service

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NEW CONTRACTdentists conditions

• Dentists entitled to specific annual contract
  value based on past performance
• Contract value for specified number of Units of
  Dental Activity (UDAs)
• Therefore annual performance is pre-determined
  and limited
• Patients no longer registered with dentist

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TREATMENT

• NHS GDS contracts Regulation 2006 part 5 section
  14.
• A contractor must provide all proper and
  necessary dental care which includes-
• That which a dental practitioner usually
  undertakes and which the patient is willing to
  undergo, including advice planning of treatment
• Treatment including urgent treatment
• Where appropriate, the referral for advanced
  mandatory services, domiciliary services,
  sedation services

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More on the new contract

• Patients no longer registered with a dentist
• Scope of treatment extended to include some items
  previously unavailable under NHS.
• GDS Regulations section 5 para 9. Mixing of
  services provided under the contract with private
  services..
• a contractor shall notadvise a patient that
  services which are necessary in his case are not
  available from the contractor under the contract
  ..or seek to mislead the patient about the
  quality

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• No prior approval
• Repair replacement of restorations 5.10 without
  charge within 12 months
• Premises 5.11 should be suitable and sufficient.
  Adequate waiting room. Provide adequate
  facilities and equipment
• Must nominate person in practice with
  responsibility for confidentiality
• Must establish maintain complaints procedure
• Informed consent. Use of FP17DC for bands 23

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DoH Objectives behind change

• Increase access to NHS dental services
• Reduce in Oral Health Inequalities
• Improve the patient experience
• Improve the working lives of dentists their
  teams
• Delegation of responsibility to local level
• Stabilisation of the dental budget

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UDAs

• Practice has set number of UDAs
• Allocation to practices based on weighted
  historic courses of treatment 2004-2005
• Three bands corresponding to patient charges

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BAND 1

• Diagnosis, Treatment maintenance
• 1 UDA
• Includes-
• Clinical Exam
• Radiographs
• Scale polish
• Preventive work
• Study models

14
BAND 2

• Treatment
• 3 UDAs
• Simple treatment
• Fillings including root canal treatment
• Extractions
• Periodontal treatment
• Surgical procedures
• Additions to dentures

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BAND 3

• Provision of appliances
• 12 UDAs
• Complex treatment including laboratory work
• Dentures
• Crowns
• Bridgework

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Urgent Treatment

• 1.2 UDAs
• Examination
• Radiographs
• Dressings
• Re-cementing crowns
• Up to 2 extractions
• One filling

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Patient Charges

• Band 1 15.50
• Band 2 42.40
• Band 3 189
• Urgent 15.50

18
Treatment exempt from charges

• Prescriptions
• Arrest of bleeding
• Removal of sutures
• Denture repairs
• Bridge repairs

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Transitional arrangements

• For treatment commenced after 1 Jan 06 and
  completed on or after 1 April 06
• Assess patients charge. Must be to patients
  advantage
• NB Problem with patients whose treatment started
  in 2005, whose maximum charge could be 384 189
  
• Submit old item of service form.
• Open new form

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NICE Guidelines

• National Institute for Clinical Excellence
  guidance on dental recall period
• 6 monthly recall not necessarily appropriate
• Dentist must assign recall period according to
  appropriate needs of each patient
• Based on initial Oral health review which takes
  into account Medical dental history, dental
  exam and preventive advice
• Reviewed at each oral health review
• 3 to 12 months for under 18s.
• 3 to 24 months for adults

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Patient entitlement

• To obtain NHS dentistry from practitioner of
  their choice subject to contracted capacity.
• To receive all proper and necessary treatment
  that the patient is willing to undergo (5.14.2a)
• Where appropriate to be referred for advanced
  mandatory services, domiciliary, sedation or
  other relevant services (5.14.2c)
• To receive written treatment plan for Band 2, 3,
  and mixed Private/NHS treatment
• To be issued with written receipt for payment

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Standards

• Oral Health Assessment
• All proper and necessary treatment which a
  dentist usually undertakes that patient is
  willing to undergo
• Evidence based dentistry
• Referrals on basis of complexity, not financial
  considerations

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Standards

• No prior approval, but can request Dental
  Reference (DRO) Officer opinion
• DRO examinations
• Premises should be suitable and sufficient
• Dental Advisor visits
• Continuing Professional Development
• Clinical Governance Quality Assurance System
• Proper standard of record keeping

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Practice considerations

• Establishment of who is a patient
• Acceptance of patients if capacity
• Cannot discriminate on grounds of dental
  condition
• Translation of UDAs into defined number of NHS
  appointment spaces
• Monthly apportionment of laboratory fees to
  maintain financial viability ?
• Cannot charge for Failure to attend (FTA)
• However, 2 FTAs represents grounds for
  discontinuation of treatment on grounds of
  irrevocable breakdown of relationship.

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Practice considerations

• Entitled to full course fee after examination
  treatment plan
• Out of Hours is responsibility of PCT, but
  closure during normal hours (eg. Vacation)
  requires locum arrangements
• Urgent care can be provided and charged under
  Band 1. Patient may be asked to return for
  examination and further treatment under
  separately charged appropriate banding.
• In practice, previously unavailable items will be
  subject to feasibility of cost of provision. (eg.
  unlikely that complex restoration with 800 lab
  fee could be provided)

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References

• GDS Contracts
• http//www.opsi.gov.uk/si/si2005/20053361.htm
• PDS Agreements
• http//www.opsi.gov.uk/si/si2005/20053373.htm
• Transitional Provisions Order
• http//www.opsi.gov.uk/si/si2005/20053435.htm
• Dental Charges
• http//www.opsi.gov.uk/si/si2005/20053477.htm
• Performers Lists
• http//www.opsi.gov.uk/si/si2004/20040585.htm
• Performers Lists Amendment
• http//www.opsi.gov.uk/si/si2005/20053491.htm
• Dental Public Health
• http//www.opsi.gov.uk/si/si2006/20060185.htm
• Functions of the BSA
• http//www.opsi.gov.uk/si/si2006/20060596.htm
• Transitional Consequential Provisions Order
• http//www.opsi.gov.uk/si/si2006/20060562.htm