Activity Measures

Background
Dental Protection's telephone helpline received about 10,000 calls between January and June 2006. Many of these calls related to uncertainties over the operation of the new "Units of Dental Activity" (UDA) system of measuring NHS activity.

Members are reminded that what is and is not possible under the NHS (General Dental Services Contracts) Regulations 2005 and the NHS (Personal Dental Services Agreements) Regulations 2005, is only one part of a much bigger story. Registered dentists must also take care to ensure that they do not leave themselves open to challenge by the General Dental Council, or to claims of negligence. Included in both cases is a failure to carry out necessary dental care and treatment, or a failure to obtain a patient's valid consent when taking the decision to defer necessary treatment.

In particular, performers should not be misled into believing that they are no longer personally accountable for their own acts and omissions. Their attention is drawn to the fact that their performer number will appear at the top of every FP17 claim form, and their signature (or PIN number) will confirm their acceptance of a new and very specific declaration which makes it clear that the performer will be implicated as well as the provider, if any inappropriate claim should occur.

Discontinuing courses of NHS treatment
The GDC expects dental registrants to place the interests of patients above their own interests. Under the current relevant NHS regulations, a course of treatment is defined as: -

(a) An examination of a patient, an assessment of his oral health, and the planning of any treatment to be provided to that patient as a result of that examination and assessment, and;

(b) The provision of any planned treatment provided by . . . . one or more providers . . . .

All the treatment that the patient is willing to undergo, that forms part of the treatment plan at (a) above, is therefore part of a single course of treatment, and a single claim for the appropriate number of UDAs attributable to it. The exceptions to this are: -

(i) Where urgent treatment (as defined by the regulations) is provided.

(ii) Where the patient elects to have some or all of their treatment provided privately.

(iii) Where the patient is not willing to undergo one or more elements of the planned treatment.

(iv) Where the patient does not attend for, or allow, the completion of the course of treatment, despite the best efforts of the provider to achieve this.

(v) Where a patient, having completed a course of treatment, returns within two months needing further treatment that would have fallen within the same band for UDA/charging purposes.

Members are strongly advised not to enter into any kind of "Disclaimer" arrangement, whereby patients are encouraged to sign a document agreeing for a course of treatment to be discontinued, and then restarted as a separate course of treatment (attracting additional UDAs) in order to complete the treatment originally envisaged. For fee paying patients this would result in much higher overall patient's charges being payable by the patient, while in charge-exempt patients, the provider would be achieving additional UDAs with no associated patient's charge.

In many circumstances, this could represent a breach of the provider contract, placing the provider at risk of termination procedures being commenced by the PCT. Secondly, it could be held to be an act of fraud, which would impact not only upon the provider, but also any performers and/or practice staff involved in the process and also the patient if he/she was complicit in the arrangement.

Thirdly, any such arrangements could also be considered by the GDC as amounting to Serious Professional Misconduct, especially if the patient had been misled in any way as to the nature and purpose of the agreement.

Band "gaming"
Decisions as to whether or not to carry out any particular treatment, must be driven by the patient's best interests, rather than the commercial or personal interests of the provider or performer.

A decision to provide, or not to provide treatment, or a failure to obtain the patient's agreement to such a decision in the light of information which is sufficient to permit a properly informed choice on the part of the patient, could form the basis for a negligence claim even in circumstances where it could be justified under NHS Regulations.

A dentist can, however, refer a patient for "advanced mandatory services" as defined by the Regulations, in circumstances where the treatment requires, in respect of a particular patient, "a high level of facilities, experience or expertise".

Members are strongly encouraged to contact our Advisory Helpline if they have any queries over the correct application of the new NHS arrangements. It is inadvisable to rely upon second or third hand interpretations of the Regulations, especially from non-authoritative sources.

Issued 12 July 2006