New patient charges confirmed

Corroborating the story first leaked in Dentistry magazine’s 16 June issue, the Government has announced a proposed system for new patient charges.

In the form of a report by Harry Cayton, the new charges will be a banded system as extensively leaked. The patient will pay a single charge appropriate to the highest band in which their treatment occurs. The banding is:

• Band one: covering clinical examination, radiographs, scaling and polishing, preventative dental work, such as oral health advice (£15)

• Band two: covering simple treatment, for example fillings, including root canal therapy, extractions, surgical procedures and denture additions (£41)

• Band three: covering complex treatment, which includes a laboratory element, such as bridgework, crowns, and dentures (£183)

• Band four: urgent treatment covering examination, radiographs, dressings, recementing crowns, up to two extractions, one filling (£15).

The charges are not cumulative so an exam, scaling and two fillings would attract the band two charge and an exam scaling root treatment and a crown the band three charge. Dentists will still be responsible for collecting the charges, but the Department has accepted in principle Cayton’s recommendation that bad debts should be written off by the PCT if a ‘vigorous’ attempt has been made to recover them. This will be contained in the forthcoming regulations.

The objective for the Government is to collect a similar amount as under the existing regime, but the amounts originally suggested by Cayton were for £11/£31/£130-140 for each band respectively. The far higher amounts in the consultation document must reflect and compensate for the lower incidence of these courses of treatment under PDS. The new charges may mean that dentists can offer private treatment at below the NHS charge, in the name of ‘patient choice’. Many dentists may regard these charges as an incentive to increase the proportion of private work in their practices. It would be necessary to make clear to patients that their treatment was private, not carried out under the NHS.

The proposed new charges will go out for public consultation over the next three months before being laid before Parliament as regulations to come into force from 1 April 2006.

It was also confirmed that this date will be when the new system starts with new GDS contracts coming into force and existing PDS contracts becoming permanent.

Negotiations over new contracts will take place from September this year and during this time no more pilot PDS contracts will be approved, unless there are exceptional circumstances. In the near future draft regulations will be laid before the House of Commons, but prior to that there will be consultation with the BDA and other interested parties.

The Public Accounts Committee in its report on 14 July expressed its concern on whether these new charges will collect sufficient sums: ‘Dentists will no longer have a financial incentive to try and collect debts from patients who fail to pay the correct NHS charges for the treatments they receive because, under the new system, dentists’ income is guaranteed for three years and is not dependent on the level of charge income.’

The new charges will also determine how the new arrangements will be monitored; the so-called currency of the contract. It is likely that the concept of weighted courses of treatment is to be called Units of Dental Activity. If dentists are contracted to provide a certain number of courses of treatment in each band they will have to do this or risk a reduction in their contract value in future years. The Minister also announced that draft regulations would shortly be laid before Parliament. The regulations will cover the new GDS contracts, making PDS pilots into permanent contracts and performers regulations. Before laying the regulations before Parliament, they will be discussing their content with ‘the profession, NHS management and other key stakeholders – so that effective, workable local contracts can be agreed in order to deliver our commitment to modernise the general dental services (GDS) contract by April 2006’.

The Department announced that only applications for PDS pilots received before 7 July would be processed, in preparation for bringing the rest of the profession into the new arrangements. PCTs have been briefed on these changes (and patients’ charges see

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