Are ethical dentists underclaiming on the NHS?

The ambiguous wording of the NHS contract could leave many dentists underclaiming to err on the side of caution, Neel Kothari says.

Over the past few years many, including myself, have highlighted the disgraceful situation where some dentists have been able to claim ludicrously high UDA amounts without raising alarm bells.

However, what seems immensely underreported is the bizarre scenario where many ethically-minded colleagues have become trapped within a fear culture of ‘underclaiming’.

It’s a simple fact that NHS dental commissioning is broken and vagueness within the dental contract make it hard to police the profession.

This lack of policing allows some to unfairly capitalise, but also leads the silent majority to be ruled by fear and conjecture, constantly practising in a defensive manner and, dare I say it, underclaiming on the false pretence that they are somehow being safe?

Grey areas

Henrik Overgaard-Nielsen, the BDA’s chair of General Dental Practice, recently said: ‘Put 10 NHS dentists in a room and you’ll get nearly half a dozen different views on how to claim for a treatment.

‘It’s an insane system, and not even officials can navigate the grey areas.’

I’m not advocating any form of unethical practice, but why are there no courses out there teaching us how to maximise our UDA claims ethically?

It seems like a taboo topic, yet in any other industry it would be considered prudent business practice.

For instance, splitting courses of treatment is clearly in breach of contract, right?

Well, according to a 2012 NHSBSA document titled ‘Dental contractor loss analysis exercise’: ‘There are no specific rules forbidding dentists from splitting up courses of treatment into separate claims for component elements, although it does demonstrate sharp practice on behalf of the dentist who earns more UDAs and collects more patient charge income than is necessary.’

The author’s use of the term ‘sharp practice’ is somewhat ambiguous – it seems derogatory, but appears to be very different to illegal practice.

On the contrary, it could be argued that the word ‘sharp’ could mean ‘clever’ and be deemed complementary to those splitting courses of treatment.

The authors report that if a dentist has treatment planned for a specific amount and then goes on to split the course, this may constitute breach of contract and fraud by false representation and/or fraud by abuse of position.

Is this a loophole?


By now many of you may be feeling slightly uneasy reading this, but please rest assured I am equally uncomfortable putting this in writing.

I will likely receive many messages of support and some elucidating how my youthful naivety has once again got the better of me.

This is exactly why we need guidance, clarity and those in power to step up and nurture ethical dentistry, not know-it-alls like myself pretending to understand the 2006 dental contract.

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