NHS Treatment turned out to be private?!!!

[wannabemedic]

Hello :)

I've just received a letter from the dental services division regarding a refund of charges I asked for at my dental appointment - they say they can't refund my charges as it was private treatment :confused:

I had a back tooth chip when I ate some crusty bread and visited my regular dentist for remedial work - I didn't have an HC2 at the time (though I was entitled and this is confirmed) so I asked before my appointment for an NHS receipt as I knew I'd claim it back.

When in the chair the dentist said it would be £43.00 (which was a little odd as I'm sure the NHS charge was £43.50) so I confirmed with the dental assistant that I would get an NHS certificate - she went to check and confirmed I'd get a receipt.

Once treatment was over I was given a form saying 'private treatment' - I queried this but the idiot on reception seemed to have completely forgotten who I was and what she'd said to me earlier.

She said she couldn't give me an NHS receipt as 'it could only be issued at the time of payment' - despite the fact I reminded her at the time I was paying that I wanted an NHS receipt. :rolleyes:

They told me to send off the claim and ask the dental services people to contact them in case of problems - however now that they have been contacted, the practise have said it was private treatment and my claim has consequently been rejected. :mad:

The letter says I can go to the local PCT if I believe my treatment was provided under NHS arrangements...

I intend to write to the practise to ask for a refund because I remember they were told off by the PCT previously for hoodwinking patients onto private treatment so that they could sign up new NHS patients to the practise.

My priority is to get the £43.00 refunded, not to get the practise into any trouble but if that's a requisite for getting my money back then I'll have to do that.Thanks in advance :D

[Toothsmith]

Not quite sure what you're asking here wannabe?

It seems you are on top of the situation and are doing exactly the right thing.

There are probably are many NHS practices up and down the country who when doing simple treatments like single fillings just pocket the NHS patient charge, and don't bother with the paperwork necessary to claim their target points.

After all, if they do fill in the paperwork, then the £43.50 patient charge will be deducted off their monthly NHS cheque - so even more incentive not to declare it, especially if they are on target with their points total anyway.

It's similar to cases of pharmacists keeping NHS prescription fees when the tablets they're dispensing are cheaper than the £6.95 fee. Then binning the NHS prescription.

You are quite right to take it further with the PCT, and if the practice has been in trouble for such things before, there may well e consequences for them this time.

The bottom line though, is that they're defrauding the NHS.

[wannabemedic]

Thanks Toothsmith! :D

Sorry I wasn't clear - I'm asking them for my £43 back as they said I'd be given an NHS receipt to claim it back. However as the letter says the surgery said it was private my claim has been rejected - who's going to refund my money in this case? :o

[alison999]

It's £43.60 for a NHS filling anyway not £43.50.

Also, I work as a dental receptionist and if someone asked me BEFORE they went into surgery if they could have a NHS receipt I'd say yes too. But she probably didnt know what was going on in surgery at the time.

Maybe you should of questioned the fee at the time? The fee for a NHS filling is £43.60, you could right and ask for a refund, however that might mean that the dentist wouldnt get paid for the work and thats not really far. Also, now theres no such thing as registration, they might not see you again.

Id try to keep it friendly if I were you, I much more likely to do as much as i can for anice person then someone that shouts at me.

[wannabemedic]

It's £43.60 for a NHS filling anyway not £43.50.

Also, I work as a dental receptionist and if someone asked me BEFORE they went into surgery if they could have a NHS receipt I'd say yes too. But she probably didnt know what was going on in surgery at the time.

Maybe you should of questioned the fee at the time? The fee for a NHS filling is £43.60, you could right and ask for a refund, however that might mean that the dentist wouldnt get paid for the work and thats not really far. Also, now theres no such thing as registration, they might not see you again.

Id try to keep it friendly if I were you, I much more likely to do as much as i can for anice person then someone that shouts at me.

Firstly, she did know what was going on; she said I "could have an NHS receipt anyway". The part of your post about registration and not being seen again is slightly worrying - I hope this isn't the line my surgery tries to take as that would come across as a sort of blackmail, i.e. if you raise a complaint you won't be seen again.

There's a difference between raising a complaint and being friendly - I intend to remain polite (as I always do) whilst pointing out their shortfall and asking for my £43 to which I am entitled :)

[donteatthat]

I think the point here is that if the patient attended an NHS practice, and is entitled to NHS care, and was led to believe they were receiving NHS care and that they could claim their payment back via a HC2 form which they were entitled to receive.....then it would appear to me that some kind of - intentional or not - fraud may have been carried out by the practice. Never mind the dentist not getting paid for the treatment!! In the grand scheme of the usually horrendous overhead this will not be a huge amount of money to them I am sure. It is the dentist's responsibilty to ensure their staff understand the contract and know how to charge the patients appropriately. After 2 years the contracts small print should be understood I feel.

The PCTs', General Dental Council and DPB (or whatever they are called now) take a VERY DIM VIEW of this kind of thing, and I know of dentists who have been struck off for as little as £200 they have fraudulently taken from patients telling them they are having NHS care when in fact they have pocketed the money privately. This has nothing to do with the standard of the treatment - it is relating to whether or not the patients have been mislead.

If I was unlucky enough to still have to try to administer this daft new NHS contract I would ensure all my receptionists, nurses and other support staff knew how it all worked, to protect my backside against being struck off for this kind of error.

I hope you get your money back, and I wouldn't give 2 wallys about who foots the bill for it. You don't have to shout at the receptionist or be obnoxious about it as alison says they will be much more likely to try to sort out the error if you don't shout at them- the practice will have a complaints system in place, and if that doesn't resolve the issue then get on to the PCT.

HTH

donteatthat

[Toothsmith]

Thanks Toothsmith! :D

Sorry I wasn't clear - I'm asking them for my £43 back as they said I'd be given an NHS receipt to claim it back. However as the letter says the surgery said it was private my claim has been rejected - who's going to refund my money in this case? :o


Ok - got it now.

Step one is to go to the practice. Probably best to write a letter to 'The practice manager' or 'the senior partner' or even both!

State the facts as you have done in your 1st post.

You attended for an NHS appointment
You asked for an NHS receipt
You paid what seemed to be an NHS fee
No receipt was given
At no point did you agree to be treated privately
You now have an HC2 form and wish to claim back the NHS fee
You cannot do this, because somewhere, someone has decided you paid privately.Say that you are prepared to let them resolve this matter through their in-house complaints proceedure, but unless it results in you being refunded your money you will take the complaint forward to the PCT.

Tell them that if they possess any signed document from you which shows that you willingly and knowingly consented to private treatment, then you will gladly drop the complaint. (That is what they will need to prove you requested private treatment)

That should cover all the bases, and hopefully a refund cheque should drop through your door within a few days.

If you here nothing within a week, then telephone and tell them that you are taking your complaint directly to the PCT. You should then here the pop from their fingers being pulled out from 5 miles away!!! :D


BTW - if as a result of this, they decide to de-register you, then that is also worthy of a complaint to the PCT. So long as you remain polite and reasonable, a complaint like this is no grounds at all for de-registration.

[wannabemedic]

Thanks - letter is ready to go but I can't find a fax number on the NHS directory or on the online directory enquiry sites, so it'll need a call on monday to ask them for it :o

Thank you ever so much everyone who's replied on this thread, appreciate your help with this and I will update as things progress :D

[domdent]

Fax ?I think you will need to post it

[Lorian]

Recorded delivery/signed for too.

[alison999]

Recorded delivery/signed for too.


id use the special next day delivery, it'll get it sorted out much quicker ... what if before all this is sorted he fractures another tooth?? also, wannabemedic, did you sign a blue form when you went in? if you did, thats a nhs form you signed, for nhs treatment. another thing to bring up maybe?

[wannabemedic]

Sent recorded but royal mail either didn't get a signature or bother to update their site so I was worried it hadn't got there, however I've just received a reply where they've said (my comments in blue):

--

1) When booking I would have been made aware that this dentist was not an NHS dentist.
I was told I'd get an NHS receipt to claim a refund from the NHS.

2) The charge I paid was "less than an NHS charge".
How is this relevant?

3) That their receptionists "are aware of the need to explain to patients if they are not seeing an NHS dentist" and "they all abide by this".
Obviously not if I was told by the receptionist and the dental nurse in surgery that I'd get an NHS receipt for my treatment.

4) There may have been "confusion" when I was told I'd get a receipt.
No confusion from my end. I made very clear it was an NHS receipt I was after and in front of the dentist too.

5) They can't refund costs of the treatment carried out.

--

Little bit confused about what to do next - obviously my priority is still getting my money back though if this means going to the PCT then so be it. As far as I'm concerned they've passed on their chance to resolve it "in-house".

alison999 mentions a blue form - I don't recall signing one of these - it was more an A4 sheet but I wrote on there myself before signing "NHS receipt to be provided" or something similar. I note the practice manager didn't mention any evidence to prove I was aware the dentist was independent :D

Incidentally this is what the practice was told off about, for confusing patients by calling their dentists "Independent" and making it appear it was the same as the NHS.

[alison999]

independent is another way of saying private. if you were getting nhs treatment you should of being asked to sign a blue form. most private practices also get you to sign something, its your agreement to be treated and that you will pay however much for your treatment. id write to them again, making it clear (not saying you didnt the first time) that you intend to take this further if it cannot be resolved between you and the practice involved. it might make them take you more seriously. also, if the practice is as unorganised as it sounds theyre probably used to getting letters like this.

however, the fact that youve bothered to put pen to paper and also to send it recorded delivery should of made them take your complaint more seriously.

[Toothsmith]

Incidentally this is what the practice was told off about, for confusing patients by calling their dentists "Independent" and making it appear it was the same as the NHS.


I think with pitching their prices so close to NHS fees, they're asking for trouble.

I would write a letter to the PCT saying that you are not satisfied with the outcome of their in-house complaints proceedure. (Incidentally - I have read the full letter that you kindly PMd to me. Did the letter have details of how to take the complaint further if you weren't satisfied? If it didn't, then they've not followed correct proceedure here too!)

I would send a copy of your letter of complaint to the practice, and I would send a copy of their reply.

I would make sure the PCT know that you were under the impression it was NHS treatment, and let them know of all the stuff you think you signed.

It might just be worthwhile ringing up the practice and telling them that you aren't satisfied with their reply, and that you intend to go to the PCT. Tell them that they have a couple of days to consider their position, but let them know that if you haven't heard from them by - say - Wednesday, your complaint will go forward to the PCT.

Incidentally, The General Dental Council now run a complaints proceedure for patients with complaints against Private dental treatment. It might be worth letting them know that you know that! And if the PCT decide that it's not an NHS matter (Which I very much doubt they will) then you do have somewhere else to go.

You can PM me for details of this should it be necessary, but as I said, the letter from the practice really should have included details of where to take your complaint if you weren't satisfied with their response.

[wannabemedic]

Thank you Toothsmith & Alison :D

No further info was included with the letter or what to do if unhappy - apart from, "If you have any further queries or concerns, please contact me either in writing or by calling me at the practice on the above numbers."

I shall give them a call tomorrow as you advise, and mention that I intend taking it to the PCT and that they have two days to reconsider their position. Personally I'm doubtful as they dont' seem too spooked by being shopped to the PCT.

I would really like to get my hands on the letter the PCT forced them to mail to all their patients last year, as they got a real verbal thrashing (I'm pretty sure that was also signed by the "Practice Manager" :rolleyes:). Although I kept it on my cluttered desk for a few months, I don't know where it is now- never thought that would come in handy!! :doh:

So, fingers crossed please and I shall update with what comes of our conversation tomorrow!! :A

[wannabemedic]

The Practice Manager wasn't there today when I called, she was at a different practice. I won't say it's name but let's just say further googling brought up an NHS counter-fraud investigation news story :eek: :rotfl:

I spoke with Mr "er, I suppose I'm the one in charge while she's away" who seemed to understand what I was saying....... consequently he has promised a call from the manager tomorrow when she's back and we're both in agreement that referring this to the PCT is a last resort and it'd be mutually beneficial to get this sorted amicably with a refund. I can only hope the practice manager has a similar attitude tomorrow though with the letter she wrote to me, I'm not gonna bet money on it! :o

Expect an update tomorrow, and if it's not too painful after one day, fingers crossed again please! :rotfl:

[alison999]

cool. this mr. ??? was he a dentist? i just ask b/c its quite rare to have male nurses/receptionists (not that im saying its wrong!)

[wannabemedic]

cool. this mr. ??? was he a dentist? i just ask b/c its quite rare to have male nurses/receptionists (not that im saying its wrong!)
He is reception/admin staff :p

By 3.30pm today there was no call from them (as promised) so I phoned and spoke with same guy again. the useless practice manager "had popped in today but didn't have time to see the notes" and "may pop in tomorrow afternoon but not for very long" but "will most likely be around on thursday". :rolleyes:

To credit this guy at the practice... he did agree they had done something wrong if I went in thinking it was an nhs appointment and even confirmed it with the nurse and receptionist and was promised an NHS receipt - that's a nice litttle bit to include in my pct complaint methinks :D

I made it clear that if I not hear from the mysterious practice manager by 5pm Thursday I will go ahead to the PCT. Maybe I am being soft but I would rather wait another couple of days to hopefully get it sorted amicably than have to go through a long drawn out complaints process - hope this is sounding ok :o

[stressedoutmum]

Sorry to jump on your bandwagon but Ive just been to my NHS dentist because my tooth broke. The dentist said it was mostly filling which is why it broke in the first place. They have said they need to build the tooth up and it will cost £194! but theres no guarantee it will work and if it doesnt I need to have it pulled. I asked how much to have it pulled and they said £27. When I said its cheaper to take it out than repair they said they wouldnt do it because they preserve teeth but this means I could end up paying £194 plus another £27 if it doesnt last and if the tooth broke because it was mainly filling - what is their to save?? I'm really confused but is it really that price for my type of filling on the NHS. Dentist was really stroppy and not really answered my questions. thx.

[alison999]

its £194.00 on the nhs for anything that involves lab work. crowns, bridges, dentures. to me, you should be glad that you have a dentist that is trying to save your teeth. and if the crown failed (im asuming thats what youre having done) within 2 months your extraction would be free b/c its classed as a continuation claim.

wannabemedia, i think waiting until thursday is more than patient, i completely agree with what youre doing. i just wouldnt say which member of staff you spoke to in your pct letter b/c he might get into trouble if the practice found out.

[Toothsmith]

I made it clear that if I not hear from the mysterious practice manager by 5pm Thursday I will go ahead to the PCT. Maybe I am being soft but I would rather wait another couple of days to hopefully get it sorted amicably than have to go through a long drawn out complaints process - hope this is sounding ok :o

I think that's quite fair of you.

It shows at least you are trying, but I would just make brief notes of all your contacts, as things can become a bit fuzzy in your mind as they go on - although this thread is an excellent timeline of it all!!!

I wouldn't let them muck you about too much. They have much more to loose than you do, so if they're too stupid to realise when they have a reasonable patient making a reasonable complaint errrr reasonably :D then they deserve all they get!

[wannabemedic]

Been busy lately hence no update on thurs :( I had a call on thursday which I missed so I called on fri to ask - he said he had called only to tell me that the practice manager hadn't looked at it yet and he just reiterated their letter. He said I should put it in writing which she will then see. I'm fed up, they're clearly incompetent.

So now I go to the PCT, right? Or....... do I give them another last chance (bearing in mind I have only actually spoken to the same Mr "er I'm in charge" bloke many times now and not the actual manager who seems to always be at 'a different practice')?? :o

[Toothsmith]

Go to PCT - They've had their chance.

[alison999]

yeah, you've waited long enough. had it being the practice manager ringing you i'd maybe say call them again tomorrow but since it wasnt, i dont see why they should get another chance. they obviously arent bothered

[wannabemedic]

Guys, I have news - since my call to them on fri where it seemed I was fobbed off, I received a call this morning (ironically as I was polishing off my letter ready for the PCT) from the one and only practice manager - who after a long discussion took the details and after I'd mentioned the PCT again, said she'd interview the receptionist who said it was NHS and promised an NHS receipt - she said she would call back, indeed she did within a few minutes and said that I'm being sent a full refund by cheque (as a goodwill gesture) :D :j :T :dance: :cool: :beer:

Luckily I've not been very organised over the past fdew days otherwise my complaint would have been winging its way to the PCT by now!! :o

Thank you guys for your help, you are a real asset to the site and I am very grateful for the time you took to help me out. _party_

wannabemedic :p

[Toothsmith]

Just keep that letter handy until the cheque is in your hand (If not the Bank!!)

[donteatthat]

A good result I feel so well done to you!

:)

[sandy2]

well done wannabemedic, and Toothsmith as well

[alison999]

in their face

[bank_of_slate]

Any update on this?
...Linda xx

[wannabemedic]

Any update on this?
...Linda xx
Update... erm, well... the cheque is now in my bank account and I plan to give up my job and live off the interest :D

[Toothsmith]

Result!! ;)

[wannabemedic]

I've just been deregistered from the practice... unless I decide to go for "independent" (private) treatment next time. :mad:

They say that my dentist is leaving and have addressed each of us (family members) saying we should call NHS Direct to find another NHS dentist or can stay registered with them if we go private.

I just looked at my first post and realised this could be a trick - they were told off by the PCT some time back for trying to pressure and scare patients into signing up privately with a sister practice.

A few years ago the last dentist (who was "our" dentist) left and was replaced by the guy who is leaving now. What's so different this time? Aren't they getting an NHS dentist to replace him? Just two weeks ago they were advertising for new NHS patients to join the practice. I really do hope my complaint and refund has nothing to do with this... I'd appreciate your advice as I'm not sure what to do.

We would sign up with another practice but a quick search on the NHS Direct site shows all local ones are not accepting new patients. :(

[bank_of_slate]

Contact the PCT!
They should invite other practices in the area to 'bid' for the practice's NHS contract value!
...Linda xx

[Toothsmith]

Easily possible that with the trouble they've had with that practice, the PCT has decided not to pass on the NHS contract to the new dentist at that practice. They can do that.

Agree with BoS above - contact the PCT and see what's going on. it might be that another practice has got the NHS funding for that practice.

It's also possible that the PCT is strapped for cash, and has decided to 'divert' the dental cash into some big hole in it's budget. Technically, they shouldn't do that, but not all PCTs play by the rules either.

[wannabemedic]

Thanks both :) yes the local NHS trust is running a defecit of 1 million or so... :rotfl:

I will call the PCT and find out about the NHS contract. The problem is I am currently exempt (but won't be from about June). My checkup is scheduled for July so the issue is signing up with an NHS dentist should I have any problems before then. Otherwise I'd have no qualms about going private as the costs seem pretty similar if not a bit less.

[Toothsmith]

If they can't tell you where the money has been redirected to in terms of new dental provision, I would ask them how you go about complaining about how they're doing their job!!

That should put the cat amongst the pigeons!!

[bank_of_slate]

You could always go direct to the Healthcare Commission!
that would also release afore mentioned feline amongst the feathery friends.
...Linda xx

[cleo1299]

Incidentally, The General Dental Council now run a complaints proceedure for patients with complaints against Private dental treatment.

It's called the Dental Complaints Service. I just recently complained to them, about a bill which I considered excessive. (Sorry to be replying to an old thread -- this one seems to be the only one that mentions the Dental Complaints Service)

Before I complained to the Dental Complaints Service, I had already complained directly to the dental service provider, and they had acknowledged (in writing) that I should have been informed what it would cost BEFORE the appointment. However, despite that acknowledgment, the next thing I heard from them was a letter threatening "debt collection procedures" if I didn't pay the bill in full. So I complained to the Dental Complaints Service.

The DCS rang me up, and advised me to pay the bill and then ask for a partial refund. I felt uneasy about this advice, as it seemed to be putting all the power in the hands of the dental services provider. Once they had the money, they could say no to my request for a refund and there would be little that I could do.

The DCS stated that they would ALWAYS advise people to pay a dental bill, and that they would NEVER advise legal action. They also stated that they would not contact the dental services provider to try to negotiate a settlement. Apparently that's not something they do. They rang me up, to advise me to pay the bill, but they don't ring the provider up, to advise them to reach a settlement. And she was not interested in the fact that the provider had already acknowledged that I should have been informed about the cost before the appointment. The DCS advisor said they don't get involved with things like that. I'm not sure exactly what she meant.

The DCS is run by the General Dental Council, which is basically a trade association. And yet, apparently, their complaint service does not contact the people you're complaining against, and does not get involved with whether or not a bill is justified. They just advise you to pay it and ask for a refund.

Instead of taking the DCS advice, I sought legal advice through my insurance (they run a legal helpline). The solicitor advised me to (a) write to the dental service provider reminding them that the matter was under dispute, and asking them to suspend the threatened debt collection procedures until the problem had been resolved; and (b) once the threat of debt collectors was suspended, send a cheque for what I felt I owed, writing on the back of the cheque "In full and final settlement etc". That's the advice I am going to follow. I don't know if it will work or not, but if they refuse to accept my offer, I'll know that they would also have refused to give me a refund if I had followed the advice of the Dental Complaints Service.

I would be interested to know if anyone else has tried complaining to the Dental Complaints Service, perhaps with a more satisfactory outcome.

[alison999]

Have you already complained to the practice that about the cost of your treatment? You only say you werent told how much it would be BEFORE you had it done. Out of interest, did you never think to ask?

[cleo1299]

Have you already complained to the practice that about the cost of your treatment? You only say you werent told how much it would be BEFORE you had it done. Out of interest, did you never think to ask?

Yes, as stated, before I contacted the Dental Complaints Service I had already complained to the dental service providers, and they had responded, acknowledging that I should have been told the cost before the appointment. They apologized, but the next thing I got from them was this threat of debt collectors. That's why I contacted the Dental Complaints Service.

This was private dental service provided in an NHS dental hospital. I was initially referred there to be assessed for endodontic treatment as an NHS patient, but for reasons that I still don't understand, I was unable to get assessed as an NHS patient. Eventually, since I really needed the treatment, I accepted an appointment for private treatment in the hospital. I received a letter beforehand, telling me what the cost of the initial consultation would be.

That treatment worked out really well. The dentist who treated me was absolutely brilliant and did a terrific job. I was so pleased with the outcome (even though I did have to pay what for me was quite a lot of money -- about £800) that I asked this dentist if I could also get another problem treated at the hospital. He referred me to another dentist, and I was seen by her a few weeks later. I didn't receive any information about charges, as I had when I saw the endodontist, and I just assumed the charge for the initial consultation would be the same as it had been for the initial consultation with the endodontist. However, the invoice I received was for more than twice as much. It's that invoice that is in dispute. (I didn't proceed with having any work done by the second dentist, because when I asked her how much it would cost she quoted a hairraising price which I could not afford.)

So you are right, it would have been better if I had not assumed that the price of the second "initial consultation" would be the same or about the same as for the first "initial consultation". I would have saved myself this hassle if I had thought to double-check. However, I do not believe that because I fell into this mistake, the dental service providers should be free to charge whatsoever they please. Fortunately, the Office of Fair Trading doesn't think so either. I did some browsing on their website, when I first received the troublesome invoice, trying to understand whether or not I had reasonable grounds for disputing it. I came across a report of an OFT investigation into the private dental market. Transparency of pricing was one of the six main areas of concern which they highlighted in their report.

The report makes interesting reading, for anybody having problems with private dentistry. It is called "The private dentistry market in the UK" and was published in 2003. So it doesn't necessarily reflect the current state of things, but it's still relevant in cases like this, where the problems of 2003 seem to be still persisting.

[alison999]

I didnt realize it was just a consultation, i thought you'd been back and fourth having treatment.

The only thing that puzzles me is who decides how much a service is "worth"?

[cleo1299]

I didnt realize it was just a consultation, i thought you'd been back and fourth having treatment.

The only thing that puzzles me is who decides how much a service is "worth"?

" It is up to dentists what they want to charge on the basis that it is agreed with the patient before treatment starts." (Hugh Smith, head of the Dental Complaints Service, quoted in an article in "The Independent" 12 Jan 2008)

In this case, it wasn't the cost of treatment but the cost of the initial consultation that led to the dispute. But it's the same principle: the seller states the price, the consumer decides if he or she is willing to buy for the stated price.

And after all, it's not like I'm trying to get something on the cheap. I reckon they should have told me what it would cost at the time the appointment was made. They've AGREED that they should have told me what it would cost at the time the appointment was made. They've apologized, they've thanked me for drawing it to their attention, they've done everything but correct the bill. I'm darned if I'm going to lay down now and let them go ahead and squeeze out their money that I never agreed to pay them. Not without a fight, anyway.

[sue.b1]

Any suggestions with this?
My husband is registered with an NHS dentist, he needs a filling replaced (it fell out) & a crown replacing (that fell out) the dentist has suggested a bridge. The dentist though refuses to do the treatment on the nhs & will only do it privately as he says its not "financially worthwhile" to him to do it on the nhs...

[Toothsmith]

If a treatment is 'necessary' then it is available on the NHS to an NHS patient.

Your dentist cannot only do things that are 'financially worthwhile' and that is a very bad thing to say to you.

Had he said that a tooth needed removing, and he would replace it with a denture on the NHS - but if you wanted you could have a bridge done privately - then that is fine. He has given you a perfectly acceptable NHS option, but made you aware that you could choose a private upgrade if you require one.

If he is telling you that the tooth needs removing, and a bridge is the only way to fix it, but he will only do that privately,then you have him banged to rights. If you complain to the PCT, they will have a quiet word with him about giving his NHS contract to a dentist who's prepared to abide by the rules of it, and you should soon get a phone call telling you that the dentist has seen the error of his ways and will now be perfectly happy to provide the 'necessary' bridge on the NHS.

Good luck! Keep me informed.

[sue.b1]

The dentist has said he will refer him to hospital to get the bit of tooth out that the crown was attached to, then said there is nothing more he can do for him. (Didn't offer to replace the lost filling.) Just charged him the £16ish fee. Husband has other crowns that the dentist feels need replacing, hence the dentists suggestion of a bridge. He reiterated that he had told him to get private insurance if he wants work done like bridges. He will only get £198 off the NHS for doing that work & it will cost in the region of £1500 to carry out, hence his refusal.
Surely if crowns needs replacing that should be done on the NHS? Should he have replaced the lost filling?

[jugglebug]

The dentist has said he will refer him to hospital to get the bit of tooth out that the crown was attached to, then said there is nothing more he can do for him. (Didn't offer to replace the lost filling.) Just charged him the £16ish fee. Husband has other crowns that the dentist feels need replacing, hence the dentists suggestion of a bridge. He reiterated that he had told him to get private insurance if he wants work done like bridges. He will only get £198 off the NHS for doing that work & it will cost in the region of £1500 to carry out, hence his refusal.
Surely if crowns needs replacing that should be done on the NHS? Should he have replaced the lost filling?

This is the problem with the NHS contract and why I can sympathise with him, whilst still being annoyed at his behaviour.
If a bridge is clinically necessary then he should offer to do it on the NHS. If another mode of treatment is adequate then that can be provided and the rules have been followed.
It is true his funding is fixed per course of treatment. But the other side of that coin is that some treatments that attract the same funding (£198) cost him considerably less to provide. There are swings and roundabouts in the system which means it is fundamentally flawed.
It seems he is trying to keep the swings but lose the roundabouts. Human nature after all.
However If you accept a contract you should abide by the contract.
As was said earlier. He can offer a bridge as a private "upgrade" but to say you *need* a bridge, then refuse on financial grounds will get him in trouble should you pursue it via the PCT.

Bottom line is the NHS system is rubbish, he is trying to make it work for him, but he is cherry picking the good bits. Few as they are

[Toothsmith]

He should have done anything necessary to secure and maintain his dental health.

£198 is the patient fee - not what the dentist will get. The dentist will get 12 points towards his contract target, which, in financial terms will be roughly 12 x £22 = £244.

Still nowhere near the cost of providing a big treatment plan - but that's not the point. The point is he's signed a contract to say he will provide NHS dental services, and those were the terms he signed up to, and is receiving taxpayers money for.

If a patient comes in and just needs one tiny filling, the patient charge is £44ish and the dentist gets 3 funding points or £66. Very few NHS dentists say "That's far too much money for 5 mins work - I won't claim it!"

The idea is (and it is a very stupid idea) that the short easy treatments will balance out the big rebuilds.

That's never going to be the case with the funding available, and all the untreated disease out there, and NHS dentists are on a hiding to nothing.

BUT - they signed the contract, and are taking the money - so they should abide by the rules, and not just cherry pick it to their own advantage.

If more dentists had refused to sign it, there would have needed to be a radical rethink, and a different system brought in.

There are ways to play the system more carefully - by not telling people that they 'need' complex treatment, and taking out a lot more teeth and making cheap plastic dentures. Figures are showing that complex treatment has dropped right down, and extractions and dentures are way up on the NHS now.

With this dentist though, he's not been that clever, and has told you you 'need' complex treatment, but isn't prepared to do it.

Ring up the PCT and complain.

[jugglebug]

Toothsmith is absolutely correct in his explanation, but you should know that the £22 he quotes as UDA value is the national average.
There is at least 1 practice I know with a UDA value of only £16.
Mine is higher.

Postcode NHS at its sneakiest

2 dentists in the same town can have wildly different values

[cleo1299]

The idea is (and it is a very stupid idea) that the short easy treatments will balance out the big rebuilds.

That's never going to be the case with the funding available, and all the untreated disease out there, and NHS dentists are on a hiding to nothing.

BUT - they signed the contract, and are taking the money - so they should abide by the rules, and not just cherry pick it to their own advantage.


Toothsmith, I wonder if you can answer a question for me.

Until about 18 months ago, I was seeing a dentist as an NHS patient, and this dentist was very much a "cherry picker". I have really serious issues over the way I was treated by this dentist. I have since "gone private" as I could not get the treatment I needed on the NHS.

My question is, is it possible that dentist is still benefiting from having my name on her register? Do I need to "de-register" in order to make sure she doesn't get a penny from the PCT for the service she refused to provide? Or can I assume that since I no longer go there, she will not get any public money "in my name"?

Thanks for any info.

[Toothsmith]

No - Nobody is 'registered' with an NHS dentist now, and there are no fees for anything other than courses of treatment.

Would be worth ringing up the PCT and letting them know what was happening though. Might help those that are 'stuck' with her.

[cleo1299]

No - Nobody is 'registered' with an NHS dentist now, and there are no fees for anything other than courses of treatment.

Would be worth ringing up the PCT and letting them know what was happening though. Might help those that are 'stuck' with her.

Thanks, Toothsmith, I'm glad to hear she's not getting any money on my account!

Actually, after reading yours and others posts, I've realized that perhaps I ought to be making a formal complaint to the PCT about this dentist.

I had two major problems with her. First, she extracted a front tooth (I think it really did have to be extracted) and when I said I wanted a bridge to fill the gap, she didn't refuse outright but just kept arguing that I should have an implant (done privately by her, of course) instead, or else settle for a denture. I didn't want an implant because in the first place I can't afford it and in the second place I have had bisphonates and don't want to risk osteonecrosis, which I read up about on the web. But she kept insisting it would be fine. Of course if she was wrong it would be me that had osteonecrosis, not her.

The other problem with this dentist was that I developed root canal problems in a molar which already had a crown. I couldn't get the dentist to sort it out. This dental practice had a sign up in their reception saying they would not do endodontic treatment under the NHS because of the ruling about only using instruments once.

Eventually I asked her to refer me for NHS treatment at a dental hospital. She did, but then the dental hospital refused to assess me for NHS treatment. The dental hospital said this was because the dentist did not provide the required information although they had repeatedly sent the referral back asking for the information they wanted.

The dentist, on the other hand, insisted to me (very crossly) that she had sent them everything she had. I tried to resolve this, by asking the dentist for a copy of everything, and taking it in person to the dental hospital, and I also asked the assistance of the PALS (Patient Assistance and Liason, or something). But I couldn't get anywhere, and the pain kept getting worse. Eventually I accepted an appointment for private treatment at the private clinic in the dental hospital.

The problem was treated, and done very well, but I am still not happy about the fact that I had to pay for it and was refused assessment for NHS treatment. I have complained to the Trust that runs the dental hospital, but they just say it was because the dentist didn't provide the information. I was planning to carry that complaint on to the Ombudsman, but now it occurs to me that maybe they are right and maybe it is the dentist I should be complaining about. Or maybe I should complain about the dentist in addition to pursuing my complaint against the Trust. What do you think?

[Toothsmith]

This all gets a bit complicated now!

The bisphosphonates thing is a variable amount of risk depending on your dosage and the length of time you've been on them.

If she was happy enough to take a tooth out for you - then having an implant is probably less risk than that - especially if done soon afterwards.

I can think of some situations where refusing a bridge is a perfectly valid thing to do. So I can't condem that without knowing all the facts.

I think the bit about refusing to do root fillings because of the directive to throw away instruments is enough to hang her - especially if the sign is still there in the waiting room.

NHS rules say it must be offered if necessary, and so the only way out of doing it would be to stop doing NHS altogether, and not take taxpayers money anymore. The NHS deemed the cost of throwing away instruments was negligable, and not worth giving any more money to support. (Which is completely wrong and mad - anybody would think they wanted to get rid of NHS dentistry!)

You seem to have been treated badly by both places - so I wouldn't drop any complaints, but it is worth telling the PCT what's going on with the first one.

[cleo1299]

Thanks, Toothsmith. I take your point regarding implants and bridges. As I understand it, NHS patients don't have the right to anything other than a denture, unless there's a clinical reason. But I still think it was wrong the way she kept trying to "sell" me an implant.

With regard to the problem about being refused assessment for NHS treatment in the dental hospital, I will wait and see what the Ombudsman says about whether the hospital is at fault for failing to assess me. If they say it's not the hospital's fault, then I will raise it with the PCT and see if the dentist can be held responsible for failing to provide the information requested.

Meanwhile, I think I'll pop back to the surgery and if the sign about no endodontic treatment is still there I will take a photo and raise that isue with the PCT.

Thanks very much for your advice.

[cleo1299]

" It is up to dentists what they want to charge on the basis that it is agreed with the patient before treatment starts." (Hugh Smith, head of the Dental Complaints Service, quoted in an article in "The Independent" 12 Jan 2008)

In this case, it wasn't the cost of treatment but the cost of the initial consultation that led to the dispute. But it's the same principle: the seller states the price, the consumer decides if he or she is willing to buy for the stated price.

And after all, it's not like I'm trying to get something on the cheap. I reckon they should have told me what it would cost at the time the appointment was made. They've AGREED that they should have told me what it would cost at the time the appointment was made. They've apologized, they've thanked me for drawing it to their attention, they've done everything but correct the bill. I'm darned if I'm going to lay down now and let them go ahead and squeeze out their money that I never agreed to pay them. Not without a fight, anyway.

Hooray, I won. This Trust has grudgingly agreed to accept £100 instead of the invoiced amount of £150. They are still trying to claim it was my responsibility to ascertain the cost, but I reckon they know they're in the wrong, they just won't admit it. Otherwise, they would not be caving in.

Victory is sweet!
:j