Dental checkup/hygienist

brook2jack

a nhs dentist is paid for a set amount of udas (units of dental treatment). The annual contract is divided into 12 monthly payments. If they do more udas they are not paid any more but if they do less they have to pay that back. The monthly amount paid has the patient charge taken off, so how much a patient does or doesn't pay doesn't affect how much the dentist is paid.

band one treatment earns one uda, band two three , band three twelve udas.

If you are charged an extra £48 on top of nhs band one fee then you are paying for a private scale and polish, not nhs. Band 2 treatment is between £40 ish and £49 ish in total depending if you are in England or Wales.

This is fine if you are asking for a scale and polish where your gums are healthy and its just cosmetic. Then a private scale and polish is appropriate.

If you have signs of gum disease then that should be treated on the nhs , perhaps on a band two treatment which including the check up will be £40 to £49 ish total England and Wales.

From the sound of it your first port of call is to write to the practice to confirm what you have paid for (nhs check up and hygiene or nhs check up and private hygiene) and your concerns.

athomick

brook2jack wrote: »

a nhs dentist is paid for a set amount of udas (units of dental treatment). The annual contract is divided into 12 monthly payments. If they do more udas they are not paid any more but if they do less they have to pay that back. The monthly amount paid has the patient charge taken off, so how much a patient does or doesn't pay doesn't affect how much the dentist is paid.

band one treatment earns one uda, band two three , band three twelve udas.

If you are charged an extra £48 on top of nhs band one fee then you are paying for a private scale and polish, not nhs. Band 2 treatment is between £40 ish and £49 ish in total depending if you are in England or Wales.

This is fine if you are asking for a scale and polish where your gums are healthy and its just cosmetic. Then a private scale and polish is appropriate.

If you have signs of gum disease then that should be treated on the nhs , perhaps on a band two treatment which including the check up will be £40 to £49 ish total England and Wales.

From the sound of it your first port of call is to write to the practice to confirm what you have paid for (nhs check up and hygiene or nhs check up and private hygiene) and your concerns.

I have written to my dentist to clarify several points and await his reply. I might make a formal complaint at a later time if I am not satisfied with his response.

I suspect that he is routinely diverting patients away from NHS treatments and onto private ones whenever possible and, in my opinion, at least "bending" the rules in the process. He then reaches his units of dental treatment targets by force feeding band 2 cleans on all of his NHS patients. This seems quite a neat way of maximising profits as cleans are not time consuming (usually about 10 minutes), do not consume expensive materials and require "cheaper" hygienists to perform them rather than dentists.

Just to be clear; I have never had a private clean and polish at this surgery only band 2 NHS cleans charged now at £48. My partner has had exactly the same experience.

brook2jack

A hygienists surgery will cost £90 to £120 and upwards an hour to run depending on area.

As band two also covers all fillings,root fillings as well for any patient needing any work the dentist will have lost a considerable amount of money if every patient sees the hygienist, as you suggest.

If you have been seeing a hygienist and paid a band two charge on the nhs then it is a question of clinical judgement.

All dentists are obliged to point out all the options for treatment , nhs and private. Some treatments are not available on the nhs at all e.g. implants, or only in very limited circumstances e.g. white fillings and crowns, but the dentist should offer you all options nhs or private.

What they shouldn't do is say a certain treatment e.g. root filling is not available on the nhs but I can do it for you privately. However the difficulty is some root treatments can be difficult and need specialist treatment which is often only available privately.

You cannot complain about what you think MIGHT be happening to other people, only what you know has happened to you. If you feel you have been told ,wrongly, that treatments were not available on the nhs then you need to include this in your letter.

athomick

My dentist appears to be very careful usually about the timing of check-ups, other treatments and cleans and leaves sufficient gaps between them to ensure that band 2 cleans are not performed in conjunction with any other treatments.

It SHOULD be a question of clinical judgement I agree but NHS dentists appear to have been put in a position where there could be a conflict of interest between profit and good clinical judgement. What would you say if it turns out that band 2 cleans are routine and used as a prophylactic measure for most or all patients at the surgery?

I am not complaining about what I think might be happening to other people. I am revealing what I suspect is happening based on the evidence I have observed over the last few years and sharing it on a public forum in order to collect data and opinion.

The letter I sent to my dentist was fairly comprehensive and factual. The purpose of it was to ensure that he had the chance to answer some of my queries and correct any misunderstandings arising from the conversations we've had.

brook2jack

athomick wrote: »

My dentist appears to be very careful usually about the timing of check-ups, other treatments and cleans and leaves sufficient gaps between them to ensure that band 2 cleans are not performed in conjunction with any other treatments.

It SHOULD be a question of clinical judgement I agree but NHS dentists appear to have been put in a position where there could be a conflict of interest between profit and good clinical judgement. What would you say if it turns out that band 2 cleans are routine and used as a prophylactic measure for most or all patients at the surgery?

I am not complaining about what I think might be happening to other people. I am revealing what I suspect is happening based on the evidence I have observed over the last few years and sharing it on a public forum in order to collect data and opinion.

The letter I sent to my dentist was fairly comprehensive and factual. The purpose of it was to ensure that he had the chance to answer some of my queries and correct any misunderstandings arising from the conversations we've had.

What you may not be aware of is all nhs dental treatment is subject to statistical analysis, amongst many other checks.

If any treatment deviates from the average by more than a fraction, an exception report is sent to the pct. Also if there are too many treatments with less than six months in between then again a report is made. Similarly if people are recalled for check ups and then have treatment in between without check ups a report is made.

Every nhs dentist will have meetings with the pcts at varying intervals. At this point any aberrations in their averages for various treatments are discussed and investigated. If there is no good reason for deviation from normal practice then a whole in depth investigation is launched.

In other words if every patient had a band two treatment without any other treatment other than scaling it would set off so many red lights at the pct the computers would probably explode.

Similarly questionnaires are sent at random to nhs patients questioning about varying aspects of treatment, and patient records are examined at random. In other words seeing every patient in this manner would set off a variety of alarm bells.

Any breach of these protocols can result at best the removal of the nhs contract, at worst a prison sentence. So these sort of complaints are taken very seriously.

athomick

brook2jack wrote: »

What you may not be aware of is all nhs dental treatment is subject to statistical analysis, amongst many other checks.

If any treatment deviates from the average by more than a fraction, an exception report is sent to the pct. Also if there are too many treatments with less than six months in between then again a report is made. Similarly if people are recalled for check ups and then have treatment in between without check ups a report is made.

Every nhs dentist will have meetings with the pacts at varying intervals. At this point any aberrations in their averages for various treatments are discussed and investigated.

In other words if every patient had a band two treatment without any other treatment other than scaling it would set off so many red lights at the pct the computers would probably explode.

Similarly questionnaires are sent at random to nhs patients questioning about varying aspects of treatment, and patient records are examined at random. In other words seeing every patient in this manner would set off a variety of alarm bells.

I'm grateful for this reply. I was aware that dentists were audited but not the details. I can see that you feel that the level of monitoring is adequate.

I will let you know how my dentist responds to the issues I have raised. I will probably gauge a lot from his willingness or otherwise to confirm in writing what he has told me verbally.

Toothsmith

If you're being charged privately for your cleans, then this will not show up on any NHS analysis.

If you're being told, as an NHS patient that you NEED to pay for a private hygienist visit, then this is against the 'rules'.

brook2jack

op seems certain he has not been charged privately , just band two.

londonTiger

brook2jack wrote: »

What you may not be aware of is all nhs dental treatment is subject to statistical analysis, amongst many other checks.

If any treatment deviates from the average by more than a fraction, an exception report is sent to the pct. Also if there are too many treatments with less than six months in between then again a report is made. Similarly if people are recalled for check ups and then have treatment in between without check ups a report is made.

Every nhs dentist will have meetings with the pcts at varying intervals. At this point any aberrations in their averages for various treatments are discussed and investigated. If there is no good reason for deviation from normal practice then a whole in depth investigation is launched.

In other words if every patient had a band two treatment without any other treatment other than scaling it would set off so many red lights at the pct the computers would probably explode.

Similarly questionnaires are sent at random to nhs patients questioning about varying aspects of treatment, and patient records are examined at random. In other words seeing every patient in this manner would set off a variety of alarm bells.

Any breach of these protocols can result at best the removal of the nhs contract, at worst a prison sentence. So these sort of complaints are taken very seriously.

that's not much of a relief to me. All my dentists have been foreign and in the last 4 years that I've been about 6 times or so I've seen 3 different dentists. I know for a fact that one left permanently, and the other I'm not sure. NHS dentists do not follow the "your dentist" policy too much. Where I am am based you end up just seeing any dentist that is available, including with GPs.

What's the worst that can happen? get suspended for a few years? Big deal - just work as a private dentist no biggie. If you have to there's work in other English speaking countries and I'm sure in the Middle East and Asia there's plenty of demand for dentists that also pay good money.

Also the issue is that if every dentist is leaning towards suggesting band 2 or "uprated" treatment to a degree (it's entirely possible, we're only human and need to make money). Then the statistical analysis is meaningless.

Not too confident about stasticial analysis anyway.

Remember harold shipman?? The GP who KILLED 250 people. Well, at what point did the statistical analysis kick in and start waving red flags?

brook2jack

GPS have never been subject to the level of regulation that dentists have possibly because due to a quirk dentists handle money for the government and GPs don't and the government values money above patients.. UK dentists are subject to more than 30 Times more regulation than any where else in the world.

Unfortunately funding for nhs dentistry is such anyone who can gets out as soon as possible. Foreign dentists are enticed here with unrealistic expectations, see the reality then go home or study further to get a qualification to get out of the nhs. Young newly qualified dentists ditto.Few see a long term future in the nhs after graduating with £60000 of debt.

If a dentist had their nhs contract taken from them for wrong doing that would automatically trigger a gdc fitness to practice hearing that would probably remove their registration.Without that a dentist cannot work anywhere in the UK nhs or private. It is also unlikely they could work anywhere else in the world either.In most cases the dentist concerned ends up bankrupt . The chances are if there is a court case that the dentist will go to prison.

The Shipman case has led to widespread consequences , some of them necessary, many not. As a practicing dentist of over twenty years with staff that are also equally long serving in the same practice we all had to have crb checks two years ago and have safeguarding policies in place to make sure we aren't doing away with patients, hardly likely in a dental setting.