Dental checkup/hygienist

brook2jack

athomick wrote: »

I've kept the issue simple as it's easy to get sidetracked on forums but I'll give a fuller explanation of my situation.





The repairs have since failed and I asked him about it again recently. He said that they could be repaired under band 2 (forgetting that I had already had them done privately at his surgery a couple of years previously) but only after undergoing my band 2 clean. ]

As both the scale and polish and filling together are band two, you are in effect not paying anything extra for the band two scaling. It is good practice to only do fillings , particularly white at the front after a scale and polish as the gums will not be inflammed and bleed whilst doing the filling. So for £48 you will get your check up, visit with the hygienist and fillings.

athomick

brook2jack wrote: »

As both the scale and polish and filling together are band two, you are in effect not paying anything extra for the band two scaling. It is good practice to only do fillings , particularly white at the front after a scale and polish as the gums will not be inflammed and bleed whilst doing the filling. So for £48 you will get your check up, visit with the hygienist and fillings.

You've misunderstood what he was suggesting. Appointments at this clinic are spaced out so that each treatment has its own slot. He was insisting that I had another band 2 clean before he would make an appointment for me to have the chips repaired, 2 lots of £48. We talked about money so it is not possible for me to have misunderstood him.

Once again he and the hygienists at his clinic all agree that my teeth and gums are healthy. The band 2 cleans are prophylactic, he has agreed that this is the case.

The whole system seems to me to be a little flawed. Some dentists suffer from a conflict of interest between the patients health and profit, and the NHS suffer from conflicting motives of appeasing dentists to keep the crumbling system afloat and patient health.

brook2jack

There should be no misunderstanding about payment. If you are having a band two treatment then you should get a fp 17dc form (England and Wales) detailing your treatment plan and costs on it. Any further treatment within two months in the same band will be covered by that payment. If your dentist has said you need a hygiene appointment and fillings then it should be as one course of treatment unless something very unusual is going on e.g. with your medical history. If nhs and private treatment is being mixed again you should get a fp 17dc form detailing what is nhs,what is private and the costs for each.

One of the key indicators the nhs computers are on the look out for are courses of treatment opened up in between check ups .

Toothsmith

It still sounds to me like he's charging you privately for the hygienist appointments.

athomick

Toothsmith wrote: »

It still sounds to me like he's charging you privately for the hygienist appointments.

Yes I'd be starting to doubt myself if it wasn't for:

1. We always sign the NHS form after treatment and are asked if we are exempt before paying
2. We were exempt for just over a year from 2011 - 2012 and signed the form, showed our card and did not pay
3. He only sees NHS patients on certain mornings
4. I know what his private fees are and cleaning is more than the band 2 charge of £48
5. I had a long discussion with my dentist about his fees just a week or so ago
6. I'm not a total baffoon (just a partial one)

Just to be clear - if I have a check-up and a band 2 treatment is indicated and carried out the same day or within 2 months should I pay £17.50 for the check-up plus £48 for the treatment or just £48 in total? If I have a band 2 clean followed by a check-up 10 minutes later what should I pay then? Is it against the rules to have a check-up followed by a treatment 6 months later followed by a check-up 6 months lated followed by a treatment 6 months later etc.

Toothsmith

athomick wrote: »

Just to be clear - if I have a check-up and a band 2 treatment is indicated and carried out the same day or within 2 months should I pay £17.50 for the check-up plus £48 for the treatment or just £48 in total?

£48 in total

athomick wrote: »

If I have a band 2 clean followed by a check-up 10 minutes later what should I pay then?

£48

athomick wrote: »

Is it against the rules to have a check-up followed by a treatment 6 months later followed by a check-up 6 months lated followed by a treatment 6 months later etc.

I don't really understand what you're getting at here - but once 2 months has passed, then you're onto a new course of treatment for anything.

Are you saying that you're paying £17.80 then 6 months later £48, then 6 months later £17.8 etc etc...? It sounds an odd way to do it, but not against the rules I think.

athomick

Thanks that's helpful. brook2jack seemed to be saying though that courses of treatment starting in-between check-ups was not allowed. So alternating check-ups and band 2 cleans every 6 months would be against the rules - if I understood him/her correctly.

Of course it seems odd if the idea is to check teeth and then sort out any problems found. Not odd though if the prime motive is profit and the dentist is charging under band 2 for simple prophylactic cleaning. You are suspicious that I am being charged privately for the cleans because that seems to be the model he is following i.e. check-up - no major problems - prophylactic clean and polish once or twice a year - check-up etc. We have been required to have band 2 cleans sometimes twice between check-ups, several months apart.

brook2jack

What I was saying is any treatment in a two month period is part of one course of treatment if it is in the same band, ie check up and band two scaling in two months would be just one band two charge.

The nhs also looks out for treatment done in between six month periods on a regular basis e.g. check up then filling three months later. This is not against the rules but the nhs is also on the look out for maximising payment for treatment.

However it is perfectly acceptable to say if someone has a problem with their gums that they have scale and polish every three months and a check up every six.

As I've said before the scenarios you have put forward may be perfectly justified for some people. You do not know what your dentist prescribes for their thousands of other patients. You can only make a complaint on the basis of your treatment. If you think it is not clinically justified and this is bourne out by the reply to your letter to the practice , then you must act as you feel circumstances dictate.

However it is grossly unfair to extrapolate this to all nhs dentists. The figures say 98% of all people have some form of gum disease. Untreated/diagnosed gum problems are the biggest cause of litigation against UK dentists who are the second most sued in the world (after Israel). The nhs statistics themselves would bear up the fact that hygiene visits are probably underprescribed rather than over.

The average spend per person treated ,per year including patient payments on nhs dentistry is between £28 and £32. Any deviation from that norm is very very closely monitored.

If you have concerns about your treatment ,follow that up. If there is an unusual prescribing pattern others will have done the same and nhs business services will have picked it up. But you cannot make assumptions about others treatment.

For the record I personally have a very small nhs contract,I mostly treat patients privately. But I am involved in the training of young nhs dentists who have to work their early years nhs. They are a committed ,ethical lot who do their best in a broken system made worse by the corrosive effect it's had on the patient dentist relationship.

athomick

brook2jack wrote: »

What I was saying is any treatment in a two month period is part of one course of treatment if it is in the same band, ie check up and band two scaling in two months would be just one band two charge.

The nhs also looks out for treatment done in between six month periods on a regular basis e.g. check up then filling three months later. This is not against the rules but the nhs is also on the look out for maximising payment for treatment.

However it is perfectly acceptable to say if someone has a problem with their gums that they have scale and polish every three months and a check up every six.

As I've said before the scenarios you have put forward may be perfectly justified for some people. You do not know what your dentist prescribes for their thousands of other patients. You can only make a complaint on the basis of your treatment. If you think it is not clinically justified and this is bourne out by the reply to your letter to the practice , then you must act as you feel circumstances dictate.

However it is grossly unfair to extrapolate this to all nhs dentists. The figures say 98% of all people have some form of gum disease. Untreated/diagnosed gum problems are the biggest cause of litigation against UK dentists who are the second most sued in the world (after Israel). The nhs statistics themselves would bear up the fact that hygiene visits are probably underprescribed rather than over.

The average spend per person treated ,per year including patient payments on nhs dentistry is between £28 and £32. Any deviation from that norm is very very closely monitored.

If you have concerns about your treatment ,follow that up. If there is an unusual prescribing pattern others will have done the same and nhs business services will have picked it up. But you cannot make assumptions about others treatment.

For the record I personally have a very small nhs contract,I mostly treat patients privately. But I am involved in the training of young nhs dentists who have to work their early years nhs. They are a committed ,ethical lot who do their best in a broken system made worse by the corrosive effect it's had on the patient dentist relationship.

Please don't confuse me with others you may have dealt with in the past - you say:

However it is grossly unfair to extrapolate this to all nhs dentists

But you cannot make assumptions about others treatment.

By saying these things you imply that I'm guilty of them. If so it is not intentional and if you point out where I have done so I will amend my posts.

To be clear - I have concerns with my dentist and no other and do not think that all NHS dentists are crooked. I have tried not to make assumptions about others treatment at this surgery but I am aware of some other patients and they all fit into the same pattern as me. I have suspicions which I have voiced but have not accused the dentist of anything in my letter, I've simply asked for clarification on a number of points.

Don't take this as an assault on dentists in general because it isn't that at all. I assume that all good ethical dentists will applaud the weeding out of the ones who give the rest of you a bad name. I suspect that mine is one of those bad eggs but time will tell.

brook2jack

The problem occurs when you make general comments such as quoted below. Every patient and dentist is an individual, what may be good clinical practice for one ,May not be for another. There is so much that is clinical judgement. The nhs regulations used to extend to over 400 pages and the new contract has none of that detail leaving patients and dentists confused after almost 7 years as to the black and white rules.

athomick wrote: »

Is this just ignored by NHS dentists?

The whole system seems to me to be a little flawed. Some dentists suffer from a conflict of interest between the patients health and profit, and the NHS suffer from conflicting motives of appeasing dentists to keep the crumbling system afloat and patient health.




Do chips qualify or not for repair under the NHS? The NHS say this to patients, although I am starting to think that what the NHS tell patients and what dentists think they are allowed to do under the NHS are not the same thing: