NHS Dental costs - have I been charged correctly?

Annonay

My first post - hope this is the correct board. I saw there was another recent thread about dental costs on here, but I didn't want to hijack that thread as the OP was asking more than costs.

Here's my situation:
I went to my dentist beginning of December for a regular 6 month check up. The bad news was that I was told I needed a filling and so would need to return.
I was charged £48 and an appointment made for the filling about a week later.
That all went well and no extra charge on second visit.
(I think this is correct and how the NHS charges should work)

However, about 4 weeks later I was getting pain from another tooth. I went back to the dentist but was advised my usual dentist was currently on holiday for 2 weeks, but that I could see another dentist at the surgery. Appointment booked for a couple of days later.

Went to the appointment (who was a really nice dentist) to be advised I had an abscess which would either need the tooth extracted or they could attempt root canal treatment. I opted for root canal treatment on the basis there was nothing to lose by at least attempting it.
Anyway, first off, I was told I needed to take some antibiotics for a week which were prescribed, after which time my usual dentist should be back from holiday and could carry out the necessary treatment.
New appointment made for about 10 days later. Was given a prescription and charged £17.50

Took my prescription to a local chemist to obtain the antibiotics, and oddly was not charged anything (I thought I would have to pay about £7-£8)

Went back to dentist for root canal treatment as arranged. The dentist removed the pulp and cleaned out the root canal leaving, and finished off with a temporary filling.
Was charged £48 and given an appointment to return in about a weeks time (for which I was told there would be no extra charge) to have the tooth filled properly.
I was also advised that the tooth should be crowned, but they don't usually do this until 6 months after treatment.

I don't have any issues over the treatment, but I can't work out if the costs are correct.

1. Bearing in mind I already paid a band 2 charge just 4-6 weeks earlier, should I have been charged £17.50 when I went back complaining of toothache?

2. Should the chemist have charged me for the antibiotics I was supplied (or is this free because I paid the dentist £17.50?)

3. Should I have been charged a second band 2 charge of £48 just 4-6 weeks after paying the first one?
(the website suggests only one NHS charge in any 2 month period - although this may only relate to a single course of treatment, and this was a completely different tooth to that which was filled)

4. Is the reason for delaying the crown for 6 months just an excuse to get another £209 (band 3 charge) out of me in addition to the band 1 (£17.50) and band 2 (£48.00) charges I already appear to have paid for this course of NHS treatment?

welshdent

Normally you can have a continuation of the same band of treatment or lower within 8 weeks of the last course. Without seeing your notes I couldn't say what the case was for you. Theoretically, discounting the time interval if you need more treatment then you would normally need to pay for it. Again ignoring the time scale as we can not corroborate this against notes, you had a band 4 to manage pain and then the second charge is for the definitive treatment namely the root filling. Regards the 6 months wait, I would say that's perfectly reasonable. Most molar teeth need "cuspal coverage" after root filling but given root treatment is not 100% effective I usually wait 3-6 months for the tooth to be stable. Wadr I think you are getting a pretty good financial deal. In total for a filling, emergency, root filling and a crown you will pay approx £320. Most people on here are paying more for the root filling alone when their nhs dentist says they need to do it privately. The only potential contentious issue I see is have you caught the continuation in enough time but only your dentist can answer if you qualified. No idea about the pharmacy though sorry. I doubt it's because you paid the practice though as the pharmacy wouldn't have know and even if they did, they Are not connected

Annonay

Hi welshdent - thank you so much for your response.

Maybe I should have mentioned that I actually live in (and am being treated in) England

I don't understand what you mean by a Band 4 charge?
According to the NHS website, there are only 3 Bands for NHS dental charges in England.

(Sorry I can't post links yet it seems, but if you do a Google search for NHS Direct Dental Costs, the appropriate page should be first or second in the list)

It also says:

If you require urgent [or out of hours] care, you will only need to pay one Band 1 charge of £17.50. Most urgent treatments can be done in one appointment. However, if more than one visit is required and you return to the same dentist to complete your urgent treatment, the Band 1 urgent charge is all that you should pay.

Once your urgent course of treatment is complete, you may be advised to make another appointment for a separate course of non-urgent treatment. In this case, the relevant Band charge will apply.

So my dentist may be correct in applying a Band 1 charge of £17.50 for what they classsed urgent care ... although I didn't ask for that and wasn't seen for a couple of days (although as it was another dentist since mine was on holiday then, I suppose they still class it as urgent)

So I'll accept that charge


Could you explain how my case notes would affect the charge?
A filling is a Band 2 charge, as is Root Canal Treatment ... and the time from the initial check up to the start of the Root Canal Treatment (not just the urgent care) is within 8 weeks.

Could you explain a little more by what you mean by me getting 'a good financial deal' please?
I thought all NHS prices are non-negotiable (I think they should actually be free at the point of delivery, but that's a different matter).

According to the website a Band 3 treatment which includes all treatment covered by Bands 1 and 2, plus more complex procedures, such as crowns, dentures and bridges is £209.

Also, an NHS dentist is specifically not allowed to charge for Root Canal Treatment privately rather than offer it on the NHS.
(They may decide it's too difficult to treat routinely and so suggest a specialist endodontist elsewhere who may charge privately, but the NHS dentist cannot do it themselves privately).

The NHS will provide all treatment that your dentist feels is clinically necessary to keep your teeth, gums and mouth healthy.

If your dentist says that you ‘need’ a particular type of treatment, it will be available on the NHS. You should not be asked to pay for it privately.

You can, of course, agree to pay your NHS dentist for any private work you would prefer he supplies.

I think you are correct about the chemist' s charge. I thought I should have paid and the NHS site confirms this:

You don’t have to pay a dental charge:

• ....
• if your dentist only has to write out a prescription - however, if you pay for prescriptions, you’ll have to pay the usual prescription charge when you collect your medicines (from 1 April 2012, this is £7.65)

Oh well, I win some, I lose some, but I still can't help feelling as though I've lost a shilling and found a sixpence.

brook2jack

,The website has missed out band four treatment which is £17.50 and is for treatment to relieve toothache , recumbent crown etc in between courses of treatment http://www.kingstonccg.nhs.uk/local-health-services/Dentists.htm

The fact is that another dentist saw you and dentists ,even if they work in the same practice, are independent contractors , so seeing a different dentist will always generate a fresh charge.

If you had your check up within eight weeks, you saw the same dentist then and now , and the treatment you need is band one or two , you shouldn't have to pay another band two charge. I would just query this with the surgery.

When Welshdent said you are getting a good financial deal I think he is referring to the fact your treatment will not have earned the practice very much as the cost if root treatment disposables alone may well exceed the amount earned for the root treatment. You are right dentists do not set or have any control over nhs fees.

As to your prescription charge check you haven't signed or ticked the exemption part on the back of the prescription. The nhs is chasing up people who wrongly tick, even by accident, and fine heavily. Go back to the chemists.

Annonay

Thanks brook2jack.

From the link you provided that relates to 2011 prices (other than the cost, it seems very similar) it says there are 4 bands but only specifies 3 ... and tacked onto 3 it says

Urgent: This treatment will be limited to the cause of the problem. The Charge applies to care given in a local dental practice or at the hospital based urgent care service, £17.00

I think this is covered by the nhs site that does say a Band 1 charge is payable for urgent cases.

But going by the link you provide, I'm not sure I should pay this as the dentist didn't actually provide any treatment, just inspected, gave advice and provided treatment planning (and a prescription for which it says there is no charge).

Regarding the different dentist, I'm don't know about how they are employed but payment is to the surgery not a specific dentist.

It's a strange place. It was set up by a dentist who wanted to offer NHS facilities as well as private treatment (e.g. implants, cosmetic veneers, etc)
The owner only does private work himself now.
(A private check up is £25 - but persuaded me to move to his surgery even though I knew he wouldn't be treating me under the NHS)

However he has 3 other part time dentists on site all of which do NHS work (and private work by agreement), one of which is his own son.
I know the son works in at least one other town where he only does private work.

They seem to work a rota:

Dentist 1 works Mondays & Wednesdays at the surgery
Dentist 2 works Tuesdays & Fridays at the surgery
Dentist 3 works Monday mornings, Tuesday mornings and all day Thursday at the surgery.

I suspect, like the son, these dentists may work elsewhere on their other days.

Regarding the cost, I don't understand all the ins and outs of how the NHS system works but I presume the dentist gets a subsidy from the NHS (which we all pay for in tax/NI) as well as the payment I make.
The dentist either agrees to provide NHS treatment or doesn't; he can't cherry pick just the most profitable bits of the contract.
Anyway, a normal filling they do in 10 minutes and charge £48 for (ignoring anything the NHS pays) so that works out nearly £300 an hour, so they should be able to afford the odd root canal.

I realise the financial rewards are probably less under the NHS compared to private treatment, but it provide a consistent revenue stream and some dentists like to give back to society what they got out, even if only part-time (especially if they got their dental training free of charge care of the taxpayer, which I think these probably did save for the specialist courses they attended since graduating to keep up with the latest techniques)

Anyway, you think I shouldn't have had to pay the second Band 2 charge within 2 months? (Yes, all treatment has been with the same dentist - it was just the investigation that was with another dentist and since he did do an xray too, I'm not too annoyed about paying the £17.50 for that)

Yeah, I think the chemist made a boo-boo. I never signed or ticked anything on the prescription form. I suppose a chemist could forge a tick, but they wouldn't have a clue what my signature looks like. I guess they wouldn't risk either for the sake of £7.65

brook2jack

Even though you pay a cheque to the surgery dentists are not employed by a surgery. They pay a percentage of what they earn (around 50 to 60%) to cover costs. A practice normally collects all the money then gives the dentists what remains after the percentage and lab bills are paid. Each dentist in a practice is an independent practitioner. So even though you see one dentist there , the others have no connection with them.

It doesn't matter whether the other dentist did anything or not, you saw them for a problem, they are not your own dentist, you need to pay the band four charge.

The amount a dentist gets on top of what you pay varies from practice to practice, on average roughly band one it is £4 , band two about £20, band three about £40.

You may be interested to know the average dental student comes out with over £60,000 of debt for their "free education" and will have spent much of that time providing free treatment for patients at a dental hospital. The average private dentist earns 5% more than a dentist providing mostly nhs treatment.

welshdent

Not so much a financial reward as the costs to the dentist. Root treatment costs more to provide than the NHS pays us to do it sadly. Hence why an NUS practice needs to cram more patients in to generate the revenue to run the practice.
Sorry if I sounded a bit flippant. What I meant was that it may not seem it but even a cheap course of treatment privately equating to all that you had would be 3 or 4 times that amount. This is not widely acknowledged in my experience but NHS dentistry can be very cheap for people when it needs to be and bears little if any resemblance to the costs needed to provide it.
re no charge for prescription, thats not entirely true either. Again, who woudl think the dept of health would be misleading eh?! LOL. You may not think you had anything done but the dentist needed to examine you to assess what the problem was and the antibiotics were the measure taken to control the problem before something definitive could be arranged. A prescription is only "free" when nothing else is done. i.e. a repeat prescription for fluoride toothpaste or soemthing else that the dentist does not feel needs examining.

You presume slightly incorrectly on funding. The practce or dentist agrees a set number of units of dental activity (UDA) which correspond to the band of treatment and those units relate to a set amount of money per UDA that the NHS will pay the practice. In return the agreement is to make patients dentally fit when needed and they tick off the UDAs from the total throughout the year running April 1st to March 31st. If they run out of UDAs then they eother work for free bearing in mind the costs have to be met by the practice or they stop working or work solely privately. If they do not do enough UDAs then they normally have to pay money back. You do not pay the dentist when you pay for a course of treatment (band) you are in fact paying the PCT who put that in effect in to their coffers. Its a tax and we do not get the money in the way you may think. If someone wants a treatment deemed to be cosmetic i.e. white fillings on back teeth or a bridge where a denture would be satisfactory then we are entitled to charge privately. Also by the sound of things I do not think for a second your dentists are cherry picking things. If they did you wouold have a greatly larger fee charged for the far more complex demanding root filling stating they could only do it privately. They didnt and it has saved a lot believe me. Thats a major bone of contention not just for patienst but dentists alike.

re free training - thats not correct. I personally no more had free training than an english student did or someone doing a degree in art history. We all as students had to pay university fees same as anyone else. We did in fact provide a useful service, treating patients for routine and emergency care in clinics. If they had to meet that demand with trained dentists mark my words, it would have costs the NHS SIGNIFICANTLY more money. Students cost materials and that salary of supervisors who also treat patients themselves.

A lot of a lot of misinformation is circulated by the government about dentists because it suits their agenda. Very little is correct. It is for example in correct that dentists give up prioviding NHS treatments to earn more money privately. IIRC data has shown many private practitioners actually earn less than some NHS practitioners.

Sorry I shall climb off my soap box now

Annonay

brook2jack wrote: »

...You may be interested to know the average dental student comes out with over £60,000 of debt for their "free education" and will have spent much of that time providing free treatment for patients at a dental hospital. The average private dentist earns 5% more than a dentist providing mostly nhs treatment.

You may be interested to know that when I went to University, the average dental student left their & year course with no debt whatsover
(and their was a very large dental school at my University)
What with fully funded course fees, maintenance grants you could afford to live on (and even benefits like housing benefit for the 40% of the year they were not actually at University) only the most financially careless ended up in any debt.
Of course, there wasn't the the temptations to spend extortionate amounts of money life's necessities like today; no expensive mobile contracts, no sky TV to pay for, not even an ISP to pay every month (we didn't even have a landline phone - there was a call box on the corner)

My mates from when I was there earn themselves a heck of a lot more doing private work than they could ever earn in the NHS. Maybe there was less competition around then when only the elite made it to University, and only the elite of the elite made it onto a dentistry course (unlike today where you seem to be in a minority if you don't go to university ... the majority are of which are just renamed polys anyway).
And since those days, their renowned experience and expertise (and additional training which they have self funded) keeps them in a position to effectively name their price.

Unfortunately, none of them live anywhere near me so I couldn't use them even if I could afford to.

brook2jack

How many dental students did you know? Dental schools run on a fourty five week academic year (always have), unlike the thirty weeks of other courses (except vets and medics) . Full time Students have not been able to claim benefits for 27 years.

They are expected to do electives in many of the remaining weeks, often in clinics providing nhs access.

Even when I graduated many years ago most dental students were in debt because the long academic year meant they couldn't work during the holidays .

Your mates are obviously very unusual because until 1996 the vast majority of dentistry provided in the UK ( 86%) was nhs. They are doubly unusual in as much as figures from the inland revenue show mostly private dentists earn 5% more the mostly nhs dentists. The charges to patients are more but the overheads in private practice are alot more.

Dentistry students today have gained a place on the most competitive course other than veterinary medicine. Not only do they need high academic grades they also need very high scores in additional tests (ukcat) , do outstandingly well in interview and have outstanding personal statements. I have to counsel prospective applicants if they haven't started to get an impressive cv at 15 they've probably left it too late.

Fees for university and loss of maintenance grant have been with us for some time now and dental student debt has been a factor for many years.

As you will know from your friends funding postgraduate training is hideously expensive. expensive. To gain qualifications in implantologist, get the required experience and to set up the kit in an existing practice cost one local practitioner £250,000.

welshdent

Heavens forbid times should change for people eh? Dental students are no different to any other students with regards fees however unlike other students they provide a service to the public for which they receive not cash just experience. Also unlike most average students they spend almost all the year in Uni not half

Annonay

welshdent wrote: »

.re no charge for prescription, thats not entirely true either. Again, who woudl think the dept of health would be misleading eh?! LOL. You may not think you had anything done but the dentist needed to examine you to assess what the problem was and the antibiotics were the measure taken to control the problem before something definitive could be arranged. A prescription is only "free" when nothing else is done. i.e. a repeat prescription for fluoride toothpaste or soemthing else that the dentist does not feel needs examining.

That is correct. I didn't expect an examination for free. As you say, it's only essentially for writing out a repeat prescription that is free (takes about 30 seconds maximum)
Can you get toothpaste on prescription? And even if you can, surely it's cheaper to buy it direct. I've never spent £7 odd on a tube of toothpaste.

My issue was that as I already paid a Band 2 charge not 2 months previously, why was I being charged a Band 1 charge?

But it's only £17.50 and I'm not going to argue over that as it was kinda urgent, and I was x-rayed too.

welshdent wrote: »

re free training - thats not correct. I personally no more had free training than an english student did or someone doing a degree in art history. We all as students had to pay university fees same as anyone else.

You see that's the difference.
When I went to University, only about the top 5% of the population did (compared to about half of todays youngsters), and only the very best of the best made it onto a Dental Course.

Dental Course fees were much higher than History of Art courses (not sure we ever had that in my day, but any arty-farty course was cheap), not just because they were 7 years compared to 3, but because they cost more to run (staffing costs, facility costs, costs of materials used, etc)

Then of course there were the 7 years of maintenace grants you were entitled to, over twice the amount an History of Arts student would get (plus you could claim some welfare benefits for the 40% of the year you were not actually at university - although how successful you were often depended on how you worded the claim and, more imnportantly, where you were claiming. Variation amongst local claims offices was vast, and those who lived in typical student ghettos often came out worst)

welshdent wrote: »

It is for example in correct that dentists give up prioviding NHS treatments to earn more money privately. IIRC data has shown many private practitioners actually earn less than some NHS practitioners.

I can assure you, none of my University mates who studied dentistry are exactly paupers ... and they all earnt it in the private sector, running their own practise. If NHS dentists earn even half of what they earn, then we are paying NHS dentists far too much money. (which I would just clarify, I don't think we are)