NHS dental charges around a private referal

tommyvn

A few months back I cracked a tooth on some pork scratchings. Sad times.

I won't bore you all with the details but the short version of what happened is:

My dentist told me I almost certainly needed a root canal but that she didn't have the equipment to do it for me.
She gave me the details of a private clinic that she said she'd always seen good results from.
She's always done right by me so I decided to go with who she trusted.

She put in a temporary filling, told me that once I'd completed the root canal I would need to come back for a crown as the tooth would be weakened.

She put in a temporary filling, told me to wait for the the private clinic to get the referral and contact me, and I paid £21.60 and went home.

I've since had the root canal privately and called the NHS practice to book the follow on appointment for the crown as discussed.
Unfortunately the dentist I started with had left the practice so I was booked in with one of the other dentists at the practice.
After this appointment I was told I'd need to pay again for a new round of treatment for the crown, that the £21.60 would not count towards the next stage of the treatment I'd discussed with the dentist that started it.

This seems off to me as it was made clear to me from the beginning that I would get a temporary filling, go to the private practice to get the root canal, and come back for the crown to complete my treatment.

The reasons I've been given for this not being a single treatment have depend on what I've challenged, but are listed below:
* I used a private practice for the middle part of my treatment
* I'm seeing a new dentist for the crown (not my fault she left, obviously I don't want to change dentist mid-treatment)
* It's been 2 months since that first appointment and the treatment plan closes after 2 months (Surely they knew how long the proposed treatment would take?)
* The first treatment was classed as "Emergency dental treatment" because I had pain and received a temporary filling (who doesn't have pain at the dentist?)
* My treatment and the price I paid for it was directly with the dentist, not the practice (all documentation has the practice letterhead on it and I paid the practice receptionist so I don't get this)

Does anyone know if this is legit? If you step out of a practice, at the recommendation of the practice, for private treatment as part of your treatment plan, do you really have to start over and pay for a whole new round of treatment with your NHS dentist?

brook2jack

A temporary filling can only be as part of an emergency treatment. It is the same charge as a band one treatment and is a stand alone charge, the dentist cannot claim this as part of a course of treatment.

Also a course of treatment cannot be split between two dentists. Dentists are self employed and pay the practice a percentage of their earnings (50 to65%) to cover expenses. Even though the practice takes in the money the NHS contract is with the individual dentist so if you see two different dentists, even though they may work in the same practice , you cannot continue a course of treatment you have to start a new course, with new fees . This is NHS rules the dentist cannot change the fees.

Finally yes if more than two months elapses between appointments the practice will close that course of treatment. They cannot wait forever to claim from the NHSthe tiny portion they pay.

In reality I think you have been charged for emergency treatment ie temporary filling. That is a discrete course of treatment and will not be counted towards band charges. https://www.nhs.uk/common-health-questions/dental-health/how-can-i-access-an-nhs-dentist-in-an-emergency-or-out-of-hours/

sheramber

You do have to pay a fee for emergency treatment and then pay the appropriate NHS charge for the follow up treatment.

https://www.nhs.uk/using-the-nhs/nhs-services/dentists/understanding-nhs-dental-charges/

tommyvn

Interesting, so in the context of NHS dentistry emergency treatment has nothing to do with it being an actual emergency, rather it's simply if a temporary filling or pain relief is used? Surely most appointments beyond band 1 would involve pain relief tho? Do you also pay an additional emergency charge for everything above band 1 in that case?

Anyway I guess I figured emergency would be a same day, pls help me I'm in pain appointment rather than a there's something wrong with my tooth but I feel fine, I'll come by in a week to have it looked at appointment. The word emergency from other contexts always gave me the impression that there was some urgency rather than that certain equipment would be used.

brook2jack

Without seeing exactly what the dentist claimed for it's difficult to know as the charge for a band 1 and for emergency treatment is the same.
However a temporary filling can only be claimed for in the context of an emergency treatment. Otherwise the dentist would just be able to claim for the permanent filling which would be a band 2 , or crown which would be band 3 . However they cannot keep treatments open for months and as explained before emergency treatment is a stand alone charge.

Even if you had the root treatment on the NHS as most dentists want a period of time for the root treatment to settle before crowning you would still have paid at least two lots of charges.

To put this into context your dentist would have earned from your appointment , x Ray and temporary filling a grand total of around £8 .
They do not make the rules about bands of treatment, emergency treatment and charges.

brook2jack

Most people keep regular appointments to catch problems early so treatment can be sorted before pain or problems start.

Time is very constrained in NHS practice , many people will have to wait weeks or longer for routine check ups. Emergency slots are kept for those whose "oral condition would deteriorate " without prompt treatment.

Because it is impossible for a dentist to estimate how long a treatment might take routine treatments cannot be booked until after an assessment or check up.

Emergency slots mean something can be done to tide you over until a check up and treatment plan plus routine care slot can be booked.

tommyvn

No need to be snarky. I know that dentists are underpaid. I know that the NHS makes the rules about the bands and not individual practices. I understand the importance of keeping regular appointments and I do. I know time is constrained. I know there are long waiting times.

When I booked this appointment I took the next available regular appointment as I was not in pain, I took one of those that people have to wait weeks for (the practice does offer same day emergency appointments but I waited just over a week for mine). During this appointment I discussed a treatment plan and agreed a path forward with my dentist, including root canal followed by a crown. She then put in a temporary filling and told me to come back for the crown once the root canal had settled.


After that appointment the practice took a further two weeks to even send my referral over to the private practice for the root canal. If there was a chance that my "oral condition would deteriorate " without prompt treatment there was zero hint of this from the practice.

So it seems we're saying that if a temporary filling touches my teeth, regardless of the urgency surrounding the appointment, this will trigger that band. That's fine, but I'd like to be clear that we're saying this rather than any other factor is what triggered that specific "emergency dental treatment" charge. Your mentioning emergency slots when I've repeatedly said I did not take an emergency slot isn't helping make this clear.


Further, the NHS web page detailing dental charges states "You will not be charged for individual items within an NHS course of treatment". It seems we're saying this statement does not hold true for root canal and crown and that a completed root canal and crown treatment plan, due to the time taken, will in fact count as two separate courses of treatment even if both are required to complete treatment. Also fine, but it would be helpful if the NHS and my dental practice would have mentioned that.


I'm not trying to steal money away from my dental practice, I'm simply asking for clear pricing and an explanation of what I have been and will be charged. If they'd told me what I'd be paying, that the temporary filling would be charged outside of my treatment plan and that if my treatment were to take longer than 2 months I may be charged multiple times, I'd not be asking these questions, I'd have paid and gotten on with it.

And a last point is that I've double checked my bank statements and they in fact charged me at the band 2 price for the appointment in question, so even armed with the knowledge about temporary fillings and lengthy treatments potentially incurring extra charges I'm still confused.

brook2jack

If you have had a band two (or three) treatment then you should have had a fp17dc form which details what the charges are and what treatment is on the treatment plan.

There is no specific treatment that triggers an urgent treatment claim , it simply means a particular problem was sorted , rather than a thorough check up and complete course of treatment.

A complete dental rehabilitation may take years and has to be staged. Each individual course of treatment that makes up that rehabilitation can be claimed for in itself. Eg a patient having a lot of teeth out may need several sets of dentures as the gums heal. Each individual set of dentures will have to be paid for as a course of treatment , although at the start it is known they will need several sets.

Similarly very many dentists will not crown a tooth straight away after root treatment. The root treatment may not be successful , and for some teeth a crown is not necessary. The crown is a separate course of treatment.

Under the new NHS pilot schemes treatment planning in stages is taken further , people's oral health care is assessed into bands red, yellow and green. Those whose self care remains poor will not progress onto treatment with crowns or other treatment until such time as their dental health is better. So they may go years before treatment is completed. In the meantime they pay for treatment they have received.

If you have paid a band two payment then you should enquire of the surgery what this was for as a temporary filling is not band two. However if you had any other fillings done in that course of treatment then yes it would be a band two and you should have had a fp17dc detailing charges and treatment.

tommyvn

Framing it as a series of treatments, like root canal followed by crown, making up a rehabilitation is a very helpful clarification. The NHS website is very unclear about what constitutes "a course of treatment" unfortunately, I hope they adopt wording as clear as yours in your last comment if they move to the pilot scheme you mentioned.


I'm still not clear on if, in the scenario you described of me having gotten a temporary filling and a permanent filling in one appointment, I would have been billed £21.60 for the temporary filling (which you said can only be as part of an emergency treatment) and a further £59.10 for the permanent filling or if £59.10 would have been the total for both but I think that's a moot point as I only got a temporary filling, the band 2 charge is certainly incorrect in my case.


I've had multiple band 2 treatments from this practice in the last 4 years, I've always been happy with the work, but I've never once received a fp17dc.


Anyway thanks for clarifying, I now understand that while something is strange with how I've been billed it's not exactly what I thought to begin with, I'll try to clear it up with the practice next week.

Toothsmith

Dentists have been wanting clarification on just what the NHS wants them to provide on the NHS for decades, but the woolyness and ambiguity is deliberate.

It leaves it up to the dentists to decide how it should be interpreted, and then blames them for interpreting it wrong if too many people kick up a stink about it!