Is NHS Dentistry effectively dead..? 27 April 2021 at 10:51PM in Health & beauty MoneySaving 45 replies 3K views

Floss

@Undervalued the NHS charge has been collected by the dentist on behalf of the NHS, and will have been paid by the dentist or need to be paid by the estate to NHS England who are dental commissioners. 

It is not within the gift of the deceased dentists estate to refund that money - it is the responsibility of NHSE to find a dentist to complete the course of treatment.

Undervalued

Floss said:

@Undervalued the NHS charge has been collected by the dentist on behalf of the NHS, and will have been paid by the dentist or need to be paid by the estate to NHS England who are dental commissioners. 

It is not within the gift of the deceased dentists estate to refund that money - it is the responsibility of NHSE to find a dentist to complete the course of treatment.

That is fair enough as long as the patient gets the complete course of treatment they have paid for.

What I couldn't accept is that the patient should end up having to pay two Band 3 charges (a total of c. £520) through no fault of their own.

Toothsmith

Indeed, but whether the process is easy, difficult, or impossibly bureaucratic - it wouldn't be right to go for the 'soft' target that isn't responsible. 

Undervalued

Toothsmith said:

Indeed, but whether the process is easy, difficult, or impossibly bureaucratic - it wouldn't be right to go for the 'soft' target that isn't responsible. 

I would still actually question the "isn't responsible" aspect.

It would be interesting to get a lawyer's take on this as when the patient pays a NHS charge at a local dentist the payment it actually to the dentist and not to the NHS. Certainly in the good old days of cheques (remember them!) I used to make it out to Joe Bloggs Dentist and not to the NHS. So, does the dentist not have a legal responsibility to make sure the patient gets all the treatment listed on the treatment plan?

The dentist banks the money initially, gets paid for the work done by some obscure formula and presumably hands over any surplus (or collects any deficit) from the NHS by some mechanism, which I imagine must be a bit like a VAT return?

Also, many NHS dentists (including mine) don't insist on payment in advance so I wouldn't be paying a Band 3 charge until all the agreed treatment had been completed to my satisfaction. Surely any business which collects money in advance (regardless of it being on behalf of another organisation) has some legal responsibility to the customer / patient for the transaction?

Floss

Do you think the NHS pays up front? Dentists will have to pay for their costs up front (building costs, insurance, utilities, medical supplies, ppe, staffing etc) before claiming the monies back for work undertaken from the NHS, and the amount you pay will not cover the costs to a dentist of that service. 

brook2jack2

The money you pay to a NHS dentist is not part of the dentists pay, the dentist is effectively acting as a government tax collector. Eg if a dentist refers to another dental service that collects a charge eg for some oral surgery and sedation procedures then the referring dentist collects the charge even though they didn't do the treatment . In many thousands of cases the charge the dentist collects is more than they will get for the procedure , the money they collect will be taken off their total contract value. 

Dental practices are allowed to collect payment in advance of treatment and , in fact , are encouraged to do so as if a patient does not pay the bad debt is the practices , the NHS takes the money off the contract value whether or not a patient has paid it. The finances of NHS practice is such that dentists cannot afford bad debts where people do not pay their bills and chasing people adds costs to a service that already is on a knife edge. 

The biggest charges will be for courses of treatment where laboratory work has been made. That fee has to be paid whether or not the patient pays and quite often will be paid before the patient has the work fitted. 

Most practices with a NHS contract that I am aware of will not undertake band three treatment without payment in advance , or certainly paid before the lab work is fitted, because they cannot afford to have bills not paid after both large amounts of surgery time and laboratory fees have to be paid . 

As has been explained , even by the OP themselves, the dentist died after doing some treatment  , the practice had to close , the health board tried to find a new dentist and failed. The money paid by the op to the practice is the practice , in effect, acting as a tax collector for the NHS . When the dentist died so did their NHS contract and the responsibility for the patient reverts to the NHS in exactly the same way that in England and Wales if a patient has a dental problem out of hours the responsibility for providing treatment is the NHS not the individual dentist. 

Undervalued

Floss said:

Do you think the NHS pays up front? Dentists will have to pay for their costs up front (building costs, insurance, utilities, medical supplies, ppe, staffing etc) before claiming the monies back for work undertaken from the NHS, and the amount you pay will not cover the costs to a dentist of that service. 

Just like most businesses!

Undervalued

brook2jack2 said:

The money you pay to a NHS dentist is not part of the dentists pay, the dentist is effectively acting as a government tax collector. Eg if a dentist refers to another dental service that collects a charge eg for some oral surgery and sedation procedures then the referring dentist collects the charge even though they didn't do the treatment . In many thousands of cases the charge the dentist collects is more than they will get for the procedure , the money they collect will be taken off their total contract value. 

Dental practices are allowed to collect payment in advance of treatment and , in fact , are encouraged to do so as if a patient does not pay the bad debt is the practices , the NHS takes the money off the contract value whether or not a patient has paid it. The finances of NHS practice is such that dentists cannot afford bad debts where people do not pay their bills and chasing people adds costs to a service that already is on a knife edge. 

The biggest charges will be for courses of treatment where laboratory work has been made. That fee has to be paid whether or not the patient pays and quite often will be paid before the patient has the work fitted. 

Most practices with a NHS contract that I am aware of will not undertake band three treatment without payment in advance , or certainly paid before the lab work is fitted, because they cannot afford to have bills not paid after both large amounts of surgery time and laboratory fees have to be paid . 

As has been explained , even by the OP themselves, the dentist died after doing some treatment  , the practice had to close , the health board tried to find a new dentist and failed. The money paid by the op to the practice is the practice , in effect, acting as a tax collector for the NHS . When the dentist died so did their NHS contract and the responsibility for the patient reverts to the NHS in exactly the same way that in England and Wales if a patient has a dental problem out of hours the responsibility for providing treatment is the NHS not the individual dentist. 

Just like any other business that outsources part of its work!

I can understand the dentist wanting to be paid up front (again like many other businesses) but, if you take a client's money in advance, you acquire a legal responsibility to provide the contracted service to a satisfactory standard or refund the money if for some reason you can't.

There is no doubt if this had been private treatment the patient would have a valid legal claim against the dentist's estate, whether you think that is morally right or not. 

brook2jack2

We are not discussing private treatment , this is a NHS course of treatment when the obligations are completely and legally different. Those legal obligations are set by the NHS not the dentist. 

A NHS course of treatment was opened , the dentist completed part and then died. The minute they died the practice lost the NHS contract and any outstanding treatment obligations became the local health authorities . They could not find a dentist to continue treatment. 

Legally , morally , ethically who should the patient blame for not being able to finish their treatment ? 

The dentist who died 

The grieving relatives who are not dentists and now have a practice that has no NHS contract and is , in effect , worthless

The bureaucrats who run NHS dentistry and have slashed funding so severely that ,despite there being more qualified dentists in the U.K. than ever before,  many parts of the country have neither the NHS funding for an adequate service nor the manpower 

The NHS system which means in cases like this the "lost" dental contract has to be put out to tender again leaving patients in limbo with no one to treat even if the practice has other dentists ready to step in. 

This is a tragic case from a few years ago but it illustrates the very real heart break that happens . The practice never re opened and it took two years, I think, before a replacement practice opened. The dentists wanted to keep the practice open but NHS rules meant it had to close and the contract was retendered. https://www.worcesternews.co.uk/news/4909810.practice-closes-following-death-of-dentist/

His wife even went to court to challenge the PCT who closed the practice , even though another dentist was ready to buy the practice and run it. https://www.gdpuk.com/mobile-news/524-dentists-widow-loses-judicial-review?tmpl=component&type=raw

She lost because the dental contract is not part of a dentists estate , it remains personal to the dentist , therefore the contract could not be continued on, not the obligations of the contract. 

I , in all honesty , cannot understand why anyone would want to chase and blame a grieving family at a time like that , for something that is not their responsibility. 

elsien

I’m going to go off topic now, but it’s relevant in the sense of two charges. 

Person visits dentist for dental plate. Dentist is incredibly rude to person.  Cast sent off and plate duly comes back and patient collects without any offer from dentist of fitting to check that it is ok.
Plate is completely ill fitting and unfit for purpose. Patient declines to see first dentist again - says she would rather go without teeth than see dentist ever again! 
 Second dentist considers plate unable to be rectified; second fee charged by second dentist. 

As the first dentist was not given the option of putting things right, is this a matter for person to just have to pay twice, or is there a case for a refund from dentist one?