NHS Dentist - Giving Private Prescriptions

Pistorius

I was on the waiting list for an NHS dentist for 18 months. I had the option of seeing the same dentist privately immediately but chose to wait for an NHS space to become available. I eventually got a call 6 months ago to say I was at the top of the list and I attended for a check up plus a filling that was necessary on the day. I paid the Band 2 NHS charge. 

I have recently returned for my routine 6 month check up, which was booked at the end of my last appointment and I was charged the Band 1 NHS charge for an examination. I was given a prescription for various items with the title ‘private prescription’. The pharmacies are trying to charge me > £60 for the items as it’s not an NHS prescription. 

When I’ve queried this with the dentist, they’ve told me that they’ve treated me as a private patient but only charging NHS prices as they’ve ’run out’ of Government funding. Hence the private prescription. Apparently if I was entitled to free NHS treatment (they ask before the appointment) then they do have funding for NHS care (+ provide NHS prescription). They’ve shown me a letter that I apparently signed on the computer alongside 3 other signatures to say my medical history hasn’t changed. They still operate an NHS waiting list and I feel a bit misled. I’ve waited 18 months to transfer from private to NHS only to end up at square one. I highly doubt they will be providing unlimited Band 3 treatment at one NHS charge if I end up needing 5 root canals and crowns in a 3 month period. Can anyone advise if this is against NHS rules? Please see contents of letter below:

“Whilst we are totally committed to providing NHS dental services your dentist has currently reached capacity for NHS dental treatment due to lack of funding from the NHS. NHS have confirmed to us that there is no funding available at this present time. You will be offered the equivalent care outside of the NHS with the same fee structure as the NHS. 

XYZ Dental Practice has always prided ourselves on providing the best possible care under the NHS contract and this will always continue. You will continue to receive the same level of care as the NHS. The following service is only available to existing patients as a goodwill gesture who have previously been seen on the NHS at XYZ Dental Practice. Otherwise our normal private charges will apply.

NHS capacity will be assessed on a monthly basis with the new booking period opening on the first working day of each month. 

Patient acknowledgement:
1) I understand the course of treatment is being provided under a contract outside of normal NHS arrangements.
2) That the total patient charges I will pay for this treatment will be the same as if the treatment was provided under the NHS. 

3) That the treatment provided benefits from the same guarantee as treatment provided under the NHS.”

mda99das

Technically the dentist is correct, NHS scripts can only be issued when having NHS treatment.

brook2jack2

Once a practice has run out of UDAs (units of dental activity) they cannot do any more NHS dental treatment . They will not be paid for it and any patient charges are taken away and used to pay for the following year. 

That leaves a practice with two choices as it cannot see any more NHS patients until the beginning of the new financial year 

a only see people as private patients , charging normal private charges

b as a goodwill guesture see people privately , charge NHS fee and run at a loss . 

Under NHS rules a dentist cannot write a NHS prescription if a patient is not under a NHS course of treatment. Therefore they can only write out a private prescription. 

A practice has only a limited contract , they cannot exceed that contract . Therefore in future they have to allocate a certain number of days/amount of NHS dental treatment per month . It may well mean that , in future , they run out of funding each month. 

They told you and you have signed , to say you understand this is not NHS treatment. They have done their best in a broken system and have probably done your check up at a loss . It costs at least £140 an hour in a cheap area to run one room in a NHS practice. They have broken no rules and tried their best in a broken system . 

DullGreyGuy

I'm surprised that a dentist will see a private patient and only charge NHS rates! 

What is the prescription actually for?

Firstly, shop around, whereas the price for an NHS prescription is fixed its not for private prescriptions. The prices vary A LOT! The first private prescription I had was an e-prescription and discovered the company powering the prescription technology had a sister pharmacy company. Their price for the medicine was half that of our local pharmacy.

Secondly... what's your relationship with your GP like? Being fortunate of having PMI and unfortunate in health in last couple of years there have been a few cases of seeing a private consultant, getting an MRI etc the same day but then speaking to my NHS GP who issues a NHS prescription for the medication based on the private prescription the consultant had given. 

brook2jack2

GPs have been given guidance not to prescribe for dental problems as they are not qualified to diagnose dental/oral problems. They are not allowed to prescribe eg high fluoride toothpaste in my area , which is what I guess op was prescribed. 

Toothsmith

This looks to be a place trying to do it's best by patients whilst still giving regular, routine care (which is being actively discouraged by the NHS) They are playing by the rules which is why they've given you a private prescription for your items - and all I can see that's not as good as it could be here is someone signing something they've not read.

They will obviously be losing money here - and you're right - they would not do unlimited root fillings or crowns for a single band 3 charge. But if they're doing what they're doing, it's my guess that they would use periods when they don't have capacity to put the regular patients on to the next financial year when they do have UDAs available again. However - there are many perfectly legitimate reasons for a dentist on the NHS to not provide multiple crowns or root fillings under the same treatment course anyway. The best, most legitimate one being that if a patient's teeth are in the sort of state that requires such an intervention, then simpler treatments like extractions are in the patient's best interest until an improvement in self care can be demonstrated.

It would be interesting to know what you were prescribed. I write private prescriptions all the time as I don't have an NHS contract at all. When the Pharmacist gives you the medicine, there is the cost of the medicine plus a dispensing charge. I know that all the pharmacies in my area charge around a £3 dispensing charge - but this is just a price they set, and has no regulation. I have had patients go out of this town and be charged a lot as a dispensing fee. Simple things like ordinary antibiotics can even be cheaper on a private prescription. High fluoride toothpaste can be about £13-15 per tube, so if it were a few tubes of this that were prescribed, that could get up to that sort of figure. These are usually given to people who are high decay risk. This can also be sorted out more cheaply and much more effectively, by cutting down the frequency of sugary drinks and snacks

Undervalued

Toothsmith said:

This looks to be a place trying to do it's best by patients whilst still giving regular, routine care (which is being actively discouraged by the NHS) They are playing by the rules which is why they've given you a private prescription for your items - and all I can see that's not as good as it could be here is someone signing something they've not read.

They will obviously be losing money here - and you're right - they would not do unlimited root fillings or crowns for a single band 3 charge. But if they're doing what they're doing, it's my guess that they would use periods when they don't have capacity to put the regular patients on to the next financial year when they do have UDAs available again. However - there are many perfectly legitimate reasons for a dentist on the NHS to not provide multiple crowns or root fillings under the same treatment course anyway. The best, most legitimate one being that if a patient's teeth are in the sort of state that requires such an intervention, then simpler treatments like extractions are in the patient's best interest until an improvement in self care can be demonstrated.

Maybe but I do wonder if the dentist has made it sufficiently clear what is and is not included in this apparently generous offer.

The OP said that they signed to acknowledge....

 Patient acknowledgement:

1) I understand the course of treatment is being provided under a contract outside of normal NHS arrangements.
2) That the total patient charges I will pay for this treatment will be the same as if the treatment was provided under the NHS. 

3) That the treatment provided benefits from the same guarantee as treatment provided under the NHS.”

I can well understand that many lifelong NHS patients (maybe most) would not realise that any prescriptions would have to be private. Indeed, item two can be read as saying the opposite?

Also, as you say, it is hard to imagine that the dentist will be keen to do any extensive treatment on this basis and it is really not clear where the line would be drawn.

Maybe this will come back to bite them 

brook2jack2

The dentist would be in deep trouble writing a NHS prescription for a patient under a private course of treatment. 

By seeing patient under NHS charges it will have already bitten them because they will have lost money unless they are one of the practices whose UDA value is less than the patient charge (ie what they recieve for treatment is less than what the patient is charged. )

Undervalued

brook2jack2 said:

The dentist would be in deep trouble writing a NHS prescription for a patient under a private course of treatment. 

By seeing patient under NHS charges it will have already bitten them because they will have lost money unless they are one of the practices whose UDA value is less than the patient charge (ie what they recieve for treatment is less than what the patient is charged. )

I appreciate that.

However, my point was that the three numbered terms that the OP agreed to do not, in my opinion, make the position about prescriptions clear. In fact I think point 2 (That the total patient charges I will pay for this treatment will be the same as if the treatment was provided under the NHS) is totally misleading.

welshdent

Its not misleading. They charged you the same for your dentistry as you would have paid under an NHS agreement. They have ZERO control over how much pharmacies charge and have no legal authority to give you an NHS prescription outside an NHS course of treatment. 
The statement is correct. You have paid the same for the DENTISTRY would have done under the NHS. 

Undervalued

welshdent said:

Its not misleading. They charged you the same for your dentistry as you would have paid under an NHS agreement. They have ZERO control over how much pharmacies charge and have no legal authority to give you an NHS prescription outside an NHS course of treatment. 
The statement is correct. You have paid the same for the DENTISTRY would have done under the NHS. 

Nonsense!

The word used in Point 2 is treatment (not dentistry) which in this case is prescribed medicine and has cost the OP £60, very significantly more than a NHS prescription charge (which might even have been free depending on their age or circumstances).

So, yes it is misleading and it certainly appears to have mislead the OP. I am not suggesting that the dentist has done this deliberately, they may well have the best of intentions in offering this "deal". However this point is not clear, nor is what would happen with a patient who needs a significant amount of treatment that is costly to provide.