Concerned I am being coerced off of the NHS register.

BillyChedder

I have been an NHS patient at South Cliff Dental Group for a number of years. Before leaving today, the receptionist handed me two forms to sign; one was the regular form regarding my medical history, and the other is a document quoted in this post, requesting me to become an independent patient. 

I did not sign the document at the time, and told the worker I would return once I fully understood what I was signing. Her agitation at this increased my suspicion, then she told me I could not have treatment at NHS prices unless I signed.

It read: 

“Independent Patient Consent

As many of you are aware there is currently a shortage of NHS dental appointments in the UK with many practices opting to only treat patients on a private basis. Each NHS dental practice has a contract with the NHS for the number of patients they can treat each year, and once they have met this target, they will receive no further funding from the NHS.

At South Cliff Dental Group we pride ourselves on providing excellent dental care at an affordable price for the local community, to ensure we can continue to do this we are requesting that on occasion, some paying NHS patients be seen and treated on an independent basis

As an independent patient the charges will be the same as if you were to be seen as an NHS patient with 3 bands of treatment charges-

Band 1 £26.80- This includes your examination, X-rays, preventative care and a scale if clinically necessary

Band 2 £73.50- Everything in band 1 plus fillings, root canal treatments or extractions of teeth 

Band 3 £319.10- Everything listed in Bands 1 and 2 plus crowns, bridges, dentures or other laboratory work.

As an independent patient the materials used would be the same as currently offered on the NHS, such as silver fillings for back teeth; however as with all our patients you of course have the option to opt for a private material such as white filling if you wish or a private hygienist appointment and you-can discuss these options with your clinician.

Should your financial situation change, and you become exempt form NHS charges please let us know and of course we will see you as an NHS patient.

Name-

Signed-

Date- ” 

As an NHS patient are practices able to threaten to charge non-NHS prices? 

Can they force me off the NHS register?  

Can they kick me out of their practice for not signing a document like this? 

I would truly appreciate any advice offered because I am lost as to what steps I should take next. 

Kind regards, 

Billy

Hoenir

Many practices are moving to be 100% private. Mine has. After many years of priding itself as accepting NHS patients. One reason cited by my dentist was the number of missed appointments by patients. Likewise costs have risen and need to be recouped. Dentists themselves are in high demand. Many people work where they earn the most money. Days of public service are long gone. 

DE_612183

My concern would be that whereas the NHS prices are set by the Government, Independent Patient prices are set by the practice.

I'd ask to see the Practice Manager for more info so you can outline your concerns.

My guess is the the receptionist doesn't know the full story behind this. 

Undervalued

BillyChedder said:

I have been an NHS patient at South Cliff Dental Group for a number of years. Before leaving today, the receptionist handed me two forms to sign; one was the regular form regarding my medical history, and the other is a document quoted in this post, requesting me to become an independent patient. 

I did not sign the document at the time, and told the worker I would return once I fully understood what I was signing. Her agitation at this increased my suspicion, then she told me I could not have treatment at NHS prices unless I signed.

It read: 

“Independent Patient Consent

As many of you are aware there is currently a shortage of NHS dental appointments in the UK with many practices opting to only treat patients on a private basis. Each NHS dental practice has a contract with the NHS for the number of patients they can treat each year, and once they have met this target, they will receive no further funding from the NHS.

At South Cliff Dental Group we pride ourselves on providing excellent dental care at an affordable price for the local community, to ensure we can continue to do this we are requesting that on occasion, some paying NHS patients be seen and treated on an independent basis

As an independent patient the charges will be the same as if you were to be seen as an NHS patient with 3 bands of treatment charges-

Band 1 £26.80- This includes your examination, X-rays, preventative care and a scale if clinically necessary

Band 2 £73.50- Everything in band 1 plus fillings, root canal treatments or extractions of teeth 

Band 3 £319.10- Everything listed in Bands 1 and 2 plus crowns, bridges, dentures or other laboratory work.

As an independent patient the materials used would be the same as currently offered on the NHS, such as silver fillings for back teeth; however as with all our patients you of course have the option to opt for a private material such as white filling if you wish or a private hygienist appointment and you-can discuss these options with your clinician.

Should your financial situation change, and you become exempt form NHS charges please let us know and of course we will see you as an NHS patient.

Name-

Signed-

Date- ” 

As an NHS patient are practices able to threaten to charge non-NHS prices? 

Can they force me off the NHS register?  

Can they kick me out of their practice for not signing a document like this? 

I would truly appreciate any advice offered because I am lost as to what steps I should take next. 

Kind regards, 

Billy

Basically yes I'm afraid.

In England and Wales (Scotland and NI are slightly different) there is no such thing as being "registered" with a NHS dentist. Once a practice starts a course of NHS treatment they must finish it but after than they are not obliged to see you again.

Confusingly, some (many?) practices still choose to operate as if patients are registered and give priority or maybe only see regular patients. That they are free to do if they wish but they don't have to.

There was another thread on here a couple of weeks ago about a practice operating in the way you describe

https://forums.moneysavingexpert.com/discussion/6511440/nhs-dentist-giving-private-prescriptions#latest

Which may be worth a read.

Grumpy_chap

DE_612183 said:

My concern would be that whereas the NHS prices are set by the Government, Independent Patient prices are set by the practice.

I don't understand how the private practice can treat "Independent Patient" as follows:

BillyChedder said:

As an independent patient the charges will be the same as if you were to be seen as an NHS patient with 3 bands of treatment charges-

Band 1 £26.80- This includes your examination, X-rays, preventative care and a scale if clinically necessary

Band 2 £73.50- Everything in band 1 plus fillings, root canal treatments or extractions of teeth 

Band 3 £319.10- Everything listed in Bands 1 and 2 plus crowns, bridges, dentures or other laboratory work.

AIUI, the NHS schedule of charges is a partial payment and the dental practice receives funding over and above the patient contribution such that the full cost is covered.

If the same charges apply for "Independent Patients" then the practice does not receive the balancing payment.

p00hsticks

Grumpy_chap said:

DE_612183 said:

My concern would be that whereas the NHS prices are set by the Government, Independent Patient prices are set by the practice.

I don't understand how the private practice can treat "Independent Patient" as follows:

BillyChedder said:

As an independent patient the charges will be the same as if you were to be seen as an NHS patient with 3 bands of treatment charges-

Band 1 £26.80- This includes your examination, X-rays, preventative care and a scale if clinically necessary

Band 2 £73.50- Everything in band 1 plus fillings, root canal treatments or extractions of teeth 

Band 3 £319.10- Everything listed in Bands 1 and 2 plus crowns, bridges, dentures or other laboratory work.

AIUI, the NHS schedule of charges is a partial payment and the dental practice receives funding over and above the patient contribution such that the full cost is covered.

If the same charges apply for "Independent Patients" then the practice does not receive the balancing payment.

My reading of the form is that the practice is only allowed funding for so many NHS patients, and that this practice is currently exceeding that number. To achieve the highest income it is therefore prioritising keeping as NHS patients those who are exempt from any charges. In these cases they presumably receive from the NHS the full cost of the treatment, rather than just the top up amount from the patients who make a partial payment, and who they now want to make 'independent'. They'll still get the same partial payment from these now 'independent' patients and of course there is nothing  to prevent them from increasing those charges going forward. 

amanda1024

one thing to watch out for (from a similar thread recently), is that even if they're saying they'll charge the same amount for the three bands of treatment, it might be that if you needed a prescription it would be a private rather than NHS prescription so could cost quite a bit more

brook2jack2

Unfortunately dental practices are given a contract that only allows them to do a set amount of dental work each. If they do more than this they are financially penalised. 

Once they have run out of UDAs (units of dental activity) they cannot do any more NHS treatment so they have a choice 

a charge full private prices to people who need check ups and treatment 

b charge a low rate similar to NHS until there are more UDAS available. 

Because the NhS insists the practice balances out activity during the year then many will allocate each day/week/month so much activity and when that is done then they cannot do any more NHS work. 

It is a mad system when so many want dental treatment but practices are financially penalised if they carry out more than they are contracted to. 

Moreover if, for any reason , a practice has not hit its target then the money is clawed back and their contract is reduced so they can only do less work the next year. 

It sounds like ops practice is trying to do its best in a broken system by only charging very low rates which are probably making a loss on treatment , rather than charge full private rates which are a lot more commercially viable. 

There is no such thing as registration in England and Wales , you are only entitled to be seen during a course of treatment , after that a practice has no obligation to see you. 

brook2jack2

Grumpy_chap said:

DE_612183 said:

My concern would be that whereas the NHS prices are set by the Government, Independent Patient prices are set by the practice.

I don't understand how the private practice can treat "Independent Patient" as follows:

BillyChedder said:

As an independent patient the charges will be the same as if you were to be seen as an NHS patient with 3 bands of treatment charges-

Band 1 £26.80- This includes your examination, X-rays, preventative care and a scale if clinically necessary

Band 2 £73.50- Everything in band 1 plus fillings, root canal treatments or extractions of teeth 

Band 3 £319.10- Everything listed in Bands 1 and 2 plus crowns, bridges, dentures or other laboratory work.

AIUI, the NHS schedule of charges is a partial payment and the dental practice receives funding over and above the patient contribution such that the full cost is covered.

If the same charges apply for "Independent Patients" then the practice does not receive the balancing payment.

Unfortunately many practices actually recieve less than the patient charges for treatment. So they pay back money for each patient they see. In my area the average practice would recieve an extra £1 , £3, £12 on top of band 1,2,3 charges . 

However with, or without any extra money what is paid on the NHS does not go far when one room in a NhS practice in a cheap area will cost £140 an hour to run. 

Martyn_H

The dental practice I go to treats me as an NHS patient but they wouldn't extract four back molars on the NHS, so I had to go privately with the same practice. It cost me £300 per tooth. As these teeth were broken, it's likely there was a lot more work involved in extracting the teeth (cutting of gums and sawing teeth in two), so the Band 2 charge of £73 wouldn't cover their overheads.

Undervalued

Martyn_H said:

The dental practice I go to treats me as an NHS patient but they wouldn't extract four back molars on the NHS, so I had to go privately with the same practice. It cost me £300 per tooth. As these teeth were broken, it's likely there was a lot more work involved in extracting the teeth (cutting of gums and sawing teeth in two), so the Band 2 charge of £73 wouldn't cover their overheads.

If that was the reason then they were breaching their contract and professional rules. 

If the procedure was beyond the competence of a general dentist and the person you were referred was more specialised who works privately (albeit in the same practice), that is a different matter.

A dentist seeing a patient under the NHS can offer private treatment that is not available under the NHS, as an optional extra. What they cannot do is decline to provide treatment that the NHS covers unless you pay privately.

NHS dentists are paid under a complex formula. They simply collect the NHS band fees on behalf of the government, they are not what the dentist gets paid. Yes, some procedures may be uneconomic for them to provide but that is not the patient's problem. They can get in serious trouble for refusing on those grounds.