Your Health Service contractual obligations
De-registering patients
A Principal is any dentist on the Department of Health’s (DoH) dental list. If you wish to deregister a HS patient, unless you have the patient's agreement, you must give the patient three months' written notice and notify the Business Services Organisation (BSO) on the appropriate Form. However, if you have the patient's agreement, you can deregister immediately.
Our template letters are designed to help you deliver this news to patients in an appropriate way. When communicating with patients, it is essential that you are not negative about the quality of NHS clinical care.
- Letter template: Three months’ notice for patients of move from NHS to private practice, Northern Ireland
- Letter template: Less than three months’ notice for patients of move from NHS to private practice, Northern Ireland
Mention can be made of the difficulties you perceive with government policy, but do not major on this. It is not appropriate, and your patients will be more concerned about the care they can receive and the cost to them. Avoid mentioning the following as patients will not be sympathetic:
- Any desire to achieve higher earnings
- Need to comply with increasing GDS regulations
- High costs and expenses
- High levels of stress and long hours.
Instead, you may wish to mention some of the benefits of private care including staying with your current dentist, access to a broader choice of treatments, improved facilities, more flexibility in appointment times, less rushed appointments and prompt treatment.
We recommend that wherever possible, you use our template letters and tailor the advantages mentioned to the needs and aspirations of individual patients. This way they are more likely to see the benefits as relevant to them.
At the same time, the Principal must advise the DoH, in writing, that such notice has been given. Details of any care and treatment which it has been agreed the patent will receive and which is outstanding at the date of the notice, should be communicated to the DoH including any arrangements made for completion of that care and treatment.
In their letter of the 7 June 2022 the DoH clarified the process to be followed when a dentist wishes to terminate a continuing care or capitation arrangement with a patient. Their letter also advises of potential Consequences of Termination of a Continuing Care or Capitation arrangement.
A WCA966 Form must be completed for every patient. This is a revised version, as of June 2022.
There is currently no electronic version of this form, copies must be submitted by post. Work is underway however to develop an electronic option for WCA 966 form submission, and we will update members once it is available.
Leaving the dental list
A Principal is required to provide the DoH with three months’ notice in writing if they wish to leave the dental list. Providing the DoH with three months’ notice is only necessary when a Principal is ceasing to provide all HSC. If you are simply reducing the number of HS patients on your list, then you need to remain on the dental list.
Communication is key
If a Principal is ceasing all HS care or intending on reducing their HS list, it is advisable to discuss this decision with the DoH. It is advisable to agree what communication will be going out to patients from the practice. The DoH may ask for details of the communication that will be going to patients. This is not unreasonable.
Any phone conversations with the DoH should be confirmed in writing. If both the DoH and dentist are ‘on the same page’, it should be easier to deal with any patient complaints. It is worth checking if there will there be any communication from the DoH to the patients, for example, to advise patients of their options/of other local practices.
If a large number of patients that are to be de-registered, then it may be worthwhile contacting the local MLA and discussing the change. This is because unhappy patients may well reach out to their MLA to complain. An MLA who understands the reasons behind the change, may well be more supportive.
Completing treatments
A Principal who is leaving the dental list/deregistering a patient must complete any open treatments. If HS treatments cannot be completed, then the treating dentist will need to consider how to deal with that patient, for example, offer a refund or continue with the treatment under HS until treatment is completed, offer to complete on a private basis and only charge the patient an equivalent HS fee.
Advice may need to be sought from a dentist’s indemnity provider in the case of any complex cases that run over the three-month period. The three months’ period is a minimum so, longer notice may be offered.
Moving a patient to private care
A capitation or continuing care arrangement may be terminated without the need to provide the patient with three months’ notice, if the patient agrees to transfer the whole of the care and treatment, which might have otherwise been provided under the capitation or continuing care arrangement, such that the treatment will then be provided privately.
This process involves speaking with each patient to seek their agreement, and so this option may only be practicable for a small number of patients, to do this for a large number of patients could be quite problematic, administratively heavy and time consuming.
You should keep paper records which demonstrate that the patient was doing this voluntarily and aware that they were entitled to three months’ notice. If the patient agrees to be deregistered without the full three months’ notice, then Continuing Care or Capitation Payment will also cease at the time they are deregistered. It may be worth also considering the financial advantage/disadvantage of deregistering patients early vs continuing to be paid Continuing Care and Capitation Payments for three months.
Out Of Hours provision
Dentists need to consider how they provide OOH care for private patients.
Out Of Hours provision is set up between the Local Dental Committee (LDC) and the DoH. Currently the OOH service for HS and unregistered patients is suspended due to the pandemic. When it is eventually reinstated, private patients may not have any automatic right to access this service.
Additionally, if the OOH service is reinstated, a dentist who is no longer on the dental list may not be able to participate in the OOH service. This may cause issues in the dentist’s patients being eligible to access any OOH service.
Dentists should discuss, with their LDC, how the dentist’s private patients may be able to access any OOH service.
Health Service allowances and benefits
A move to private will likely impact on practice allowances and individual HS allowances e.g. HS sick pay etc. It will also impact on any NHS pension contributions. Please note that this list may not be exhaustive.
Members should seek IFA advice/dental accountant advice when considering such a significant change to their business model.
We strongly encourage members to make use of specialist dental accountants for advice. In particular, we suggest engaging an accountant who is a member of the National Association of Specialist Dental Accountants and Lawyers, NASDAL.
Clawbacks / Covid support conditions
Consider any Covid support money that has been paid to dentists and the practice as a whole and how a move away from the HS may impact any conditions that may be in place – see below and the FAQ on the Rebuilding Support Scheme published by the DoH.
A full list of the Rebuilding Support Scheme (RSS) conditions is detailed each month in the online application form that dentists must complete. Those dentists applying for the RSS must ensure that they meet all these conditions. Failure to meet these conditions may lead to a loss of eligibility to the RSS payments and recovery of funding already provided. Any recoveries will be discussed with the GDP in advance of action being taken.
Dentists availing of the RSS will be subject to a requirement to prioritise treatment of all patients, registered or unregistered, based on clinical need until such times as the Out of Hours (OOH) arrangements are reinstated. The DoH will monitor compliance with this requirement.
Dentists who choose to reduce their Health Service commitment may find that their Practice Allowance and Continuing Care & Capitation payments may change, as per the current arrangements, however it will depend on the individual’s particular circumstances.
FSS payments already paid will not be affected, provided the dentist was eligible and has adhered to the conditions of the FSS. These conditions include the provision of their DA1 to the DoH and that they have continued to provide access to patients without any significant change to their pre- Covid-19 work pattern in terms of the balance between those exempt/non-exempt from fees and private patients.
No claw back is intended for those eligible dentists and practices who have adhered to the conditions of the FSS, even if they now decide to reduce their Health Service commitment.
The Revenue Grant Scheme
This scheme included the following conditions:
- The practice committed to maintaining (or increasing) current patient registration numbers until 31 March 2024 within a 5% tolerance level.
- The practice cannot make a claim against this RGS1 if they proactively deregister patients or switch HSC patients to private/independent care during the remainder of 2021/22, other than for the reasons set out in the GDS Regulations.
- Where a practice proactively de-registers patients or switches HSC patients to private/independent care during 2022/23, other than for the reasons set out in the GDS Regulations, then they must not make a claim against this RGS1.
Where there is evidence of the deregistration of patients or switching HSC patients to private/independent care, other than for the reasons set out in the GDS Regulations, then the grant allocation will be recovered by the DoH.
Practice Allowance
MDS 748: “The BSO would like to draw your attention to the following section from the SDR relating to practice allowance:
DETERMINATION X - Conditions of Entitlement, 2 (3) (d) This states notwithstanding regulation 2 (2) of the Health Services (Choice of Dental Practitioner) Regulations (Northern Ireland) 1998, the practice gives an undertaking to make available all proper and necessary care and treatment under general dental services (except for specialist services on referral) to the full range of health service patients for the following 2 years.”
The impact on patient throughput of enhanced infection control procedures necessitated by the Covid-19 pandemic has clearly had an effect on the ability of GDPs to meet this requirement. These matters have been considered by the Department and HSCB and it has been agreed that, despite the reduced level of treatment being provided to some patients at this time, the Practice Allowance will continue to be paid, subject to the conditions of the Financial Support Scheme (FFS) being met.
GDPs should be mindful of the declaration on the FSS Application Form that practitioners are expected to be currently operating as a GDP or specialist practitioner and would have been providing the same level of services as in 2019-20, in the absence of the COVID-19 outbreak. Wherethere is evidence of the deregistration of patients or switching HSC patients to private/independent care, other than for the reasons set out in the GDS Regulations, then practice allowance paymentsmay be withheld’.”
Recent Correspondence (hscni.net)
MDS Library (hscni.net)
If I’ve considered all that, am I ready?
The following webinars may also be useful to you:
We also recommend you talk the matter through with our advisors before making your final decision.
Our advisors can support you with terminating your NHS contract, get the wording right in any communications with patients and help with setting up private capitation schemes.
To speak to our expert advisors, who provide Extra and Expert members throughout the UK with unlimited, one-to-one advice, call 020 7935 0875 or email advice.enquiries@bda.org.
