More than 1,500 people signed up to our webinar Dental Contract Changes in England on Tuesday 7th April, which is a record for us! Hundreds more have also watched it on demand since then.
During the course of the webinar those of you watching Nigel Jones, Eddie Crouch and Len D’Cruz submitted nearly 90 questions asking for clarification or more information. We’re grateful to the BDA’s Eddie Crouch for taking the time to answer them so swiftly. You can read his responses below.
Clearly, it’s a subject that people want to know more about and we’ll do our best to help. If the changes to the NHS Dental contract have got you thinking about your options why not book a no obligation conversation with one of our NHS experts? They can help you assess your current situation and talk about what’s possible for you and your practice.
You can book your 1-2-1 conversation here.
Your webinar questions answered
Q: I’ve heard this is a voluntary scheme; will it be possible for an associate working for a corporate to opt out of the scheme?
A: You will be able to opt out of the care pathways and that will be an individual clinical decision. You can opt out of the Quality Initiative but that will be a practice-based decision. You can’t opt out of any of the unscheduled element, and it replaces the previous 1.2 UDA claim.
Q: A patient attends for a fractured tooth, are we able to place a temporary filling, claim the 1.6 UDAs, charge the patient the Band 1 fee, close the COT, and amp; then bring the patient back for the finite filling, claim the 3 UDAs but the patient gets charged the Band 2 fee. £75 is less than the Practice gets paid for 3 UDAs.
A: The 1.2 UDA claim no longer exists but you can still provisionally fix the problem and recall for a full banded course of treatment which will produce better remuneration.
Q: How does the peer review work with solo dentists who work with dental therapists?
A: You would be paired with other participating practices and be expected to take part in a wider ICB footprint.
Q: 1: Regarding unscheduled care: e.g. patient with emergency with pain in 3-4 teeth, 3 need RCT, 1 needs filling, do I need to finish all of these in Emergency?
A: You should deal with the most urgent need at the unscheduled appointment.
Q: Which codes will the BSA recognise for unscheduled COTs: 4701 or 3701 or both?
A: Neither of these codes now apply and the software companies have introduced a drop-down menu to mark as unscheduled care.
Q: With regards to unscheduled care, there is not a not a clear understanding within practices as to how much associates will be paid, or should be paid, for completed or FTA for unscheduled care. What should associates be paid for this service?
A: That is a matter for negotiation within practices, but the BDA believes the associate should receive the % for normal contractual activity applied to the whole £75.
Q: We have two full-time dentists and two full-time therapists in the practice. We understand that skill mix is a key part of the contract changes. Can you advise what the optimal arrangements look like in setting up the appointment book and urgent COT allocations to the practice?
A: No expert sorry but understand the CDO is putting on a webinar to describe effective delivery on 14th April.
Q: I have submitted an urgent COT early April, but I received a response that the claim is not accepted, and it is related to a code 252. SOE has already updated the contract. Then what should I do with that? How do you put the claim through?
A: One for discussion with your software provider and BSA.
Q: Once a new unscheduled patient is seen do we HAVE to take them on our NHS books and continue needed treatment on these patients under NHS?
A: No.
Q: How will dentists be paid for missed urgent appointments if the practice gets paid £15?
A: If the practice hits target, this £15 will be part of the £75. If the target is not hit, the practice will retain the £15 which will partly pay for any missed appointments. You should negotiate with the practice owner over what happens in those circumstances, but there is no means of claiming for missed appointments.
Q: SOE now shows emergency appointments as being 1.6 UDAs. How do we, as associates track how many emergency appointments we have done? And also, this £15 per emergency is that going towards the associate on top of the 1.6?
A: The software is set at a notional £35 UDA value and can be adjusted depending on your correct UDA value and will be higher or lower than 1.6 UDAs depending on that value. The element of the £15 remuneration is down to local negotiation with the practice owner.
Q: Talking to colleagues, everyone will be going full out to provide as many unscheduled care appointments as they can and will run out by Christmas – what will happen then?
A: Was answered in the webinar but you can be provided with more activity by the ICB if available, refer the patient elsewhere for NHS care, provide the care privately or ask the patient to return when the new allocation of UDAs start.
Q: Is it 8.2% of the contract value or of the number of UDAs? Also, our software is asking us what is our notional UDA value.
A: Contract value and you need to let your software know your UDA value for it to correctly calculate the UDA tariff.
Q: Should we be sending claims down to the BSA? The ICB has asked us to refrain from doing so for a couple of months.
A: That sounds like incorrect information, but the care pathway claims and denture modifications do not start until June.
Q: Are the UDAs deducted from the total number of UDAs or extra to the total?
A: They are not extra.
Q: Do the unscheduled appointments include children or just adults?
A: It applies to all patients.
Q: I don’t understand how the £75 payment fits in. Could you please explain this again? Does that go to the associate fully INSTEAD of the 1.6 UDAs?
A: See previous answers
Q: We also have an exempt patient only contract which means we would only be able to see patients who are eligible for free dental treatment.
A: There is an exclusion if the contract is Child Only, but other exclusions depend on contract size of more than 100 UDAs, below that figure is excluded.
Q: Why can the BSA not introduce a specific code for cases where unscheduled care slots is available but not filled. This is important as it should go towards your activity and for associates it will give an audit trail and payment tool.
A: Not the design of the scheme. See above.
Q: Please can you advise how to best manage the unscheduled care? My 8.2% target is approx. one/two emergencies a day. We have kept 1 slot per day and then tell patients (existing and new) if slots have been filled (usually by 9.30am.) We kept extra open today, and today we had 4 new patients and 8 existing call us (after our 3 emergency slots were filled). NHS 111 still kept sending them our way. I had asked the ICB before and they didn’t clarify if our area was split between us and any other practices. My concern is less about the payment, but more about the sudden demand that we can’t manage now, with suddenly having a lot more new patients calling, (and then not having space for existing patients) as we have a shortage of associates in our practice already.
A: I would provide the unscheduled care when you wish and if you over deliver, it would come off your core contract allocation at the equivalent UDAs for £75.
Q: if you hold a UDCH contract for 11 service, does the 1.6 UDAs apply to all the urgent patients that get sent to us via the 111 service under the PDS contract?
A: Unsure but check with local ICB.
Q: For a contract of 1000 UDAs/year, how many emergency slots per week should I offer?
A: It’s 1 appointment per £10,000 contract value, not UDA.
Q: How can an associate show/prove that a patient has failed to attend his/her appointment?
A: There is no need for this as it is not a claim see above.
Q: If a provider decides to pay associates the £15, how is it done? Is it added to the unscheduled care UDAs or paid separately?
A: All in % of UDAs
Q: We have a Historical ‘Children’s Only Contract’ and less than 1,000 UDAs per Annum. To clarify: these new changes DO NOT apply?
A: That is right, it doesn’t apply.
Q: Once a new patient is seen for unscheduled care on the NHS, must the practice continue to offer NHS treatment to them, or can it be a one off?
A: No need to take on further care
Q: If I get an unscheduled patient for 15min but I can’t finish the treatment within that time and I want to recall the patient back only for this tooth treatment, how do we charge this patient? Band 1 or band 2?
A: You should provide the treatment to alleviate the problem not definitive treatment if you have insufficient time.
Q: There is mention of delaying submission of unscheduled care claims for April until July. How would this work with the two-month rule for claims?
A: Think that is inaccurate
Q: How many unscheduled courses can a patient have? If a filling is required and 50 days later another one is required as the patient is ‘nonregistered’, is this allowed?
A: The patient has no limit on unscheduled care appointments and registration doesn’t exist.
Q: Is there any requirement to see patients on an NHS basis beyond an NHS urgent care appointment?
A: No
Q: With the urgent care it is a case of resolving a particular issue for a patient and not taking on that new to the practice patient with commitment of continuous treatment- do I understand this correctly?
A: You do.
Q: What happens if they don’t finish their treatment?
A: Depends on the treatment but for care pathways we await guidance.
Q: When a patient doesn’t complete their complex care financially where do we stand?
A: See above
Q: How will the BSA know that a CCP has been carried out?
A: Will be in clinical guidance perhaps.
Q: What is the relevance of the time frame in CCP, especially in non-Perio cases, Rx can be completed quicker?
A: See above
Q: When it comes to grade C periodontal cases, can we still refer them to hospital for advanced mandatory services?
A: Will not affect referrals but may affect acceptance if the patient has not complied.
Q: Was there any negotiation to adjust the UDA to a uniform value? It is really unfair that some practices are on nearly £50 a UDA and some only £28.
A: Not in the phase of contract reform but the standard fees rather than UDAs are part of the means of addressing this in these changes.
Q: With Complex Care Pathway, once the patient is at a stable condition, do we start a new COT for things such as RCT, Crowns etc or will it be under the same COT?
A: The pathway is a stabilisation phase, and additional treatments will be additional claims.
Q: If we have unused appointment slots, can we fill them on the day from 111? And how does this work?
A: Depends on local arrangements and acceptance criteria with ICB and 111
Q: How would the care pathways monthly payments be allocated to the associates?
A: In % UDAs
Q: What is meant by getting paid monthly for the care pathways?
A: UDA credits are monthly during the pathway.
Q: If we have already started a phased treatment plan, what do we do now?
A: Complete it and these changes don’t affect pre-1st April.
Q: If a patient on a complex care pathway comes in for an emergency during the 6- or 12-month period, do you charge them the unscheduled fee or is it covered in the care pathway for the duration of the pathway?
A: We will need to see the clinical guidance for the pathways to know the answer.
Q: Assuming you start endodontic treatment during a complex pathway, would you have to finish the treatment by the end of it?
A: Until we see the clinical guidance for the care pathways, I cannot be sure.
Q: When do we close the COT if the patient is on one of these pathways? What if we finish their treatment before the end of the 6 months?
A: See above.
Q: How does the care plan work with different clinicians seeing the patient, as GDP and DHT?
A: The gross UDA allocation stays the same, and the proportioning would need to happen at a practice level.
Q: What would happen if you have filled all the five carious lesions in less than 6months? How would you be paid? Or if they fail?
A: See clinical guidance when published.
Q: Could you have a patient on Practice Plan or Denplan Essentials, that ONLY covers exams and prevention, and still provide an Unscheduled CoT under the NHS for a toothache etc?
A: All patients are able to access unscheduled care even if paying into a plan.
Q: If a patient fails to attend on CCSI then you take them off and then rings and asks to return what happens then? Do you have to start whole process again?
A: Will hopefully be clear with clinical guidance that is promised
Q: Can a therapist do px for 3/12 fl+ placement by the nurse?
A: Yes, if appropriately trained and indemnified.
Q: If there is a clawback then if you’ve already paid staff for the UC UDA equivalent do you claw back money from staff? Do staff have to have UDA targets then? What happens to the £15 paid to associates if contract target not hit?
A: All part of a local contract variation and BDA will offer guidance to members.
Q: In a majority private setting, how do I manage my patient complaints at having to pay privately for urgent care, when they can be seen somewhere else or by me on the NHS (possibly for free).
A: Will depend on your capacity to see them and if they can access care elsewhere you can provide them information on that. But there is no compulsion to provide the care, only contract sanctions if targets are not hit.
Q: Hygienists and therapists are not under NHS in my practice and many of my patients are not willing to see the hygienists under private. How to handle this?
A: One for you to decide at a practice level, but the DCP members can provide treatment in the care pathways if you chose that collectively.
Q: The ‘not less than 3 months’ for fluoride application doesn’t make sense if they are aiming for four in a year for high needs as this would require incredibly accurate timing of all appointments – this just isn’t realistic!
A: There is a 3-month time bar to prevent over claiming but not sure it’s essential to deliver 4 treatments exactly in 12 months.
Q: How many UDAs can be given to the dentist if they use fluoride varnish?
A: 0.5 UDAs if not including a routine examination where a Band 1 claim would supersede.
Q: How is access going to increase – the claimed objective – when funding is going to be ‘used up’ considerably faster on multiple fronts?
A: Access increase to urgent and unscheduled care is the objective, not global access increases and it will mean routine non urgent care will be squeezed out.
Q: What about patient choice with regards to recall? They will just come in for unscheduled care.
A: If a patient wants more regular recalls than NICE guidance, you can offer that outside the NHS. If they come in for unscheduled care this is simply to deal with an urgent problem and will not be a regular check-up.
Q: I really don’t get the reason behind these unscheduled appointments changes if it can be patients that are known to the practice. Surely it should have been 111 patients if the whole point is to give more patients access to emergency care and alleviate the pressure off 111?
A: Not our construct but the directive of patients via 111 to all practices was deemed too difficult to deliver.
Q: What about dentures? Any changes with regards to payments?
A: Yes, planned changes in June with 2 UDAs per repair or adjustment.
Q: Does this mean the ICB is responsible for providing an appraisal mechanism?
A: No, it remains the practice’s responsibility.
Q: If we pay our associates different value of UDAs, how do we work out unscheduled care pay?
A: The UDA allocation will be based on the contract UDA value.
Q: For stabilisation you can decide to place a non GIC, amalgam or composite restoration for instance IRM. But there is no code for that. Amalgam and composite should be considered definitive restoration rather than stabilisation restoration as you have no intention to replace the restoration at a later stage.
A: You will be claiming for the stabilisation phase not individual claims for fillings.
Q: How do you “claim” for an appraisal, either as the appraiser or appraisee, or is this a separate payment from the practice Principal?
A: Details of appraisals are here https://www.england.nhs.uk/publication/nhs-dental-quality-and-payment-reforms-guidance/
Q: Is there a specific time allocation for the appraisal?
A: See above.
Q: On my software, there is a place about lab fees. How is this related to the new contract reform?
A: Are you working in Wales?
Q: How do I add a dental nurse to Compass?
Q: Details here https://faq.nhsbsa.nhs.uk/knowledgebase/article/KA-01724
Q: If you have a child only contract do the appraisal and fluoride varnish/ fissure sealants apply? Is it just the urgent care element that does apply?
A: Yes
Q: Can we still use the assessment and advice code for 1.2 UDAs alongside?
A: No.
Q: When getting consent you can provide options that you are not going to provide. My understanding is that nobody can force a dentist to provide a treatment item that the dentist cannot provide as he might not have the experience, equipment, materials or ability to provide. That statement would then be true privately or NHS. Therefore, no question of NHS vs Private. This only relates to the specific ability or experience to perform the treatment. Does that remain the case within unscheduled care pathway but especially the new high care treatment pathway?
A: Most of these treatments are tier 1 delivery and every dentist should be able to provide that level of care.
Q: A patient comes with a lost crown – for an emergency appt. Do we claim a B4 separately and bring back the pt for a new crown B3 or include the whole treatment in B3 please?
A: Yes.
Q: The question is less about completing UDAs ‘earlier’ in the year and more about the much-reduced amount of dentistry that will be completed for the same funding. Access will plummet.
A: In overall terms it may but for the cohort that are struggling for unscheduled care it will rise.
Q: How do I deal with complaints from patients who currently access private care (we have a very small NHS contract) but can now access the same service with us on an NHS basis despite paying towards a private plan with us?
A: You will have a very small capacity to deliver unscheduled care and if the contract is below 99 UDAs, doesn’t apply at all.
Q: Will this be more expensive for a practice owner to pay associates as UDAs will not be converted against practice’s actual contract value compared with previously?
A: There is no additional gross funding to the contract but will assist the delivery of the contract, reducing prospects of clawback.
Q: It’s not clear to me how to calculate how many emergency slots to book depending on my contract.
A: There is a calculator available on the BDA website for members: https://www.bda.org/representation/priorities/fair-pay-and-contracts/uda-contract-changes-information-and-advice/uda-contract-changes-explained/
Q: What treatment is required to be done in an unscheduled appointment for the £60 payment? Extraction? Temp fill? Perm fill?
A: Any or all of those.
Q: Can one dentist in a multi-dentist practice solely provide unscheduled care, another high care pathway one and another pathway three, with the proviso that the unscheduled availability is an 8.2% or above of the contract value?
A: This will be down to local arrangements within the practice.
We hope you find Eddie’s answers useful and informative.
Please remember, if you’d like to have a no-obligation chat with one of our NHS experts about what introducing private dentistry into your practice might look like, you can book your conversation here.