Avoiding confusion over dental charges and exemptions

Background

Complaints about dental charges may arise where:

• dentists might have failed to explain dental charges properly to the patient
• the difference between NHS and private treatment options hasn't been made clear
• there has been confusion about a patient's exemption from NHS charges.

GDC guidance

'Standards for the Dental Team' advises that dental professionals:

• "must give patients clear information about costs", including a written and costed treatment plan and explanation of which treatments can be provided under the NHS and which privately
• must provide patients with clear information about charges in their practice literature and on their website
• should tell patients if treatment is guaranteed, under what circumstances and for how long
• "must make sure a simple price list is clearly displayed in your reception or waiting area." (GDC Standards 6.6.11)

DDU advice

In our experience, confusion or disagreement over dental fees can be a factor in the practice losing a valued patient and, in some cases, facing a GDC investigation.

To avoid problems, we advise reflecting on how you communicate charges and your practice's fee policy. Our recommendations include the following points.

Update your website and literature

• Clearly set out services and charges in practice notices and on your website.
• State whether you currently accept NHS patients and provide details of payment arrangements, such as whether patients are expected to pay for their treatment in advance or on completion.
• Provide practice information in accessible formats when required.

Explain the treatment plan in full

• Provide a written treatment plan that includes costs and whether the patient has chosen to have some elements of treatment on a private basis and the charge. Keep a copy with the patient's records.
• Warn the patient in advance if you believe further treatment may be required and advise them of possible additional costs.
• Obtain the patient's consent if you need to revise your treatment plan. Give them an amended plan in writing and include a revised cost estimate.
• Ask patients to sign their treatment plan, including any amended plans (GDC Standards 2.3.6).

Ask for proof of NHS exemption

• In all four UK countries patients may face a penalty charge if they wrongly claim free dental treatment. Guidance can change from time to time so it can be helpful to check with the relevant authority for any specific guidance in your area. Some authorities provide useful guidance for dental practice staff when asking for evidence of patients' eligibility for health service costs. Please see links below for details.
• If a practice has helped the patient apply for free treatment, the patient may blame them and make a complaint.
• Make sure you understand the rules around patients' entitlement to free treatment or help with NHS charges, and ask patients for proof of their exemption status.
• It is the patient's responsibility to complete any relevant forms and make the claim for free treatment or assistance. It's important not to advise the patient about their entitlement, as this could raise their expectations and lead to a complaint if they are found not to be exempt.

If patients pay NHS dental treatment charges and later find out that they're entitled to an exemption, they may be able to claim a refund. Please see links below for details.

Don't put pressure on the patient

• Make sure you don't put pressure on patients to accept private treatment. For example, it is not acceptable to tell NHS patients that they can only have a particular treatment privately when that treatment is available on the NHS.
• Consider providing a 'cooling off' period before expensive or extensive procedures begin, so patients don't later feel they were rushed into a costly decision.

Helpful links

• Penalty charges explained - NHSBSA
• Patient exemption checking A guide for dental teams in England - NHSBSA (PDF)
• Help with NHS dental costs - NHSBSA
• NHS dental charges and exemptions - .gov.Wales
• Help with health costs: quick guide - July 2022 - gov.Scot
• How we check patient exemptions - National Services Scotland (nhs.scot)
• Guidance on patient charge exemption - HSC Business Services Organisation (.doc)
• Patient exemptions - HSCNI.net
• Help with health costs - NI Direct

This page was correct at publication on 24/10/2022. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.