Indemnifiers Advise on Top Up Fees

Indemnifiers Advise on Top Up Fees

The full implications of the GDC v Williams case, which led to the recent Appeal Court decision on NHS patient charge top ups, remain uncertain.

What cannot be denied is that the court has upended the generally accepted view about these extra charges. There had been a consensus amongst NHS authorities, indemnifiers and most of the profession, that top ups were strictly forbidden. It was a view that the GDC was happy to see enforced through the most severe sanction in its power, erasure from the register. Now, the GDC after electing to pursue the matter for as long as they could through the courts, have passed the problem to NHS England and the Department of Health and Social Care. While the authorities play pass the parcel, dentists have looked to their indemnifiers for guidance.

BDA Indemnity and the Dental Defence Union (DDU) were first off the blocks with statements, as reported on GDPUK. Now two more major indemnifiers have provided guidance for their members, as well as adding to the demands for clarification. Just who should be doing that clarifying, remains unclear. The DDU wrote last week to the Department of Health. The Medical and Dental Defence Union of Scotland (MDDUS), however, sent their epistle to the Office of the Chief Dental Officer, England (OCDO). They have asked for urgent clarification about the way NHS England will interpret the NHS dental charges and contract regulations in relation to mixing NHS and private treatment.

In their statement, Stephen Henderson, head of dental at MDDUS, said: “Following the GDC v Williams case, the Court of Appeal has identified a new interpretation of the regulations introduced in 2006. 

“It is important that dentists and their teams have a very clear understanding of what the NHS regulations will allow when it comes to offering patients a choice about mixing NHS and private dental treatment.”

The MDDUS concluded by advising, “members to be extremely cautious about mixing NHS and private treatment within an individual item of treatment until NHS England has issued updated guidance.”

The next day Dental Protection provided GDPUK with Dental Director, Raj Rattan’s comments:

“Dental professionals work in a complex system and there are many interdependencies.  This complexity is compounded by what the Court noted as ‘unclear Regulations’ which were ‘not at all straightforward.

“There will inevitably be unforeseen and unintended consequences of any policy change, not to mention that the introduction of a top-up fee would in effect create a new hybrid category of care and raises questions about how, for example, the replacement or repair (guarantee) Clause is applied. The GDS contract was not drafted with this in mind, and a redrafting of the Regulations is perhaps now inevitable to provide the much-needed clarity.”

Offering guidance that will by now be familiar to dentists he continued, “Pending further clarification, we advocate the precautionary principle and advise members to refrain from offering patients top-up options or accepting top-up fees from patients.”

In something of an understatement, he added, “We look forward to receiving further guidance and will be keeping members updated as the implications for them become clearer.”

Notably, Raj Rattan did look beyond the current uncertainty and observed that, “Optimists may argue that this development presents a wider opportunity – a catalyst to drive system reform.”

Many dentists will have benefited from hearing Raj speak through his involvement with Vocational Training for their foundation year in practice. They will likely remember the SWOT analysis that Raj introduced them to, and that in the acronym, Opportunities were followed by Threats.

Imagefrom used under CC licence.


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