NHS or private treatment

...The dentist agrees to treat her on a private basis as is standard with all non-registered patients to the practice attending on an emergency basis...

A 38-year-old woman – Mrs P – presents at a dental surgery with a broken upper incisor. The dentist agrees to treat her on a private basis as is standard with all non-registered patients to the practice attending on an emergency basis. He notes acute pulpitis in the tooth caused by gross caries. The patient agrees to root treatment and the dentist builds up the tooth with composite as an interim measure. He advises Mrs P that a crown will be necessary and also stresses the importance of improving her oral hygiene.

Mrs P says she is satisfied with the treatment and pays the charges without comment.

Two months later Mrs P returns to the surgery complaining of the loss of the composite material and demands a refund. The dentist explains again the temporary nature of the treatment provided and the need for a permanent crown. He refuses to refund the fee and Mrs P leaves the practice seemingly satisfied with the explanation.

A month later the practice receives a letter from Mrs P complaining of her treatment and also claiming that a large sign in the practice window advertises "NHS Dentistry". She claims to have requested her treatment on that basis and demands to be refunded all charges. She also complains that she was not provided a treatment plan.

The practice refuses to refund the costs and Mrs P writes to complain to the local primary care trust. When it is established that the treatment was provided on a private basis, the PCT complaints officer advises her to contact the GDC.

The dentist later receives a letter from the GDC stating that the matter will be considered by the Investigating Committee of the Council which will decide if the case should be referred to the Professional Conduct Committee. An explanation in writing from the dentist is required.

Analysis and outcome

MDDUS assists the dentist in drafting a response. The GDC is also provided with full patient notes and a copy of the practice policy on NHS treatment which was displayed in the waiting area of the dental surgery. It explains on what basis NHS care is provided to registered patients only. A note in the file confirms that when Mrs P enquired about further treatment under the NHS the dentist advised her that she would have to find another dentist to carry out this treatment.

The GDC responds with a letter to confirm the dentist will not be called before an Investigating Committee but drawing his attention to guidance about the duty to explain clearly treatment and costs and also that the onus is on the dentist to make clear to the patient what contract they are to be treated under and that a treatment plan should be provided.

Key points

  • GDC guidance states dentists must always "make clear to the patient the nature of the contract, and in particular whether the patient is being accepted for treatment under the NHS or privately".
  • Make clear to patients the charge for an initial consultation and the probable cost of further treatment.
  • Ensure that any signs and practice notices do not have the potential to mislead patients on costs.