NHS Contract and Fee Scale

NHS Primary Care Contracts

Dentists are given a Performer Number when they register with a Primary Care Trust (PCT), they must give three months notice prior to terminating a NHS contract.

Assistant dentist are not restricted to a three month notice period, and can work on principle and associate dentist patients, even though they have a performer's number.
Any dentist working in the GDS (General Dental Service) or PDS (Personal Dental Services) must work within the confines of the NHS contract.
Dental practices are paid by the PCT's who in turn received their funding from the Dental Practice Board DPB.
Prior to receiving any dental treatment a patient must complete a FP17 form, this states the patients name and has the dentist stamp.
Before you can see a patient he/she must have completed and FP17 form. This form has a space for the dentists stamp and patients name on the top.  
Examinations: 

Dental Examination
The NHS examinations (sometimes referred to by patients as check-ups).
1(a) 1(a) This routine dental examination can be performed at intervals of 3 to 24 months, depending on the patients age, dental and general health. You are expected to examine and report (in the notes) the following things:

  1. Check the patient's medical history (the best way to do this is by having the receptionist give the patient his old medical history sheet in the waiting room and then getting the patient to bring the sheet in with him. You can then look over the sheet and confirm any changes).
  2. Ask the patient if they are having any dental problems.
  3. Examine the patients extra-oral jaw area, for asymmetry, TMJ problems, enlarged lymph nodes.
  4. Examine the intra-oral structures ;
    (a) hard tissues (i.e. teeth) and existing restorations 
    (b)Soft tissues gingivae i.e. inflammation, recession, record BPE, examine and record the health of the oral tissues eg: tongue, floor of mouth, buccal mucosa, palate etc.
  5. Record the level oral hygiene and location of plaque and calculus.

You need to write all of this in the notes. The best way is to educate your nurse on what you want to be recorded. She can then note down the headings and your remarks whilst you examine the patient. (This also maintains cross-infection control as you are not touching anything other than the patient during this time. You can complete the notes fully once the patient has left the surgery and you have removed your gloves and washed your hands)..

Example of dental notes for a simple examination: MH (Medical History) MH (Medical History): checked
Patient on 50mg prednisolone for last 2 months
CO (Complaining of); dull ache, LLQ worse to pressure, nil to temp, spontaneous intermittent discomfort.
EO (Extra Oral): Enlarged L submanibular lymph nod
IO (Intraoral): HT (hard tissues): LL6 grade3 mobility, UR7 # AF
ER (Existing restorations): large ditched AF LL6 ST (soft tissues) LL6 associated buccal gingivae inflamed,
LL6 buccal 8mm pocket,
Gingivae generally erythematous and inflamed
CPITN 222 224OH (oral hygiene) marginal gingivitis associated with calculus at gingival margin,
 
 
So as you can see this records the basic information about the patient. The next step, in this case, may be to take the necessary radiographs (i.e. perhaps a periapical of the LL6 and some bitewings if the patient has not had any in the last 18 months). Remember to record the reasons for taking any radiographs in the notes, along with the details of the views taken and then a written report on any results from the radiographs.

eg: Radiographs: BWs to check for caries and bone levels, PA LL6 to assess periodontal health. Radiographic report: LL6 1/3 alveolar bone support, large periapical area. Secondary MO caries UR7.

Afterwards, communicate to the patient what you believe is the cause of the problem and discuss with them what the options of treatment are. The patient would then leave the surgery and be given an estimate of treatment cost on an FP17dc form and a date for their next appointment.  
You can then write your treatment plan in the notes, e.g.Periapical radiograph shows large periapical and furcation lesion LL6, poor bone support.TCA for xla LL6 and fill UR7, check OH To contact GMP (general medical practitioner) for advice re steroids.

 
You need to be methodical in your work, especially at examinations. This will ensure you examine and record everything that is required of you. This is especially important considering you will probably only have 10 minutes to do each exam along with a scale and polish.  
Since 1st April 2006 all contract values are linked to UDAs (Units of Dental Activity).
For NHS treatments dentists will receive a contract offering a set annual amount (contract value) that is paid in 12 fixed monthly payments (similar to a salary).
The dentist will be expected to achieve an amount of UDAs specified in their contract.
There is not a single set contract value across the UK. You should expect to discuss this when speaking about specific roles.
Each dental procedure has been classified into a band which determines the amount of UDAs.

  • Band 1-1 UDA
  • urgent treatment only- 1.2 UDAs
  • Band 2- 3 UDAs
  • Band 3 12 UDAs
  • Issue of prescription- 0.75 UDA
  • Repair of dental appliance (denture)-1 UDA
  • Repair of dental appliance (bridge)-1.2 UDAs
  • Removal of sutures -1 UDA
  • Arrest of bleeding -1.2 UDAs

Band 1: Diagnosis, treatment planning and maintenance Clinical examination, radiographs, scale and polish, preventative work e.g.: oral health assessment, study models, denture eases.
Band 2: Treatment
Simple treatment e.g.: fillings including root canal therapy, extractions, surgical procedures and dental additions, periodontal treatment.


Band 3: Provision of appliances
Complex treatment that includes a laboratory element e.g.: bridgework, crowns and dentures, excludes mouth guards. Urgent treatment Examination, radiographs, dressings. Re-cementing crowns, up to two extractions and one filling.

 
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