NATIONAL HEALTH SERVICE, ENGLAND AND WALES Citation, commencement and interpretation 1 1 These Regulations may be cited as the National Health Service (General Dental Services) (Miscellaneous Amendments) Regulations 1990 and shall come into force— a except for the purposes of regulation 4(2), on 1st October 1990; and b for the purposes of regulation 4(2), on 1st April 1991. 2 In these Regulations, the “principal Regulations” means the National Health Service (General Dental Services) Regulations 1973 . Amendment of regulation 2 of the principal Regulations 2 1 In regulation 2(1) of the principal Regulations (interpretation)— a for the definition of “capitation arrangements” there is substituted the following definition:— “capitation arrangement” means an arrangement between the dentist and the patient whereby the dentist provides care and treatment in accordance with paragraph 5 of Schedule 1; b the definitions of “dental estimate form”, “dental fitness”, “dental health” and “emergency treatment” are omitted; c for the definition of “estimate” there is substituted the following definition:— “estimate” means a form supplied by the Family Authority, or a form to like effect, completed by the dentist and submitted to the Board in accordance with paragraph 24 of Schedule 1 for the purpose of obtaining prior approval under that paragraph; d in the definition of “occasional treatment” there are substituted for the words “Schedule 1 Part I paragraph 10” the words “paragraph 16 of Schedule 1”; e the definition of “preventive treatment” is omitted; f for the definition of “salaried dentist” there is substituted the following definition:— “salaried dentist” means a dentist employed by a Family Authority who undertakes to provide general dental services at a health centre; g for the definition of “treatment” there is substituted the following definition:— “treatment” means all proper and necessary dental treatment which a dentist usually undertakes for a patient and which the patient is willing to undergo, including examination, diagnosis, preventive treatment, periodontal treatment, conservative treatment, surgical treatment, the supply and repair of dental appliances, orthodontic treatment and the taking of radiographs and the administration of general anaesthesia and sedation in connection with such treatment and the supply of drugs and the issue of prescriptions in accordance with paragraphs 20 and 21 of Schedule 1; h the following definitions are inserted in the appropriate places in the alphabetical order:— i “care and treatment” means— all proper and necessary care which a dentist usually undertakes for a patient and which the patient is willing to undergo, including advice, planning of treatment, preventive care, and treatment; ; ii “continuing care arrangement” means an arrangement between the dentist and the patient whereby the dentist provides care and treatment in accordance with paragraph 4 of Schedule 1; ; iii “dental surgery” means any part of the practice premises, where care and treatment is provided; ; iv “an emergency” means the circumstances set out in paragraph 6(2) of Schedule 1 in which a patient requires prompt care and treatment; ; v “Family Authority” means Family Health Services Authority ; ; vi “mobile surgery” means any vehicle in which care and treatment is provided; ; vii “NHS charge” means the charge, authorised under the National Health Service (Dental Charges) Regulations 1989 , to the patient within the meaning of those Regulations; viii “oral health” means such a standard of health of the teeth, their supporting structures and other tissues of the mouth, and of dental efficiency, as in the case of any patient is reasonable having regard to the need to safeguard his general health; ix “patient record” means the form supplied by the Family Authority for the purpose of maintaining a record of treatment or a form to like effect; x “practice premises” means, in relation to any dentist, any premises at which he provides general dental services, or any mobile surgery of his; xi “prior approval treatment” means any item of treatment referred to in Part I of Schedule 1C or any care and treatment specified in paragraph 1 or 2 in Part II of that Schedule; xii “private”, in the context of care and treatment, means otherwise than under general dental services or Part I of the National Health Service Act 1977 and “privately” shall be construed accordingly; ; xiii “trauma” means damage to teeth, gingival tissues, or alveoli caused by a force arising outside the mouth resulting in mobility, luxation, subluxation or fracture of the hard tissues or injury to the soft tissues; xiv “treatment on referral” means any care and treatment provided by a dentist under paragraph 13 of Schedule 1; . 2 In regulation 2(4) of the principal Regulations (interpretation) there are inserted after the word “regulation” where it last appears the words “and any reference in a regulation to a numbered Schedule is a reference to the Schedule bearing that number in these Regulations”. Amendment of regulation 3 of the principal Regulations 3 In regulation 3 of the principal Regulations (terms of service) for sub-paragraphs (a) and (b) there are substituted:— a in the case of a dentist undertaking to provide general dental services otherwise than as a salaried dentist, the terms of service contained in Parts I, II, III, IV and V of Schedule 1; and b in the case of a dentist undertaking to provide general dental services as a salaried dentist, the terms of service contained in Parts I, II, III, IV and VI of Schedule 1; . Amendment of regulation 4 of the principal Regulations 4 1 Regulation 4 of the principal Regulations (dental list) is amended in accordance with the following paragraphs of this regulation. 2 There are substituted for paragraph (1) the following paragraphs:— 1 The Family Authority shall prepare a list, to be called the dental list, of dentists who, pursuant to the provisions of paragraph (2), have undertaken to provide general dental services in its locality and who are not disqualified for inclusion by virtue of the provisions of— a section 36(2) or 47(1) of the National Health Service Act 1977 ; or b section 8(2) of the Health and Medicines Act 1988 . 1A The dental list shall, in addition to the name of a dentist,— a contain— i the addresses of all the practice premises and, where he provides general dental services at a mobile surgery only, the address at which correspondence in connection with such provision may be sent to him; ii particulars of the days and hours when he is or will be usually in attendance at the practice premises for the provision of general dental services and, in the case of any mobile surgery, particulars of the places regularly visited by him and the times of those visits; iii the name of any other dentist in association with whom he provides general dental services at the practice premises; iv the date of his registration as a dental practitioner in the register kept under section 14 of the Dentists Act 1984 , particulars of the dental qualification held by the dentist which entitled him to be so registered, including the date on which the qualification was awarded, and particulars of any other dental qualification held by him which is registerable pursuant to section 19(1)(c) of the Dentists Act 1984 ; and b indicate— i whether the dentist provides only orthodontic treatment; and ii whether there is access to the dental surgery without the use of stairs. 1B The dental list may, provided that the dentist consents to its inclusion, also give particulars of any languages, other than English, spoken by the dentist. 1C The dental list may, if the Family Authority thinks fit, be so arranged as to show the part of the locality in which each dentist has undertaken to provide general dental services. . 3 There are substituted for paragraph (2) the following paragraphs:— 2 A dentist who wishes to have his name included in the dental list shall make an application to the Family Authority in writing which— a shall include the information and undertaking specified in Part I of Schedule 1A; and b may include the information specified in Part II of that Schedule. 2A A dentist whose name is included in the dental list of any Family Authority, who is requested in writing by the Family Authority to supply any information mentioned in paragraph (2B), shall supply that information to the Family Authority within 28 days of the date of the Family Authority’s request. 2B The information mentioned in paragraph (2A) is— a if the dentist provides general dental services at a mobile surgery, particulars of the places regularly visited by him and the times of those visits; b if he provides general dental services at a mobile surgery only, the address at which correspondence in connection with such provision may be sent to him; c the name of any other dentist in association with whom the dentist provides general dental services at the practice premises; d the date of the dentist’s registration as a dental practitioner in the register kept under section 14 of the Dentists Act 1984 , particulars of the dental qualification held by the dentist which entitled him to be so registered, including the date on which the qualification was awarded, and particulars of any other dental qualification held by him which is registerable pursuant to section 19(1)(c) of the Dentists Act 1984 ; e whether he provides only orthodontic treatment; f whether there is access to the dental surgery without the use of stairs; and g where the dentist consents to the inclusion of such information in the dental list, particulars of any languages, other than English, spoken by him. . 4 There are inserted after paragraph (4) the following paragraphs:— 5 The Family Authority may prepare, and thereafter maintain, in addition to a dental list, any other list which may contain, in respect of each dentist whose name is included in its dental list— a any information included in the dental list in respect of the dentist; and b any other information related to the provision of general dental services which the Family Authority has agreed with the Local Dental Committee to be appropriate. 6 Where the Family Authority has agreed with the Local Dental Committee that certain information is appropriate for inclusion in the list referred to in paragraph (5), it may request in writing any dentist whose name is included in its dental list to furnish the Family Authority with such information as it relates to him, and the dentist shall furnish that information to the Family Authority within 28 days of the date of the Family Authority’s request. . Substitution of regulation 8 of the principal Regulations 5 For regulation 8 of the principal Regulations (arrangements to complete treatment) there is substituted the following regulation:— Arrangements to complete care and treatment 8 1 Subject to sub-paragraph (2), where a dentist who is providing care and treatment for patients under continuing care arrangements or capitation arrangements ceases to have his name included in the dental list, the Family Authority may, after consultation with the Local Dental Committee and with the agreement of the patients concerned, make arrangements with one or more dentists (whose names are included in the dental list) for the continuing care arrangements or capitation arrangements to be transferred to that or those dentists. 2 Where a dentist has died and his name remains on the dental list in accordance with the proviso to regulation 6(1), the Family Authority shall, subject to the agreement of the patients concerned, make arrangements with the dentist appointed by the personal representatives of the deceased dentist for the care and treatment under any continuing care arrangements or capitation arrangements entered into by the deceased dentist to be provided by that dentist. . Amendment of regulation 11 of the principal Regulations 6 In regulation 11 of the principal Regulations (functions) there are substituted for the words from “dental estimate forms” to the words “or for approval for payment” the words “claims for remuneration submitted for approval for payment and all estimates whether or not sent in by computer”. Insertion of regulation 11A into the principal Regulations 7 After regulation 11 of the principal Regulations (functions) there is inserted the following regulation:— Prior approval—patterns of treatment 11A 1 Where it appears to the Board that a dentist’s pattern of treatment in respect of all or any particular description of treatment, provided as part of general dental services in the locality of any Family Authority, differs so substantially from the local or national pattern of treatment of other dentists as to warrant, in the opinion of the Board, further investigation, the Board may write to the dentist— a giving details of his pattern of treatment in respect of all or any particular description of treatment and stating the extent to which it differs from the local or national pattern of treatment of other dentists; b inviting him to submit to the Board in writing the reasons why his pattern of treatment differs to the extent identified by the Board under sub-paragraph (a) of this paragraph, from that local or national pattern; and c giving notice to him that if— i he fails to reply within 28 days; or ii his reply discloses no reasonable grounds, in the opinion of the Board, for his pattern of treatment to differ, to the extent identified by the Board under sub-paragraph (a) of this paragraph, from that local or national pattern of treatment; the Board may give a direction as mentioned in paragraph (2). 2 Where the dentist fails— a to reply within 28 days; or b to disclose the reasonable grounds as mentioned in paragraph (1)(c)(ii); the Board may direct the dentist that he may not, for a period of not less than 3 months nor more than 9 months specified in the direction, carry out treatment, or a description of treatment specified in the direction, without first obtaining approval of an estimate from the Board, but nothing in any such direction shall prevent the dentist, without such approval, from giving treatment following trauma or in an emergency, any private treatment or, in the course of any single consultation, treatment of a patient consisting of one examination and the taking of no more than two radiographs, each of a size not exceeding 16 centimetres square. 3 Where the Board gives a direction under paragraph (2), the direction shall inform the dentist of his right of appeal under regulation 21 of the National Health Service (Service Committees and Tribunal) Regulations 1974 and shall have no effect until the expiry of the period allowed by that regulation for the bringing of an appeal and, if such an appeal is brought, until the determination of the appeal. 4 The Board shall not give a direction to a dentist under paragraph (2) in consequence of having written to him under paragraph (1) more that 12 months previously. 5 Where the Board gives a direction to a dentist under paragraph (2) and— a the dentist does not appeal; b he does appeal and his appeal is unsuccessful; or c he appeals successfully; the Board shall not give a further direction under paragraph (2) in relation to that dentist in respect of any treatment specified in the earlier direction for a period of 9 months beginning with the expiry of the period specified in the earlier direction or, as the case may be, the date on which the appeal is allowed. 6 Paragraphs (1) and (2) shall not apply to any treatment for which a dentist is remunerated in accordance with Section X (treatment under capitation) of Determination I of the Statement of Dental Remuneration dated 8th August 1990 and for which he receives no remuneration other than a capitation payment. 7 In this regulation— a “pattern of treatment” means— i the number of instances in which an item or items of treatment are provided by or on behalf of a dentist, or ii the ratio which the number of instances relating to one such item bears to the number of instances relating to another such item; b “local”, in relation to pattern of treatment, means throughout the locality of a Family Authority; and c “national”, in relation to pattern of treatment, means throughout England and Wales. . Amendment of regulation 14 of the principal Regulations 8 In regulation 14 of the principal Regulations (standing orders) in paragraph (f) there is inserted after the word “estimate” in both places where it occurs the words “, claim for remuneration”. Substitution of regulation 16 of the principal Regulations 9 For regulation 16 of the principal Regulations (application for services) there is substituted the following regulation:— Application for services 16 1 A person aged 18 or over may apply to any dentist whose name appears in any dental list for general dental services by way of— a care and treatment under a continuing care arrangement; or b occasional treatment. 2 Subject to paragraph (3), a person under the age of 18 may apply to any dentist whose name appears in any dental list for general dental services by way of— a care and treatment under a capitation arrangement; or b occasional treatment. 3 A dentist may not enter into a capitation arrangement with a person during the month before he attains the age of 18. 4 A person under the age of 18 may apply to a dentist for general dental services by way of care and treatment under a continuing care arrangement at any time during the month before he attains the age of 18 provided that he is not immediately before that date receiving care and treatment under a capitation arrangement with that dentist. 5 A person who is receiving care and treatment under a capitation arrangement with a dentist may at any time after he attains the age of 17 apply for general dental services by way of care and treatment under a continuing care arrangement with that dentist from the date that he attains the age of 18. 6 Application under this regulation shall be made in person at the practice premises unless a person is unable to attend those premises owing to illness or any other reasonable cause. . Amendment of regulation 23 of the principal Regulations 10 In regulation 23(1) of the principal Regulations (Statement of Dental Remuneration) for all the words after “Statement of Dental Remuneration” there is substituted:— Column 1 Column 2 Determination Subject matter of determination I A Scale of Fees which shall prescribe the remuneration to be paid to a dentist, other than a salaried dentist, for care and treatment under a continuing care arrangement or a capitation arrangement, treatment on referral and occasional treatment and the conditions of payment of remuneration; II Rates of remuneration for a salaried dentist; III Seniority payments; IV Vocational training allowances; V Incentive scheme allowances; VI Maternity payments; VII Long term sickness payments; VIII Postgraduate education allowances. . Amendment of regulation 24 of the principal Regulations 11 In regulation 24 of the principal Regulations (approval of payments)— a there are substituted for paragraph (1) the following paragraphs:— 1 The Board shall, where it receives notification that— a a patient has been accepted by a dentist, other than a salaried dentist, under a continuing care arrangement or a capitation arrangement or for treatment on referral, authorise the payments which, in accordance with the Scale of Fees, fall to be made by the Family Authority to the dentist in respect of such an arrangement or referral; or b a continuing care arrangement or a capitation arrangement has terminated or treatment on referral has been completed, authorise the Family Authority to cease such payments to the dentist. 1A The Board shall, where it approves a claim for remuneration made by a dentist, other than a salaried dentist, in respect of— a care and treatment under a continuing care arrangement or a capitation arrangement; b treatment on referral; or c occasional treatment; completed by the dentist, authorise, in accordance with the Scale of Fees, the remuneration to be paid by the Family Authority to the dentist in respect of such care and treatment, treatment on referral, or occasional treatment. 1B In any case falling within paragraph 14(1) or 16(4) of Schedule 1 (inability of dentist to complete treatment), the Board shall authorise in accordance with the Scale of Fees, and without prejudice to the provisions of the National Health Service (Dental Charges) Regulations 1989 , the remuneration to be paid by the Family Authority to a dentist, other than a salaried dentist, in respect of such care and treatment or occasional treatment provided by him. 1C A Family Authority shall pay to a dentist, other than a salaried dentist, the remuneration— a authorised by the Board under paragraphs (1)(a), (1A) and (1B); and b in accordance with Determinations III, IV, V, VI, VII and VIII of the Statement of Dental Remuneration. ; and b in paragraph (2) for “IV” there is substituted “II”. Amendment of regulation 25 of the principal Regulations 12 In regulation 25 of the principal Regulations (drugs) there are substituted for the words “in pursuance of Schedule 1 Part 1 paragraph 12(1)” the words “under paragraph 20(1) of Schedule 1”. Revocation of Part VIB of the principal Regulations 13 Part VIB of the principal Regulations (use of computers in general dental services) is hereby revoked. Substitution of Schedule 1 to the principal Regulations 14 For Schedule 1 to the principal Regulations there are substituted the Schedules set out in the Schedule to these Regulations. Amendment of the National Health Service (Dental Charges) Regulations 1989 15 1 The National Health Service (Dental Charges) Regulations 1989 shall be amended in accordance with the following paragraphs of this regulation. 2 In regulation 2(2) (interpretation)— a the definition of “dental estimate form” is omitted; and b the following definitions are inserted in the appropriate places in the alphabetical order:— i “capitation arrangement” has the same meaning as in the National Health Service (General Dental Services) Regulations 1973; ; ii “continuing care arrangement” has the same meaning as in the National Health Service (General Dental Services) Regulations 1973; ; iii “emergency” has the same meaning as in the National Health Service (General Dental Services) Regulations 1973; ; iv “estimate” has the same meaning as in the National Health Service (General Dental Services) Regulations 1973; v “treatment” has the same meaning as in the National Health Service (General Dental Services) Regulations 1973; ; and vi “treatment on referral” has the same meaning as in the National Health Service (General Dental Services) Regulations 1973; . 3 In regulation 3 (charges for other general dental services)— a in paragraph (2)(c) and (d) there are substituted for the words “emergency treatment” wherever they occur the words “treatment in an emergency”; b in paragraph (2) after sub-paragraph (d) there is inserted the following paragraph:— e treatment provided pursuant to paragraph 7 or 13(2) (repair or replacement of restorations) of Schedule 1 (terms of service) to the National Health Service (General Dental Services) Regulations 1973. . 4 In regulation 4 (calculation of charges) in paragraph (2)(b) there are inserted after the word “arrangement” where it last occurs the words “, but where a patient has been accepted by the dental practitioner under a continuing care arrangement or a capitation arrangement or for treatment on referral, does not include the payments which, in accordance with that Statement, fall to be made to the dentist in respect of such an arrangement or referral”. 5 In regulation 5 (conditions for exemption under the Act) in paragraph (2)(a) there are substituted for the words “dental estimate form” the words “claim for remuneration or estimate”. 6 In regulation 6 (making and recovery of charges) in paragraph (2)(b) there are substituted for the words “dental estimate form, and before that form” the words “claim for remuneration or estimate, and before that claim or estimate”. 7 In regulation 8 (charges for more expensive supplies and repairs) paragraphs (2), (3) and (4) shall be omitted. 8 In regulation 11 (reduction of remuneration and accounting for charges — general dental services) in paragraphs (2) and (3) for “IV” there is substituted “II”. 9 Schedule 3 (charges for more expensive supplies and repairs — general dental services) shall be omitted. Amendment of the National Health Service (Service Committees and Tribunal) Regulations 1974 16 1 The National Health Service (Service Committees and Tribunal) Regulations 1974 shall be amended in accordance with the following paragraphs of this regulation. 2 In regulation 2(1) (interpretation) in the definition of “treatment” for the words “has the same meaning as in the General Dental Regulations” there shall be substituted the following words:— means— a except in the context mentioned in sub-paragraph (b) of this definition— i where at the material time the dentist is providing occasional treatment under the General Dental Regulations, treatment within the meaning of those Regulations; ii in any other case, care and treatment within the meaning of those Regulations; b in the context of the description of treatment to be specified under regulation 10(5)(d) or 15(1), treatment within the meaning of the General Dental Regulations other than— i one examination in the course of any single consultation; ii treatment in an emergency within the meaning of those Regulations; iii two radiographs, each of a size not exceeding 16 centimetres square, in the course of any single consultation; and iv treatment for which a dentist is remunerated in accordance with Section X (treatment under capitation) of Determination I of the Statement of Dental Remuneration dated 8th August 1990 and for which he receives no remuneration other than a capitation payment; . 3 In regulation 10 (decision of Committee), in paragraph (5)(d) for the words from “all or any” to the end of the sub-paragraph there shall be substituted the words “any description of treatment specified in the recommendation;”. 4 In regulation 13 (denture conciliation committees) in paragraph (4) for the words “the dental fitness” there shall be substituted the words “and maintain the oral health”. 5 In regulation 14 (procedure on withholding money)— a in paragraph (1)— i in sub-paragraph (c) for the words “paragraph 6 or paragraph 19” there shall be substituted “paragraph 23”; ii in sub-paragraph (d) for the words “paragraph 2(a) or paragraph 2(b)” there shall be substituted the words “paragraph 18(1)(a) or (d)”; b in paragraph (5) for the words from “failure to complete” to “skill” there shall be substituted the words “failure to exercise a proper degree of skill and attention”. 6 In regulation 15 (procedure in dental prior approval cases), for the words in paragraph (1) from “specific treatment” to “emergency treatment” there shall be substituted the words “specified description of treatment”. 7 In regulation 18 (investigation of record keeping)— a in paragraph (1) for the words “paragraph 6 or paragraph 19” there shall be substituted “paragraph 23”; b in paragraph (7)(b) for “paragraph 6” there shall be substituted “paragraph 23”. 8 In regulation 21 (appeals from Dental Practice Board)— a after paragraph (1) there shall be inserted the following paragraph:— 1A Any dentist who is aggrieved by a decision of the Board under regulation 11A of the General Dental Regulations (prior approval— patterns of treatment) may, in accordance with paragraphs (2) and (3), appeal against the decision— a where the name of the dentist is included in the dental list of only one Family Health Services Authority, to that Authority; b where the name of the dentist is included in the dental list of more than one Family Health Services Authority, to any such Authority. ; b in paragraph (5)— i in sub-paragraph (a) for the words from “an estimate” to “relates” there shall be substituted the words “a claim for remuneration on the grounds that the services to which the claim relates”; ii in sub-paragraph (d) for the words from “appoint” to “the appeal” there shall be substituted the following words:— appoint— i where the appeal is made under paragraph (1A) three dentists; ii in any other case, two dentists; as referees to determine the appeal . 9 Regulation 22 (investigation of excessive dental treatment) is hereby revoked. 10 In regulation 53 (power to extend time limits) the figure “, 22” shall be omitted in paragraph (1)(a). Transitional Provisions 17 1 Where— a a dentist has begun treatment of a patient before 1st October 1990 with a view to securing dental fitness in accordance with paragraph 2(b) of Schedule 1 to the principal Regulations as in force before that date, and b that treatment is not completed by 1st October 1990, the principal Regulations shall continue to have effect as respects completion of that treatment as if these Regulations had not been made, unless and until that dentist accepts the patient for care and treatment under a continuing care arrangement or a capitation arrangement under the principal Regulations as amended by these Regulations. 2 A dentist shall not accept for care and treatment under a continuing care arrangement or a capitation arrangement a patient who is receiving treatment pursuant to paragraph (1), other than orthodontic treatment, and remains willing to undergo that treatment (whether or not pursuant to that paragraph). 3 A patient who, before 1st October 1990, is receiving care and treatment from a dentist under a capitation arrangement under Part IV of Schedule 1 to the principal Regulations as in force before that date shall be treated as having applied to, and been accepted on that date by, that dentist for care and treatment under a capitation arrangement under the principal Regulations as amended by these Regulations; and in relation to such a patient paragraph 5 of Schedule 1 to the principal Regulations shall have effect as if the references in paragraph 5(1)(a) to the time at which the dentist accepts the patient were to the time of his consultation with the patient after 1st October 1990 and in paragraph 5(1)(b) and (c) to the time of the dentist’s first examination of the patient were to the time of the first such examination taking place on or after 1st October 1990. 4 The amendments made by these Regulations to the National Health Service (Dental Charges) Regulations 1989 shall apply in relation to general dental services only where the contract or arrangement leading to the provision of the services is made on or after 1st October 1990. 5 Where on or after 1st October 1990 a matter falls to be investigated, referred or determined (whether by a service committee, a denture conciliation committee, a Family Authority, the Secretary of State or otherwise) under Part II of the National Health Service (Service Committees and Tribunal) Regulations 1974 following a complaint which relates to treatment, as part of general dental services, begun before 1st October 1990, those Regulations shall apply to the investigation, referral or determination of that matter as if these Regulations had not been made. Revocation 18 The National Health Service (General Dental Services) Amendment Regulations 1988 are hereby revoked. Signed by authority of the Secretary of State for Health Virginia Bottomley Minister of State, Department of Health 8th August 1990