HEALTH AND PERSONAL SOCIAL SERVICES PART I GENERAL Citation and commencement 1 These regulations may be cited as the Health and Personal Social Services General Dental Services Regulations (Northern Ireland) 1993 and shall come into operation on 1st September 1993. Interpretation 2 In these regulations— “ the Agency ” means the Northern Ireland Central Services Agency for the Health and Social Services established under Article 26 of the Order; “ assistant ” means any dentist employed either whole-time or part-time under a contract of service by another dentist for the purpose of providing general dental services on behalf of that other dentist; “ associateship agreement ” means an agreement between dentists practising as principals— to which there are two parties, not being partners of each other, and whereby one party is liable to provide, for financial consideration, the use of some or all premises and of some or all facilities for the provision of general dental services by the other party; “ Board ” means a Health and Social Services Board; “ 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 2; “ 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 and preventive care, and treatment; “ charge ” means the charge, authorised under the Dental Charges Regulations to the patient within the meaning of those regulations; “ Committee ” means the Dental Committee constituted under regulation 30; “ 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 2; “ the Dental Charges Regulations ” means the Health and Personal Social Services Dental Charges Regulations (Northern Ireland) 1989 ; “ dental payment claim form ” means a form provided by the Agency on which a dentist may claim payment for treatment provided; “ dental officer ” means a dentist in the employment of the Agency; “ dental surgery ” means any part of the practice premises where care and treatment is provided; “ dentist ” means a registered dental practitioner; “ the Dentists Act ” means the Dentists Act 1984 ; “ deputy ” means a dentist acting on behalf of another dentist, otherwise than in the capacity of an assistant, for the purpose of providing general dental services; “ doctor ” means a registered medical practitioner; “ Drug Tariff ” means the statement prepared by the Department under regulation 40 of the Health and Personal Social Services (General Medical and Pharmaceutical Services) Regulations (Northern Ireland) 1973 ; “ an emergency ” means the circumstances set out in paragraph 6(2) of Schedule 2 in which a patient requires prompt care and treatment; “ emergency dental services ” means treatment which is provided pursuant to arrangements made under regulation 14; “ estimate ” means a form supplied by the Agency, completed by the dentist and submitted to the Agency in accordance with paragraph 26 of Schedule 2 for the purpose of obtaining prior approval under that paragraph; “ health premises ” means any facility made available by a Board for the provision of general dental services; “ listed drugs ” means such drugs and medicines as are included in a list for the time being approved by the Department for the purposes of Article 63 of the Order ; “Local Dental Committee”, “Local Medical Committee” and “Local Pharmaceutical Committee” mean the committees of those names which are recognised by a Board in relation to its area under Article 55 of the Order ; “ medical card ” means a card issued to a person by the Agency in a form approved by the Department for the purpose of enabling that person to obtain or establish a title to receive general medical services, including maternity medical services, general dental services or general ophthalmic services; “ mobile surgery ” means any vehicle in which care and treatment is provided; “ occasional treatment ” means such treatment as is mentioned in paragraph 17 of Schedule 2; “ 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; “ the Order ” means the Health and Personal Social Services (Northern Ireland) Order 1972; “ patient ” means a person for whom a dentist agrees to provide general dental services; “ patient record ” means a form supplied by the Agency for the purpose of maintaining a record of treatment; “ practice premises ” means in relation to any dentist, any premises at which he provides general dental services, or any mobile surgery of his; “ practice record form ” means a form supplied by the Agency and completed in accordance with paragraph 27 of Schedule 2 for the purpose of obtaining general dental services in circumstances where the dentist intends to use a computer to send an estimate to the Agency; “ prescription form ” means a form provided by the Agency and issued by a dentist to enable a person to obtain pharmaceutical services; “ prior approval treatment ” means any item of treatment referred to in Part I of Schedule 5 or any care and treatment specified in paragraph 1 or 2 in Part II of that Schedule; “private”, in the context of care and treatment, means otherwise than under general dental services or Part VI of the Order and “ privately ” shall be construed accordingly; “ referral dental officer ” means a dental officer in the employment of the Department; “ salaried dentist ” means a dentist employed by a Board who undertakes to provide general dental services at health premises; “ Scale of Fees ” means the Scale of Fees set out in Determination I of the Statement of Dental Remuneration; “ the Services Committee Regulations ” means the Health and Personal Social Services (Services Committee) Regulations (Northern Ireland) 1973 ; “ Statement of Dental Remuneration ” means the Statement published by the Department pursuant to the provisions of regulation 19; “ supply ”, in relation to an appliance, includes replacement; “ terms of service ” means the terms of service contained, or referred to, in Schedule 2; “ 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; “ 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 provision of general anaesthesia and sedation in connection with such treatment and the supply of listed drugs and the issue of prescriptions in accordance with paragraphs 22 and 23 of Schedule 2; and “ treatment on referral ” means any care and treatment provided by a dentist under paragraph 13 of Schedule 2. PART II GENERAL ARRANGEMENTS FOR PROVISION OF GENERAL DENTAL SERVICES Terms of service 3 The arrangements with dentists for the provision of general dental services which it is the duty of a Board under Article 61 of the Order to make, and under Article 17(1)(a) of the Order to administer, shall incorporate— a in the case of a dentist undertaking to provide general dental services (other than emergency dental services), otherwise than as a salaried dentist, the terms of service contained in Parts I, II, III, IV and V of Schedule 2; b in the case of a dentist undertaking to provide general dental services (other than emergency dental services), as a salaried dentist, the terms of service contained in Parts I, II, III, IV and VI of Schedule 2; c in the case of the provision of emergency dental services by a dentist undertaking to provide emergency dental services, the terms of service contained in Parts I and III, paragraphs 19, 20, 21, 22, 23 and 25 of Part IV and paragraphs 39, 40, 41 and 42 of Part VI, of Schedule 2. Dental list 4 1 The Agency shall, from information obtained from Boards, prepare a list, to be called the dental list, of dentists who, pursuant to the provisions of regulation 5, have undertaken to provide general dental services and who are not disqualified for inclusion by virtue of the provisions of— a Article 61(2A) or Article 65 of, and Schedule 11 to the Order; or b Article 4 of the Health and Medicines (Northern Ireland) Order 1988 ; or c regulation 7 (restrictions on the right to be included in the dental list). 2 The dental list shall, in addition to containing the name of a dentist,— a contain— i the addresses of all his 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 usually be 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 visited regularly 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 his practice premises, iv the date of his registration as a dental practitioner in the register kept under section 14 of the Dentists Act, particulars of the dental qualification 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 registrable pursuant to section 19(1)(c) of the Dentists Act; 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. 3 The dental list may, provided that the dentist consents to their inclusion, also give particulars of any languages, other than English, spoken by the dentist. 4 The dental list may, if the Agency thinks fit, be so arranged as to show the area in which each dentist has undertaken to provide general dental services. 5 A dentist whose name is included in the dental list shall notify the Board of any occurrence requiring an alteration to the information recorded in relation to him in the dental list within 14 days of the date of such occurrence. 6 The Agency shall— a send to the Department, each Board and each Local Dental Committee a copy of the dental list; and b notify the Department, each Board and each Local Dental Committee of any alteration to the dental list within 7 days of the date on which the alteration is made. 7 Subject to paragraph (9), the Agency shall— a send, if requested to do so, a copy of the dental list to— i a Local Medical Committee, ii a Local Pharmaceutical Committee, iii a hospital or HSS trust, iv any organisation representative of the dental profession, v a person whose name is included in the list maintained by the Agency pursuant to Article 63(2A) of the Order ; and b in that event, notify them, at intervals of not less than 3 months, of any alterations made to the dental list. 8 The Agency shall prepare an updated dental list each year and send a copy— a to the Department, to each Board and to each Local Dental Committee; and b subject to paragraph (9), to any person mentioned in paragraph (7)(a) who under that paragraph requested a copy of the dental list. 9 Where the Agency considers that only parts of, or only some of the alterations to, the dental list are likely to concern any person mentioned in paragraph (7)(a), the Agency may instead of sending him a copy of the list or notifying him of all those alterations send that person a copy only of those parts or, as the case may be, notify him only of those alterations. Application for inclusion in the dental list 5 1 A dentist who wishes to have his name included in the dental list shall make an application to the Board in writing which— a shall include— i in the case of a salaried dentist or a dentist undertaking to provide only emergency dental services, the information specified in paragraphs 1, 2, 3, 4, 5 and 11 of Part I of Schedule 3 and the undertaking specified in that Part of that Schedule, and ii in any other case, all the information and the undertaking specified in Part I of Schedule 3; and b may include the information specified in Part II of that Schedule. 2 The Board shall determine an application made by a dentist under paragraph (1) within 14 days of the date of its receipt of the application or, where the Board considers the proposed practice premises should be inspected, within 14 days of the date of that inspection. Local directory of dentists 6 1 A Board may prepare, and thereafter maintain, a list to be known as the local directory of dentists, which may contain, in respect of each dentist whose name is included in the 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 Board has agreed with the Local Dental Committee to be appropriate. 2 Where the Board has agreed with the Local Dental Committee that certain information is appropriate for inclusion in the local directory of dentists, it may request in writing any dentist whose name is included in the dental list to furnish the Board with such information as it relates to him, and the dentist shall furnish that information to the Board within 28 days of the date of the Board's request. Restrictions on the right to be included in the dental list 7 1 A dentist shall not be entitled to have his name included in the dental list if he has previously withdrawn his name from a list in circumstances where— a the Department has certified for the purposes of regulation 7(7) of the Health and Personal Social Services (Superannuation) Regulations (Northern Ireland) 1984 ; or b the Secretary of State has certified for the purposes of regulation 8(7) of the National Health Service (Superannuation) Regulations 1980 ; or c the Secretary of State for Scotland has certified for the purposes of regulation 10(4) of the National Health Service (Superannuation) (Scotland) Regulations 1980 ; that, in the interests of the efficiency of general dental services, he should cease to provide such services. 2 Where the Board is not satisfied (following an inspection) that the proposed practice premises meet the requirements of paragraph 33 of Schedule 2 it may refuse to include a dentist's name in the dental list. Removal from dental list 8 1 Subject to sub-paragraph (2), where a Board determines that a dentist whose name is included in the dental list— a has died; or b subject to section 35(3) of the Dentists Act, is no longer a dentist; the Board shall remove his name from the dental list with effect from the date of its determination. 2 Where a dentist has died and— a for so long as his practice is carried on by his personal representatives in accordance with the provisions of the Dentists Act, and b the personal representatives have appointed for that purpose a dentist whose name is included in the dental list, the Board shall not remove the dentist's name from the dental list. 3 Subject to paragraph (5), where a Board determines, in accordance with paragraph (4), that a dentist whose name has been included for the preceding 6 months in the dental list has not during that period provided general dental services, the Board may remove the dentist's name from the dental list. 4 Before making any determination under paragraph (3) the Board shall— a give the dentist 28 days' notice of its intention to do so; b afford the dentist an opportunity of making representations to the Board in writing or, if he so wishes, in person; and c except where the dentist is a salaried dentist, consult the Local Dental Committee. 5 In calculating the period of 6 months referred to in paragraph (3) there shall be disregarded any period during which— a the dentist was performing relevant service; b the dentist was on maternity leave; or c the dentist was unable to provide general dental services because of sickness. 6 In this regulation— a “ relevant service ” means— i whole-time service in the armed forces of the Crown in a national emergency as a volunteer or otherwise; or ii compulsory whole-time service in those forces, including service resulting from any reserve liability; or iii any equivalent service by a person liable for compulsory whole-time service in those forces; and b “ maternity leave ” means the period of one year beginning with the date of confinement. 7 Nothing in this regulation shall prejudice any right of a dentist to have his name included again in the dental list. Removal from dental list on grounds of age 9 1 A Board shall, on each of the dates specified in column (1) of the Table below, remove from the dental list the name of any dentist included in the list who has, on or before that date, attained the age specified in column (2) of the Table in relation to that date. TABLE (1) (2) 1st April 1994 the age of 68 1st April 1995 the age of 67 1st April 1996 the age of 66 1st April 1997 the age of 65 2 A Board shall, on 1st April in 1998 and in each successive year thereafter, remove from the dental list the name of any dentist included in the list who has attained the age of 65 during the period of 12 months ending on 1st April in that year. 3 A Board shall give to any dentist whose name is to be removed from the dental list in accordance with paragraph (1) or (2)— a notice in writing to that effect not less than 12 months nor more than 13 months before the date on which his name is to be removed; and b a further such notice not less than 3 months nor more than 4 months before that date; but failure to give notice to any dentist as required by sub-paragraph (a) or (b) shall not prevent the removal of that dentist's name from the dental list in accordance with paragraph (1) or (2). 4 A Board shall, no later than 7 days after the removal in accordance with paragraph (1) or (2) of the name of any dentist from the dental list, notify the Agency in writing of the name, address and date of birth of the dentist in question and of the number by which his arrangement with the Board is identified. Withdrawal from dental list 10 1 Where a dentist wishes to withdraw his name from the dental list— a he shall give 3 months' notice in writing to the Board, or such shorter period as he may agree with the Board, before the date on which he wishes his name to be removed from the dental list; and b subject to paragraph (2), the Board shall remove the dentist's name from the dental list on the expiry of the period of notice given under sub-paragraph (a). 2 Where, in relation to any dentist, representations are made to the Tribunal under Schedule 11 to the Order (disqualification of persons providing certain services) that the continued inclusion of his name in the dental list would be prejudicial to the efficiency of general dental services, the name of the dentist shall not, except with the consent of the Department, be removed from the dental list until the proceedings in relation to those representations have been determined. 3 Paragraph (2) shall not apply in the case of a dentist who has reached an age at which on the following 1st April his name shall be removed from the dental list in accordance with regulation 9. Information about assistants 11 A Board shall send to the Agency any information it receives under paragraph 35(5) of Schedule 2 (employment of assistants) within 7 days of the date of its receipt of the information. Information about associateship agreements 12 1 Where an associateship agreement is made, written notice of the parties to that agreement and of the date on which the agreement was made shall be given to the Board within 7 days of the date on which the agreement was made. 2 Written notice of any change in the parties to, or of the termination of, any associateship agreement shall be given to the Board within 7 days of the date of such change or termination. 3 Any notice required by this regulation shall be given by the person or, if more than one, one of the persons, liable by virtue of the associateship agreement to provide the use of premises and facilities. 4 A Board shall supply to the Agency the information it receives under paragraphs (1) and (2) within 7 days of the date of its receipt of the information. Transfer of continuing care and capitation arrangements 13 1 Subject to 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 Board 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 regulation 8(2), the Board 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. Emergency dental services 14 1 A Board may make arrangements, with any dentist whose name is included in the dental list, for the provision of treatment for urgent cases at health premises when dentists in its area or part of its area are not normally available to provide general dental services. 2 In this regulation an “ urgent case ” means any circumstances in which, in the opinion of the dentist, a patient needs immediate treatment for an acute condition. Arrangements for emergency cover 15 It shall be the responsibility of a Board to make any arrangements that may be necessary to enable a salaried dentist whose name is included in the dental list to comply with his obligation under paragraph 6 of Schedule 2. Board patient information leaflets 16 A Board shall compile and make available to any person who may reasonably require one, a document about the provision of general dental services by salaried dentists at any health premises in its area (in this regulation called a “ Board patient information leaflet ”) which shall include the information specified in Schedule 7. PART III METHOD OF OBTAINING GENERAL DENTAL SERVICES Application for services 17 1 Any person ordinarily resident in Northern Ireland, or being a person to whom the provisions of the Health Services (Persons not Ordinarily Resident in Northern Ireland) Regulations (Northern Ireland) 1970 apply, requiring general dental services may apply to a dentist whose name appears in the dental list. The person shall produce to the dentist his medical card and shall complete so far as applicable that part of the dental payment claim form or practice record form or estimate together with such declaration as may be required by the Agency relating to eligibility for (a) general dental services or (b) general dental services without charge. 2 A person aged 18 or over to whom the provisions of paragraph (1) apply may apply to any dentist whose name appears in the dental list for general dental services by way of— a care and treatment under a continuing care arrangement; or b treatment on referral; or c occasional treatment. 3 Subject to paragraph (4), a person under the age of 18 to whom the provisions of paragraph (1) apply may apply to any dentist whose name appears in the dental list for general dental services by way of— a care and treatment under a capitation arrangement; or b treatment on referral; or c occasional treatment. 4 A dentist may not enter into a capitation arrangement with a person during the month before he attains the age of 18. 5 A person under the age of 18 to whom the provisions of paragraph (1) apply 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. 6 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. 7 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. Exercise of choice of dentists in certain cases 18 1 An application to a dentist for general dental services shall be made— a on behalf of any person under the age of 16, by either parent, or in the absence of both parents, the guardian or other person who has the care of the child; b on behalf of any other person who is incapable of making such an application, by a relative or any person who has the care of such person; and c on behalf of any person under the age of 18— i in the care of a Board to whose care he has been committed under the provisions of the-Children arid Young Persons Act (Northern Ireland) 1968 , by a person duly authorised by that Board, ii in the care of a voluntary organisation by that organisation or a person duly authorised by them. 2 An application under paragraph (1) may not be made by the dentist to whom the application is made. PART IV REMUNERATION OF DENTISTS Statement of Dental Remuneration 19 1 The Department shall after consultation with such organisations as appear to it to be representative of persons providing general dental services make provision for each of the matters set out in column (2) of the Table below in a determination and each determination shall bear the number in column (1) of that Table which corresponds to the subject matter of the determination. TABLE (1) (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 and for the provision of emergency dental services; III Seniority payments; IV Vocational training allowances; VI Maternity payments; VII Long term sickness payments; VIII Postgraduate education allowances; IX Reimbursement of non-domestic rates. 2 The Department shall publish the determinations in a statement called the Statement of Dental Remuneration. 3 The Department— a may amend the determinations, in whole or in part, after consultation with the organisations referred to in paragraph (1); and b shall publish any such amendment in the Statement of Dental Remuneration. Approval of payments 20 1 The Agency shall, where it is satisfied— a that 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, make the payments which, in accordance with the Scale of Fees, fall to be made by it to the dentist in respect of such an arrangement or referral; or b that a continuing care arrangement or a capitation arrangement has terminated or treatment on referral has terminated or has been completed, cease such payments to the dentist. 2 The Agency 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; or b treatment on referral; or c occasional treatment; completed by the dentist, pay, in accordance with the Scale of Fees, the remuneration due to the dentist in respect of such care and treatment, treatment on referral, or occasional treatment. 3 The Agency shall, where it approves a claim for remuneration made by a dentist, other than a salaried dentist, in any case falling within paragraph 14 or 17(4) of Schedule 2 (inability of dentist to complete treatment), pay, in accordance with the Scale of Fees, and without prejudice to the provisions of the Dental Charges Regulations, the remuneration due to that dentist, in respect of such care and treatment or occasional treatment as he has provided. 4 The Agency may, before deciding whether to approve a claim for fees payable to a dentist in respect of his provision of general dental services refer the claim to the Dental Committee for advice. 5 The remuneration which it is the function of the Agency to pay shall be paid in accordance with Determinations I, III, IV, VI, VII, VIII and IX of the Statement of Dental Remuneration. 6 The Board shall pay to a salaried dentist and a dentist providing emergency dental services remuneration in accordance with Determination II of the Statement of Dental Remuneration. 7 In the case of orthodontic care and treatment the Agency may make such payments on account as it considers appropriate pending completion of that care and treatment. Appeals against decisions of the Agency 21 1 Where any dentist is aggrieved by a decision of the Agency concerning fees payable to him in respect of his provision of general dental services, that dentist may, in accordance with paragraph (2), appeal against the Agency's decision to the Department. 2 An appeal under paragraph (1) shall be brought by giving notice of appeal in writing to the Department within 30 days of the date on which the dentist was informed of the decision of the Agency, or within such longer period as the Department may, for reasonable cause, allow. 3 A notice of appeal under paragraph (2) shall contain a concise statement of the facts and contentions upon which the appellant intends to rely. 4 The Department shall, within 30 days of receiving a notice of appeal, request from the Agency a written statement of the reasons for its decision, and the Agency shall within 30 days of receiving the request send such a statement to the Department. 5 The Department shall consider the notice of appeal and the Agency's statement and— a where the Department is of the opinion that the notice discloses no reasonable grounds of appeal, or that the appeal is otherwise vexatious or frivolous, it may dismiss it forthwith; b where the appeal is against a refusal of the Agency to approve a claim for remuneration on grounds that the services to which the claim relates cannot be provided as part of general dental services, the Department shall determine it in such manner as it thinks fit and shall give notice of its decision and of the reason for it to the appellant and the Agency; c where— i the appeal is brought under paragraph (1) against a decision of the Agency concerning a dentist's fees, and ii the Agency has certified in its statement under paragraph (4) that it has authorised those fees and that they were the fees or maximum fees prescribed by Determination I of the Statement of Dental Remuneration for the services provided or to be provided, the Department shall dismiss the appeal forthwith unless it is of the opinion that it involves a dispute as to the item or sub-item of treatment in that Determination applicable to the services provided or intended to be provided; d except where an appeal is dismissed in accordance with the preceding provisions of this paragraph, the Department shall, within 30 days of receiving the Agency's statement under paragraph (4), appoint 2 dentists, who are or have been engaged in the provision of general dental services, as referees to hear the representations of the appellant and the Agency and determine the appeal. One such dentist shall be appointed after consultation with such organisation as represents the dental profession; e for the purposes of any appeal, the dentists so appointed may, if satisfied that the appeal can properly be determined without an oral hearing and with the agreement of the appellant and the Agency, dispense with an oral hearing in which case the appellant and the Agency shall be given an opportunity to amplify their statements. 6 Where the Department dismisses an appeal under paragraph (5) it shall give notice in writing to the person who brought the appeal and to the Agency that the appeal has been dismissed, and, where the appeal is dismissed under sub-paragraph (c) of that paragraph, they shall include with the notice to the appellant a copy of the Agency's statement under paragraph (4) and a statement of its reasons for dismissing the appeal. 7 A party to an appeal which is to be determined by referees following a hearing shall not be entitled to rely upon any facts or contentions not contained in the notice of appeal or the statement of the Agency unless that party gives notice in writing of those facts or contentions to the referees and to the other party to the appeal at least 7 days before the date of the hearing. 8 The referees shall within 7 days after determining an appeal give notice in writing to the Department of their decision and of the reasons for it, and the Department shall within 14 days of receiving the notice send copies of it to the parties. Drugs 22 The fees payable by the Agency to a dentist in respect of listed drugs supplied by him under paragraph 22(1) of Schedule 2 for use before a supply can otherwise be obtained under paragraph 23 of that Schedule shall be calculated in accordance with the provisions of the Drug Tariff. Recovery of overpayments 23 1 Where the Agency or the Board considers it has made a payment to a dentist owing to an error or in circumstances when it was not due, the Agency or the Board shall, except to the extent that the Department on the application of the Agency or the Board directs otherwise, draw that overpayment to the attention of the dentist and— a where he admits the overpayment; or b where he does not admit the overpayment but, the matter having been referred under regulation 4(2) of the Services Committee Regulations for investigation, the Agency, the Board or the Department on appeal, decides that there has been an overpayment, the amount overpaid shall be recoverable either by deduction from the remuneration of the dentist or in some other manner. 2 Recovery of an overpayment under this regulation shall be without prejudice to the investigation of an alleged breach of the terms of service. PART V PAYMENTS IN CONSEQUENCE OF SUSPENSION Interpretation 24 In this Part— a “ claimant ” means a person claiming to be entitled to, or receiving, payments; “ erasure ” means the erasure of a person's name from the register; “ fees ” does not include remuneration by way of salary; “ immediate suspension ” means suspension by virtue of an order under section 30(3) of the Dentists Act except suspension which is terminated by the court under section 30(6) of that Act; “ interim suspension order ” means an order under section 32 of the Dentists Act; “ payment ” means a payment under this Part; “ register ” means the register kept under section 14 of the Dentists Act and “ registration ” means registration in that register; “ suspension date ” means the date on which suspension of a person's registration takes effect; b a reference to a direction or an order of the Health Committee is to a direction or an order of that Committee under the Dentists Act. Entitlement to payments 25 1 Payments shall be made as provided for by this Part to a person whose registration is suspended by an interim suspension order or by a direction or an order of the Health Committee. 2 Subject to paragraph (3), no payment shall be made to a person— a whose registration has been suspended by a direction or an order of the Health Committee once he has received payments in respect of 12 months' such suspension, whether in respect of the same or a previous period of such suspension and whether or not those 12 months formed a continuous period; b in respect of any part of a period of suspension where in the period of 2 years immediately preceding the suspension date he received no fees for the provision of general dental services. 3 In calculating whether a person has received payments in respect of 12 months' suspension under paragraph (2)(a), no account shall be taken of any payment made in consequence of the suspension of his registration by a direction or order of the Health Committee more than 5 years previously. 4 No payment shall be made to a person for a period (whether the whole or part of a period of suspension)— a earlier than 8 weeks before the date on which an application for payments is received by the Board, unless the Board is satisfied that the lateness of the application is due to illness or some other reasonable cause; b during which his name is not included in the dental list; c during which he is absent from the United Kingdom; d for which he is entitled to any benefit under a contract of insurance against the risk of the suspension of his registration or of the circumstances which led to it or for which the Board is satisfied he could have been so entitled but for his failure to enter into such a contract or to pay any premium due under such a contract; e during which he is serving a term of imprisonment; f during which he is remanded in custody in connection with a criminal offence for which he is (then or later) convicted; or g during which he is in breach of any condition of bail in connection with a criminal offence for which he is (then or later) convicted. Application for payments 26 An application for payment shall be made to the Board and shall— a be made in writing; b be made by the claimant or, where he is incapable of applying, on his behalf; and c contain or be supported by such information as the Board may reasonably require for the purpose of establishing the claimant's entitlement to payments. Amount and time of payments 27 1 A Board to whom an application for payments is made in accordance with regulation 26 shall, having made such enquiries as it considers relevant, if satisfied that the claimant is entitled to payments by virtue of regulation 25, determine that he shall, in respect of any period for which he is so entitled, receive payments which, subject to paragraphs (2) to (6), shall be of the following amounts— a where his registration is suspended by a direction or an order of the Health Committee— i £2,984 per month for each of the first 6 months for which payments are made to him, whether in respect of that or a previous period of such suspension and whether or not those 6 months form a continuous period, and ii £1,492 per month thereafter; b where his registration is suspended by an interim suspension order— i where the period of interim suspension ends with an order for erasure or immediate suspension, £1,492 per month, and ii in any other case, £2,984 per month. 2 Where in the period of 2 years immediately preceding the suspension date the total amount of a claimant's gross fees received for the provision of general dental services was less than £ 142,242, the amount of payments made to him shall (subject to any further reduction under paragraph (3)) be the same proportion of the amount otherwise payable in accordance with paragraph (1) as that total amount of fees is of £142,242. 3 Where a claimant's name was included in the dental list for a period of less than 2 years immediately preceding the suspension date the amount of payments made to him shall be the same proportion of the amount otherwise payable in accordance with paragraph (1) or paragraph (2) as the number of complete months in that lesser period is of 24. 4 Where a claimant's registration has been suspended by an interim suspension order or by a direction or an order of the Health Committee within a period of 2 years after the expiry of a previous period of any such suspension, the references in paragraphs (2) and (3) to the suspension date shall be taken as references to the suspension date as respects that previous period. 5 Where the Board has to make a determination as to payments at a time when it does not know whether or not the period of a person's interim suspension will end with an order for erasure or immediate suspension, or whether or not he will be convicted of a criminal offence, it shall make that determination as though his period of interim suspension did so end or he was convicted of the offence; but it shall review that determination and determine that a claimant is entitled to an appropriate payment of any arrears if subsequently that period does not so end or he is not convicted of the offence. 6 Where the Board determines that a claimant is entitled to a payment, it shall inform the Agency of the amount of that payment and authorise the Agency to make the payment to the claimant. 7 The Agency shall make to the claimant any payments authorised by the Board. 8 Payments under paragraph (7) shall be made monthly in arrears, and an appropriate proportion of the amount for a full month shall be paid where the claimant is entitled to a payment for part only of a month. Changes of circumstances 28 1 A claimant shall notify the Board in writing immediately of any changes in his circumstances which he might reasonably be expected to know might affect his entitlement to, or the amount of, any payment made or to be made to him, and in particular of any erasure, immediate suspension, or termination of suspension, of his registration. 2 Where the Board considers, whether or not following a notification under paragraph (1), that there has been a change of circumstances affecting a claimant's payments it shall determine the adjustment as respects those payments which is appropriate to take account of that change and notify the Agency accordingly. Overpayments 29 Where the Agency considers that a payment has been made to a person owing to an error, or in circumstances where it was not due, it shall, except to the extent that the Department on the Agency's application directs otherwise, draw the overpayment to the attention of that person and— a where he admits the overpayment; or b where he does not admit the overpayment but the matter having been referred under regulation 4(2) of the Services Committee Regulations for investigation, the Agency, or the Department on appeal, decides that there has been an overpayment, the overpayment shall be recoverable either by deduction from that person's remuneration or payments or in some other manner. PART VI DENTAL COMMITTEE, PRIOR APPROVAL (PATTERNS OF TREATMENT) AND SURVEYS Constitution of the Dental Committee 30 The provisions set out in Schedule 8 shall apply in relation to the Committee which shall be constituted by the Agency for the purpose of carrying out the duties assigned to it by these regulations. Delegation of duties to Dental Officer 31 The Committee may delegate to a Dental Officer such of its duties with respect to the approval of estimates for dental treatment and appliances under these regulations as it thinks fit. Prior approval — patterns of treatment 32 1 Where it appears to the Committee 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 area of a Board, differs so substantially from the area or regional pattern of treatment of other dentists as to warrant, in the opinion of the Committee, further investigations, the Committee 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 area or regional pattern of treatment of other dentists; b inviting him to submit to the Committee in writing the reasons why his pattern of treatment differs to the extent identified by the Committee under sub-paragraph (a), from that area or regional 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 Committee, for his pattern of treatment to differ, to the extent identified by the Committee under sub-paragraph (a), from that area or regional pattern of treatment, the Committee 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 Committee 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 Committee, 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 2 small radiographs, each of a size not exceeding 16 square centimetres. 3 Where the Committee gives a direction under paragraph (2), the direction shall inform the dentist of his right of appeal under regulation 33 and shall have no effect until the expiry of the period allowed under that regulation for the bringing of an appeal and, if such an appeal is brought, until the determination of the appeal. 4 The Committee shall not give a direction to a dentist under paragraph (2) in consequence of having written to him under paragraph (1) more than 12 months previously. 5 Where the Committee gives a direction to a dentist under paragraph (2), the Committee shall not give a further direction under that paragraph 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, where the dentist appeals that earlier direction and the appeal is allowed, 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 and for which he receives no remuneration other than a capitation payment. 7 Where, on the date on which the Committee gives a direction under paragraph (2), the name of the dentist in respect of whom the direction is given is not included in any dental list the period specified in the direction shall not begin until the next day on which his name is again included in the dental list. 8 For the purpose of computing the date on which the period specified in any direction given under paragraph (2) comes to an end, no account shall be taken of any day on which the dentist's name is not included in the dental list. 9 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 “ area ”, in relation to pattern of treatment, means throughout the area of a Board; and c “ regional ”, in relation to pattern of treatment, means throughout Northern Ireland. Appeals against the Dental Committee 33 1 Any person aggrieved by a decision of the Committee shall be entitled to appeal by sending to the Department a notice of appeal within 30 days from the date on which the decision of the Committee was received by that person. 2 The notice of appeal shall contain a concise statement of the facts and contentions upon which the appellant intends to rely. 3 The Department shall, within 30 days of receiving a notice of appeal, request from the Committee a written statement of the reasons for its decision, and the Committee shall within 30 days of receiving the request send such a statement to the Department. 4 The Department shall consider the notice of appeal and the Committee's statement and, where the Department is of the opinion that the notice discloses no reasonable grounds of appeal, or that the appeal is otherwise vexatious or frivolous, it may dismiss it forthwith. 5 Except where an appeal is dismissed under paragraph (4) the Department shall, within 30 days of receiving the Committee's statement under paragraph (3), appoint, after consultation with such organisation as represents the dental profession— a where the appeal is made under regulation 32, 3 dentists who are or have been engaged in the provision of general dental services; b in any other case, 2 such dentists; as referees who shall hear the representations of the appellant and the Committee and determine the appeal. 6 For the purposes of any appeal relating to paragraph (5)(b), the dentists so appointed may, if satisfied that the appeal can properly be determined without an oral hearing and with the agreement of the appellant and the Committee, dispense with an oral hearing, in which case the appellant and the Committee shall be given an opportunity to amplify their statements. 7 Where the Department dismisses an appeal under paragraph (4) it shall give notice in writing to the person who brought the appeal and to the Committee that the appeal has been dismissed and shall include with the notice to the appellant a copy of the Committee's statement under paragraph (3) and a statement of its reasons for dismissing the appeal. 8 A party to an appeal which is to be determined by referees following a hearing shall not be entitled to rely upon any facts or contentions contained in the notice of appeal or the statement of the Committee unless that party gives notice in writing of those facts or contentions to the referees and to the other party to the appeal at least 7 days before the date of the hearing. 9 The referees shall within 7 days after determining an appeal give notice in writing to the Department of their decision and of the reasons for it, and the Department shall within 14 days of receiving the notice send copies of it to the parties. Surveys 34 A Board or the Agency may conduct or commission surveys or other research relating to the provision of general dental services. PART VII MISCELLANEOUS Publication of documents 35 1 A Board shall make available for inspection at its offices copies of— a the dental list; b the local directory of dentists; c these regulations including the terms of service; d the Statement of Dental Remuneration; and e the list of listed drugs, and keep them up-to-date. 2 A Board shall make the documents referred to in paragraph (1) available for inspection at such other places in its area as appear to it to be convenient for informing all persons interested. Service of documents 36 Any notice or other document which a Board or the Agency is required or authorised by these regulations (including the terms of service) to give or send to a dentist may be given or sent by delivering it to the dentist or by sending it by post to the dentist at his usual or last-known address. Signatures 37 Any signature by a dentist required by these regulations (including the terms of service) shall be handwritten in ink with his initials, or forenames, and surname in his own handwriting, and not by means of a stamp. Revocations 38 The Regulations specified in column (1) of Schedule 9 are hereby revoked to the extent specified in column (3) of that Schedule. Sealed with the Official Seal of the Department of Health and Social Services on 22nd July 1993. (L.S.) D. A. Baker Assistant Secretary Sealed with the Official Seal of the Department of Finance and Personnel on 22nd July 1993. (L.S.) Doreen Brown Assistant Secretary