NATIONAL HEALTH SERVICE, ENGLAND AND WALES Citation, commencement and interpretation 1 1 These Regulations may be cited as the National Health Service (Dental Charges) Regulations 1989 and shall come into force on 1st April 1989. 2 In these Regulations, unless the context otherwise requires– a “ the Act ” means the National Health Service Act 1977; “basic type” means, in relation to a dental appliance, a type no more expensive than that which is clinically necessary for such a reasonable standard of dental efficiency and oral health as is necessary to safeguard general health; “the Board” means the Dental Practice Board constituted under section 37 of the Act ; “bridge” means a fixed or a removable bridge which takes the place of any teeth; “dental estimate form” has the same meaning as in the National Health Service (General Dental Services) Regulations 1973 ; “denture” does not include an obturator; “patient” includes a person who pays or undertakes to pay a charge on behalf of a person to whom a dental appliance is supplied or to whom some other service is provided; “Statement of Dental Remuneration” means the Statement published under regulation 23 of the National Health Service (General Dental Services) Regulations 1973; “Statement remuneration” has the meaning assigned to it by regulation 4(2) and (3); “supply”, in relation to an appliance, includes its replacement; b a reference to the Secretary of State includes a reference to a health authority exercising functions on his behalf ; c a reference to a numbered regulation or Schedule is to the regulation in, or Schedule to, these Regulations bearing that number and a reference in a regulation or Schedule to a numbered paragraph is to the paragraph in that regulation or Schedule bearing that number. Charges for supply of dental appliances 2 1 Subject to paragraph 2(3), (4) and (8) of Schedule 12 to the Act (which provides for circumstances in which no charge may be made) and to paragraph (2), a charge of the amount provided for by regulation 4 may be made and recovered under section 78(1A) of the Act in accordance with these Regulations in respect of the supply under the Act of dentures and bridges. 2 No charge shall be made and recovered under section 78(1A) of the Act in respect of– a a supply, otherwise than as part of general dental services, to a person who has undergone operative procedures affecting the mandible, the maxilla or the soft tissues of the mouth as part of treatment for invasive tumours; or b a supply as part of general dental services for which a charge may be made under regulation 8(2). Charges for other general dental services 3 1 Subject to section 79(1)(b) and (c) of, and paragraph 3(4) of Schedule 12 to, the Act (which provide for circumstances in which no charge may be made) and to paragraph (2), the amount of the charge which may be made and recovered under section 79(1) of the Act in respect of services provided as part of general dental services is that provided for by regulation 4. 2 No charge shall be made and recovered under section 79(1) of the Act in respect of– a the supply of a dental appliance described in regulation 2(1); b a visit by a dental practitioner to a patient; c the opening by a dental practitioner of his surgery outside his normal opening hours in order to provide emergency treatment; or d the attendance at the surgery of a dental practitioner providing emergency treatment of a medical practitioner or of another dental practitioner, specifically with a view to the administration of a general anaesthetic in connection with emergency treatment. Calculation of charges 4 1 Subject to paragraphs (4) and (5), the amount of the charge which may be made and recovered– a under section 78(1A) of the Act for the supply of an appliance described in regulation 2(1); b under section 79(1) of the Act for the provision of services other than those described in regulation 3(2), is 75% of the Statement remuneration (rounded down, where necessary, to the nearest whole penny), being an amount not exceeding that which the Secretary of State considers to be the cost to the health service (within the meaning of section 79A(5) of the Act) of the supply or provision. 2 In these Regulations “Statement remuneration” means– a in relation to the supply (whether or not as part of general dental services) of an appliance described in regulation 2(1), the remuneration provided for by the Statement of Dental Remuneration as that payable to a dental practitioner for the supply of an appliance of that type; b in relation to other services provided in pursuance of a contract or arrangement for the provision of general dental services, the total amount provided for by that Statement as that payable to the dental practitioner for the provision of those services under that contract or arrangement. 3 For the purposes of paragraph (2), where the Statement remuneration for any service is a fee of such amount as the Board may in its discretion approve, whether or not subject to a maximum, the amount is– a if the Board has approved a fee for the service, the amount of the fee so approved, notwithstanding any subsequent variation of that amount on appeal ; b if the Board has refused to approve a fee for the service, the amount of any fee authorised for it on appeal. 4 Where a dental practitioner– a has, under a contract or arrangement for the provision of general dental services, begun to provide for a patient services which include the supply of an appliance described in regulation 2(1); and b has referred that patient, for the supply of that appliance otherwise than as part of general dental services, to a health authority or to a person or body pursuant to arrangements made under section 23 of the Act, the amount of the charge for that supply shall be calculated in accordance with Schedule 1, and the dental practitioner shall provide the health authority or other person or body with a written statement of the amounts mentioned in sub-paragraphs (a) and (b) of paragraph 1 of that Schedule. 5 The amount of the charges payable under sections 78 and 79 of the Act in respect of all dental appliances supplied and other services provided in pursuance of any one contract or arrangement for the provision of general dental services shall not exceed £150 in the aggregate; and £150 is the sum prescribed for the purposes of paragraph 3(3) of Schedule 12 to the Act. Conditions for exemption under the Act 5 1 It is a condition of the exemption under sub-paragraph (4) of paragraph 2 of Schedule 12 to the Act in respect of the supply of a dental appliance to a person otherwise than as part of general dental services– a that a written declaration on a form provided for that purpose by the Secretary of State shall be made to the effect that that person is, at the time of the examination or first examination leading to the supply of the appliance, within one of the specified categories; and b where the Secretary of State so requires, that the specified evidence shall be supplied by or on behalf of that person. 2 It is a condition of the exemptions under sub-paragraph (4) of paragraph 2 and sub-paragraph (4) of paragraph 3 of Schedule 12 to the Act in respect of the supply of a dental appliance, or other services provided, to a person as part of general dental services– a that a written declaration on a dental estimate form shall be made to the effect that that person is, on the date of the contract or arrangement for the services, within one of the specified categories; and b where the Board so requires, that the specified evidence shall be supplied by or on behalf of that person. 3 The declarations referred to in paragraphs (1)(a) and (2)(a) shall be made by the person to whom the services are to be provided, except that where the application for services is made by another person on his behalf it shall be made instead by the person who applies for the services. 4 Nothing in paragraph (1)(b) or (2)(b) prevents the Secretary of State or the Board from accepting evidence other than the specified evidence as establishing that a person is within one of the specified categories. 5 In this regulation “the specified categories” means the categories of person specified in column (1) of Schedule 2 and “the specified evidence”, in relation to any of those categories, means the evidence specified in relation to it in column (2) of that Schedule. Making and recovery of charges 6 1 Where any charge is payable under section 78 of the Act in respect of the supply of a dental appliance under the Act otherwise than as part of general dental services, the Secretary of State or health authority may– a on arranging to supply it, make the appropriate charge; and b on supplying it or having it available for supply, recover the appropriate charge from the patient (if it has not previously been paid). 2 In providing general dental services for which a charge may be made under section 78 or section 79 of the Act, a dental practitioner– a may, on arranging to provide the service, make the appropriate charge; b shall require the patient to acknowledge, on the appropriate part of the dental estimate form, and before that form is sent to the Board, his obligation to pay a charge which is made; c may, on providing the service, recover the charge from the patient (if it has not previously been paid); and d shall, on receiving a sum in payment (in full or in part) of the charge, give a receipt for it on a form provided for that purpose by the Family Practitioner Committee or a form to the like effect. 3 Where a declaration in support of a claim for exemption has been made under regulation 5(2)(a) but the claim is not substantiated, and in consequence of the claim a dental practitioner has not recovered a charge in respect of an appliance supplied or other services provided, the Family Practitioner Committee may recover the charge from the person who made the declaration (whether or not the obligation to pay has been acknowledged). Remission and repayment 7 1 The charges which may be made and recovered by virtue of the preceding provisions of these Regulations are subject to the provisions of regulations made under section 83A of the Act providing for remission or repayment. 2 In regulations 3(2)(b) and 5(2) of the National Health Service (Travelling Expenses and Remission of Charges) Regulations 1988 for “section 78(1)” there is substituted in each case “section 78(1A)”. Charges for more expensive supplies and repairs 8 1 Where the Secretary of State– a supplies a dental appliance which is, at the request of the person supplied, of a type more expensive than the basic type; or b repairs such a dental appliance at a cost exceeding that of repairing a dental appliance of the basic type, he may make and recover from the patient a charge equal to the difference between the cost of supplying or repairing the appliance and the cost of supplying or repairing an appliance of the basic type, in addition to any charge authorised by section 78 of the Act. 2 Where a dental practitioner providing general dental services, as part of those services and at the request of the person supplied,– a supplies a denture which is of a type more expensive than the basic type; b repairs such a denture at a cost exceeding that of repairing a denture of the basic type; or c supplies a bridge which is of a type more expensive than a denture or a bridge of the basic type, he may, subject to paragraph (4), make and recover from the patient in respect of the supply or repair of the appliance a charge of an amount calculated in accordance with Part I of Schedule 3. 3 Part II of Schedule 3 shall have effect with respect to the procedure for determining the amount of the charge referred to in paragraph (2). 4 In the case of an appliance supplied or repaired by a dental practitioner who is remunerated in accordance with Determination IV of the Statement of Dental Remuneration (salaried dentists), the Family Practitioner Committee, and not the dental practitioner, shall make and recover the charge. Charges for replacement – general dental services 9 1 Where a dental practitioner providing general dental services replaces a dental appliance supplied as part of those services and it is determined in accordance with Schedule 4 that the replacement is necessitated by– a an act or omission on the part of the person supplied; or b if the act or omission occurred when the person supplied was under 16 years of age, an act or omission of the person supplied or of the person having charge of him when the act or omission occurred, the dental practitioner may make and recover a charge from the relevant person. 2 The amount of the charge to be made and recovered under paragraph (1) is, subject to paragraph (3), the Statement remuneration for the supply of the dental appliance. 3 If the Family Practitioner Committee considers– a that payment of the full amount of the charge under paragraph (1) would involve undue hardship to the relevant person; or b that the replacement, though necessitated by the relevant person’s act or omission, was not wholly necessitated by lack of reasonable care on his part, it may determine that the charge shall not be payable, or that its amount shall be reduced. 4 In this regulation, “relevant person” means– a where paragraph (1)(b) applies, the person having charge of the person supplied when the act or omission occurred; b in any other case, the person supplied. Discontinuation of treatment – general dental services 10 A dental practitioner providing general dental services may decline– a to begin treatment; or b where treatment has begun, to continue with it, until he or the Family Practitioner Committee has received payment of the amount of any charge payable to him or it in accordance with these Regulations. Reduction of remuneration and accounting for charges – general dental services 11 1 Subject to paragraph (2), the remuneration which would otherwise be payable by a Family Practitioner Committee to a dental practitioner providing general dental services shall be reduced by the amount of the charges authorised by these Regulations in respect of those services. 2 Paragraph (1) does not apply to remuneration under Determination IV of the Statement of Dental Remuneration (salaried dentists). 3 A dental practitioner remunerated under Determination IV of the Statement of Dental Remuneration shall account for and pay to the Family Practitioner Committee, in such manner as it may require, the amount of any charges recovered from a patient under these Regulations. Revocations, amendment, savings and application of Regulations 12 1 The regulations specified in column (1) of Schedule 5 are revoked to the extent specified in column (3) of that Schedule. 2 In the National Health Service (General Dental Services) Regulations 1973– a in regulation 26H, for “carried out pursuant to regulation 20” there is substituted “referred to in regulation 8(2) of the National Health Service (Dental Charges) Regulations 1989” and for “pursuant to regulation 21” there is substituted “in consequence of loss or damage”. b in Part I of Schedule 1 (terms of service), in paragraph 17(a), after sub-paragraph (ii), there is inserted the following sub-paragraph:– iii regulations 4(4), 6(2) and 8(2) to (4) of, and Schedule 3 to, the National Health Service (Dental Charges Regulations 1989; 3 These Regulations apply to the supply of a dental appliance otherwise than as part of general dental services only where the examination, or first examination, leading to the supply takes place on or after 1st April 1989; and where the examination or first examination leading to the supply takes place before 1st April 1989 the charge which may be made and recovered in respect of the supply shall be that authorised by the Act and regulations made under it as in force at the time of that examination or first examination. 4 These Regulations apply to the provision of general dental services only where the contract or arrangement leading to the supply, as part of those services, of a dental appliance or to some other provision of general dental services is made on or after 1st April 1989; and where the contract or arrangement is made before that date, the charge which may be made and recovered in respect of the supply or the other provision of general dental services shall be that authorised by the Act and regulations made under it as in force at the time when that contract or arrangement was made. Signed by authority of the Secretary of State for Health D. Mellor Minister of State, Department of Health 8th March 1989