Referrals & NHS rules

11/08/2016
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The number of UDAs you can claim for an NHS referral in England and Wales depends on whether you are referring a patient for a full or partial course of treatment, and if you are referring to another dentist within primary care or to a hospital.

If you are referring to a hospital you should detail the band of treatment that you have provided and apply the patient charge for the treatment that you have completed.

It is imperative you only refer cases where it is clinically necessary and in the patient’s best interests. If the treatment could reasonably be expected to be within the competence of a dentist in general practice, you might need to consider further training.

If a patient needs advanced mandatory services – treatment normally provided within general practice but which needs specialist equipment, expertise or facilities unavailable in your practice – you can refer them to a dentist who has such equipment, expertise or facilities. Such referrals are likely to be for only part of a course of treatment.

Here, you should set out the patient’s entire treatment plan on a referral-treatment plan, always using a referral form. Give copies of the original treatment plan and the referral-treatment plan to the other dentist and the patient.

Even though you are referring to a second dentist, the patient should only be charged once. It is your responsibility to collect the charges for the whole course of treatment, including the work that will be done by the second dentist. Always include details of the amount the patient has paid or is due to pay on the claim form.

As the referring dentist, you will only be able to claim the UDAs for the work you have done (though you should collect the full patient charge for the whole treatment). The dentist providing the advanced mandatory treatment will be credited with the UDAs for the band of treatment that they carry out. They should cross the referral box on Part 6 of the FP17/FP17W form and will receive the UDAs for the treatment provided. For example, if they do an extraction they will be credited with three UDAs under Band 2. The patient charge, where payable, will not be deducted from their contract value.

Where a patient needs an orthodontic assessment, sedation services or domiciliary services you will be referring them for a whole course of treatment. You should refer the patient to a dentist who has a contract to provide these additional services.

You will only receive the UDAs for the treatment you have actually provided and can make only the appropriate charge. Do not charge the patient for work that will be done by the second dentist. The dentist providing the referred course of treatment will charge the patient for the work they do and receive the relevant UDAs or units of orthodontic activity (UOAs).

Such a referral may arise where you have a phobic patient who needs two fillings but is not willing to have them done under local anaesthetic. You could refer them for sedation services. You would charge the patient Band 1 for an examination and claim the relevant UDA. The dentist who provides the sedation service will charge the patient under Band 2 for the fillings under sedation and receive the relevant UDAs.

In Scotland and Northern Ireland

If a patient needs particular care and treatment under a continuing-care or capitation arrangement and you lack the necessary facilities, experience or expertise, you should, with the patient’s agreement, refer the patient to a General Dental Services (GDS) practitioner who has the necessary expertise, equipment or experience, or to a hospital. You will need to ensure you refer the patient appropriately because the dentist accepting the referral will be responsible for the care and treatment they provide.

Give them: the reason for the referral; information on the oral condition of the patient; and details of any treatment that has been, or will be, provided to secure and maintain the patient’s oral health. Include details of payments made by the patient for GDS treatment already done. Indicate on the claim form aspects of the treatment that are being carried out on referral. You can claim for any care and treatment provided in the course of treatment before the referral is made.

The dentist providing the treatment on referral can claim item-of-service fees for what they provide. A quarterly referred-patient management fee may also be claimed by that dentist if the treatment consists of more than one examination. This fee may be claimed every three months, for a maximum of eight quarters (12 for orthodontics) provided that there has been at least one patient visit each quarter.

In Scotland, the dentist providing the treatment on referral must give the patient: information on the dentists who will carry out the care and treatment; the address where they will be provided; and contact telephone numbers, including the emergency-cover arrangements for the referred treatment. You remain responsible for the rest of the patient’s emergency needs. 

By Sarah Cook, an NHS adviser in the BDA's Business Team. Sarah advises members on all aspects of NHS dental regulations and agreements. A version of this article was first published in BDA News in May 2013.

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