Title



Contents

1. Introduction 3

1.1 About Islington LINk 3

2. Background information

2.1 Findings from previous LINk work

2.2 Office of Fair Trading's findings

2.3 Other sources of feedback

2.4 Information from service commissioners

2.5 Further information

3. Methodology: How we carried out the research 7

4. Findings 7

4.1 Services used 8

4.2 Information about treatment and charges 10

4.3 Getting an appointment 11

4.4 Overall satisfaction 11

5. Summary of Findings 11

6. Recommendations 12

Appendix A: Department of Health’s Patient Information on dental charges 13

Appendix B: Office for Fair Trading Advice to Patients 16

Appendix C: General Dental Council 'Conduct, Performance and Ethics' consultation 21

Appendix D: Survey questions 22

1. Introduction

1. About Islington LINk

Islington LINk (Local Involvement Network) is an independent organisation, led by a network of elected volunteers from the local community (both individuals and representatives of community and voluntary organisations). LINks were set up in every local authority area in England in 2008, under the ‘Local Government and Public Involvement in Health Act’ 2007.

LINks are a channel for the community voice on health and social care services. They collect local people’s views and experiences and feed these back to the people responsible for local health and social care services. LINks enable local people to engage in decision-making and scrutiny of health and social care services.

Through this work, LINk helps the London Borough of Islington and the NHS to provide an improved quality of services that better reflect local needs.

This report will be shared with local practices, with NHS North Central London as the current commissioners of these services and with Islington’s Public Health team for inclusion in the Joint Strategic Needs Assessment, which assesses health and care needs in the borough.

Where LINk encounters people who are not sure about how to access dental services, or about their entitlements we give them a copy of, or information from, the Department of Health’s Dental Patient Leaflet ‘NHS Dental Services in England’ (see appendix A).

If people need further help on finding a dentist, LINk advises them to contact the North Central London NHS PALS (Patient Advice and Liaison Service) team or use NHS Choices, an on-line directory of NHS services with feedback from service users.

2. Background: Feedback on dental services

1. Findings from previous LINk work

Through the LINk’s ‘1,000 voices’ report, published in June 2012 the LINk had collected views of many residents on local dental services. We had collected 259 general comments about local dental services in our 1,000 Voices report. Of these 153 were compliments and 99 were concerns. For this piece of work, respondents are welcome to comment on any services they have used in the past twelve months and on any area within that service.

On the whole, the people interviewed reported being satisfied with waiting times for dental appointments, with typical waiting times of a few days to a week. About half of respondents said that they were satisfied with the care they received with higher satisfaction rates amongst those who had used the community dental practice. Some issues around patient’s awareness of their eligibility for NHS services, and of feeling steered towards private services were raised.

Throughout the report, we have included quotes from service users. Below these quotes we have included some basic equality monitoring data where provided by respondents. Where no monitoring data was provided we have written ‘No EQM’.

Some patients mentioned choosing a particular dentist because of a language spoken by clinical staff and a couple of people mentioned that they were not offered an interpreter for their dental appointment.

Some respondents stated that they had not used an NHS dentist because they were not sure if they were entitled to this service. Many respondents raised concerns about costs both of NHS and private treatments. Part of Islington’s Fairness Commission report ‘Two Islington’s, Understanding the Problem’ highlights the gap between rich and poor in the borough. It notes that data on earned income suggests that in Islington the gross full-time earnings of the lowest earners is £351 per week which will have an effect on people’s ability to pay for services.

I don't use the dentist here because it is too expensive. I go at home in the Philippines

Male, Chinese, 46-60

The hygienist is £45 which is too expensive.

Female, White British, 46-60

Comments suggest that information about treatment and charges had not been clearly explained to patients.

The dentist seems to be charging me for one filling as a full course of treatment then sending me away. I then have to pay again for another filling. I don't think this is right.

Male, Black African, 31-45

Some patients felt that they had been encouraged to have private treatment so that they could be seen as an emergency. Emergency appointments are available on the NHS and should be charged as a Band One course of treatment (unless patients are exempt from charges).

Went to my dentist on Holloway Road but it was closed and no dentist would give me emergency treatment as I'm not their patient. They told me I had to go private and then after the treatment they told me that I had signed a form that said I wanted to go private.

Male, ‘Other’, 61-75

Referred her [interviewee’s wife] to Eastman's Dental Hospital where we are still waiting for an appointment. Although the infection was treated with amoxicillin it flared up repeatedly and eventually we had to find £1,300 to get her treatment privately.

Male, White British 31-45

Other respondents reported being encouraged to consider or take up private treatment, instead of NHS treatments to which they would have been entitled. This included patients who were in receipt of benefits and may struggle to pay.

A scale and polish, where clinically necessary, should be included in the cost of a check-up. However, many respondents stated that they were not offered this service on the NHS, but steered towards private care.

They charged me £50 to see the hygienist…They [the dental practitioner] condemned NHS services and said I should go private and that I needed all sorts of work done. Then they changed the diagnosis once I said I wouldn't go private...Another time they removed my teeth and then told me to come back three months later for my dentures. Said I could get it done quicker if I went private but that I would have to wait three months otherwise. Without teeth!

No EQM

These findings highlight that many patients are not aware of what dental services they are entitled to as part on the NHS, and that even in cases where patients are aware of their rights it can be difficult to assert them.

At the end of 2012, BUPA stated that it has plans to open 50 dental surgeries in the next three years, focusing on London, as part of its plans to be a major provider in Britain’s £2.4 million annual dentistry market. The company had only eleven dental surgeries to date and plans to open new centres near major office centres and to open later in the evening. BUPA commented that private dentistry is forecast to grow at 2.7% a year over the next five years.

2. Office of Fair Trading findings

A report commissioned by the Office of Fair Trading, ‘Dentistry Consumer Research: A Research Report by TNS-BMRB’ from January 2012 found that while the majority of patients are satisfied with their dentist:

• Patients do not have enough information to make informed decisions about their choice of dentist and the dental treatments they receive, and

• Dentists may provide around 500,000 patients a year with inaccurate information regarding their entitlement to particular NHS dental treatments. As a result they may pay more to receive private dental treatment.

The OFT and British Dental Association have joined together to launch the Right to Smile campaign. The campaign aims to help patients make informed decisions, understand more about their entitlements to NHS treatments and what their options are if things go wrong. They have developed some consumer education films and leaflets in partnership with The British Dental Association, the Chief Dental Officers of England, Scotland and Wales and other professional dental organisations in the public and private sectors.

3. Other sources of feedback

Feedback about dental practices in the borough on NHS Choices was limited but quite varied. Some practices had received no comments at all at the time LINk viewed the site (October 2012). Others had a mixture of positive and negative feedback

In the NCL’s Annual Complaints report 2011-12, 50 cases fell within dental care in Islington. Of these 50, 40 related to concerns about charging related to charges for dental care where NHS patients allege that they have been misled into paying private fees. The Patient Advice Complaints Service liaised with practices on behalf of individual patients. Where concerns or complaints identified possible poor performance or contractual concerns, these were been brought to the attention of the Primary Care Dental Team.

The Care Quality Commission (CQC) had recently visited several dentists in the borough. These were City Dental Clinic (May 2012), Holloway Dental Centre (May 2012), N7 Dental Care (June 2012) and Pickering Dental Studios (December 2011). The CQC’s findings showed that at all four practices patients felt that they were given sufficient information about their treatment and the costs.

4. Information from service commissioners

We asked commissioners at NHS North Central London (NCL), the team responsible for commissioning dental services for Islington, what obligation they have to ensure that residents have access to NHS dentists within all three bands of NHS dental treatment including people in prison, in care homes or who cannot leave their own home.

NCL told us that since 2006 the local Primary Care Trusts (PCT) had had the role of commissioning dental services ‘to reflect local needs and priorities’, so in the case of Islington, NHS Islington would be responsible. If a patient cannot find a dentist to treat them, they can contact North Central London (NCL) Patient Advice and Liaison Service (PALS) team.

The commissioners referred us to the dental pledge, specifically mentioned in the handbook accompanying the NHS Constitution, which sets out the right of access to dental services: The dental Operating Framework for 2009/10 makes it clear that PCTs need to continue to develop NHS dental services, with the aim of being able to provide dentistry for anyone who seeks help in accessing services. Local strategies for achieving this could change when the dental contract changes in 2014.

LINk asked the commissioners about the maximum waiting times for patients accessing routine and emergency dental care. They informed us that there is no waiting time limit for obtaining appointments with dentists. NCL suggested that this was probably because patients are able to exercise choice and choose any dentist if they are not happy with waiting times at a particular practice.

NCL informed LINk that information was available to patients and prospective patients on surgery satisfaction levels via the NHS Choices web-site which can be accessed via the NHS Islington web-site. If this information is not clear, or not accessible, patients can contact the NCL PALS team.

Some local people had told LINk that they were only offered teeth cleaning services as private treatment, yet the patient leaflet outlining NHS patient entitlements states that a Band One course of treatment (costing £17.50 in the year 2012-13) can include a ‘scale and polish’ to clean patients’ teeth. NCL informed us that some practices employ a dental hygienist but that if teeth cleaning is deemed clinically necessary then it should be available as part of the patients’ Band One course of NHS treatment and included in the £17.50 cost. If the cleaning is solely cosmetic, patients may not be offered cleaning on the NHS.

We sought clarification from NCL as to whether patients are only able to receive a ‘deep clean’ if they seek private treatment. It was acknowledged that it can be difficult to monitor whether patients referred to private teeth cleaning services had a clinical need for the service. As LINk does not deal with clinical issues it was agreed that it would be most appropriate for LINk to focus on the information that patients were given about both the range of care available to them and the charges that would apply to those treatment options.

NHS dental treatment is separated in to three bands, depending on the type of care that is needed. Each band carries a different charge. The Department of Health’s 2012 patient leaflet ‘NHS dental services in England’ (Gateway number 2900136 1200k) details what is included in each band of treatment. It states that a course of treatment may require more than one visit but that patients should only be charged once for each course of treatment.

We had asked NCL for clarification on where one course of dental treatment finishes and the next one begins. They directed us to further information from NHS Choices, which states that “If, within two months of completing a course of treatment, you need more treatment from the same charge band or a lower one, for example another filling, you don't have to pay anything extra”. They pointed out that after two months, you will have to pay an additional band charge. Similarly for urgent care you will be charged only a Band One fee, but that once your urgent course of treatment is complete, you may be advised to make another appointment for a separate course of non-urgent treatment. In this case, the relevant band charge will apply.

3. Methodology: How we carried out the research

At the LINk’s annual fair in March 2012, attended by 90 LINk members and community representatives, attendees prioritised dental services for the 2012-13 work plan.

LINk set up a small working group to plan this piece of work. We visited the web-site of NHS Choices and NHS Islington to ascertain what information is available to patients and contacted NHS North Central London as the commissioners of local dental services to find out more about how the service is commissioned and about patients’ entitlements.

We drafted an initial survey following these discussions and the commissioning team gave useful feedback which was incorporated in to the final draft. The survey was carried out as a short interview. We advertised the survey in the local press and through our network and took it out to local venues such as day centres and parent and children’s groups as well as some local practices.

When planning the visits to services, LINk made sure that visits included practices with a range of feedback. We visited three local practices and would have liked to visit more but some practices were concerned about there being enough space for interviews to take place. To increase participation, we also developed an on-line version of the survey using Survey Monkey, which was promoted through LINk’s network by email, Facebook and Twitter.

Charges quoted in the report are based on figures for 2011-12, see appendix A.

4. Findings

The LINk survey ran from October to December 2012. We received feedback from 105 respondents to this survey on dental services. There were 47 responses to its on-line survey and 58 people took part in interviews. Of those 105 respondents, 30 stated that they were male, 59 that they were female and 16 did not respond.

The age breakdown of respondents was as follows:

0 – 17 year olds, none;

18 – 30 year olds, 14;

31 to 45 year olds, 17;

46 – 60 year olds, 24;

61 – 75 year olds, 22.

Respondents over 75, five.

23 respondents did not answer this question. See graph below.

[pic]

The ethnic breakdown of respondents was as follows: White British, 35; White Other 15 and White Irish, five. Seven respondents stated that they were Black British, four Black African and one Black Other. One respondent described themselves as British Asian, one as Pakistani, one as Bangladeshi, one as Chinese and eight as Other. 26 people did not respond to this question. See graph below.

[pic]

1. Services used

The majority of respondents (57) stated that they had used a dental service in the last three months or less. Some interviews took place in dental surgeries which explains this high proportion.

17 respondents had visited within the last six months, 17 within the last year and eight within the last two years. Two respondents had used a dental practice outside of Islington. Five on-line respondents stated that they never visited a dentist, though later answers seemed to contradict this. Two respondents using Islington dentists were not Islington residents.

71 respondents had received only NHS treatment, 14 had used a private service and 17 had used a mix of both NHS and private services during their last course of treatment. Two respondents did not know if their care was on the NHS or private, and six had not responded to this question.

Of the 41 respondents who had had private treatment or a mix of NHS and private treatment, 24 knew that they may be entitled to NHS treatment and 12 did not (five did not respond). Of those same respondents, 16 said that they were offered NHS treatment and 18 said that they were not (seven did not respond).

There were several reasons given for patients choosing private care over NHS care. For some patients private care offered a preferred treatment that was not available on the NHS, some had taken out dental plans and some felt the quality would be better. Some respondents had opted for private care because their dentist had stopped offering NHS appointments.

Because of pain. Needed filling and gum treatment, could get it quicker if private.

Male, 31-45

Time and pain (it would end up costing more if I had waited)

Female, White French, 46-60

Better quality and longer lasting

Female, Black, 31 - 45

Sometimes, as found in the LINk’s 1,000 voices report, it seems that patients were not clear about what they were entitled to on the NHS. This may have been due to how the treatment options were explained by dental staff.

Told root canal would be private, but extraction on NHS.

No EQM

Several respondents had used private hygienist services stating that an NHS option had not been given. Again, this was an issue highlighted in the LINk’s previous work.

Dental Hygienist - no NHS option given.

Female, White British, 18-30

Pay for cleaning. Three sessions for cleaning cost over £80 (interviewee, who was on benefits was advised cleaning was needed).

Female, Chinese, 18-30

Deterred me from having treatment I wanted - said I could only do it privately.

Male, White British, 46 – 60

Services that people had used included check-ups (64), scale and polish/ cleaning (35), x-ray (19 ), sealant (6), fillings (28), root canal work (6), removal (10), crown (14), bridges (10), implants (1), other (17) . Some patients would have used more than one service for their course of treatment. See table below.

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2. Information about treatment and charges

Most respondents (82 out of 105) said that they were given clear information about their course of treatment, ten said that they were not. Four did not know and nine did not answer. Some of those who were not given information reported being exempt from charges. However, there were cases where patients had not been given information about costs but did have to pay.

Very confused… They switch you to private. I'm a pensioner. Don't have this kind of money. Costs thousands.

Female, British Asian, 61 – 75

This respondent still rated the service as ‘very good’ but suggested that patients be given written information about the costs before treatment.

Another patient who was on benefits was asked to pay for their first appointment and told they would be refunded because they were exempt. However, the practice did not refund them.

Most respondents (75 out of 105) were given information about the cost of treatment and 20 said that they were not. One respondent did not know and 14 did not answer.

One patient had stated that they were told root canal treatment would cost them £500 on the NHS, yet the maximum NHS charge for a course of treatment is £209 (2012), and this would include items such as root canal work. Another patient was referred to the practice for an emergency for a same day appointment. He had visited three times already in quick succession when LINk interviewed him. The dentists told him required cleaning and then charged him £42. The patient was upset as he is on benefits. He raised his concern with manager but they were unable to help.

When asked what information they had been given, respondents listed a range of suggestions including prices of different types of fillings, comparative costs of NHS and private treatments, how long a procedure might take, how to pay in instalments, and the number of appointments that would be needed.

When asked what information would have been helpful about the course or cost of treatment, respondents suggested clear, comprehensive, written information or verbal information that was explained, as one respondent put it, ‘at a slower place’.

Respondents had found it helpful to know: what should have been in their treatment plan, what treatments were available, and what patients were entitled to receive on the NHS, as well as costs for different types of treatment. Some patients had seen information clearly displayed at the practice reception desk on the cost of treatment.

A written statement about the course of treatment and printed information on what range of treatments are available on NHS.

No EQM

Decision on NHS v. Private treatment for filling had to be made on the spot - would be good to have written information on each of the options - for example how long an NHS filling will last and how often it will need to be replaced.

Female, White British, 18-30

Tell me straight if I was being treated as an NHS patient and approximately how much would the final cost be.

No EQM

Others suggested that clear, written information would be helpful.

Interviewees were asked: ‘Do you feel you have ever paid privately for any treatment which you could have received on the NHS?’ Seven respondents felt that they had and one that they possibly had, 30 felt that they had not and 19 did not respond. Of those respondents, one felt that they had been charged for filings and sealants when they were exempt and another felt they were charged for cleaning that could have been done on the NHS. This question was not asked in the on-line survey.

3. Getting an appointment

Most interviewees and on-line respondents (94) reported being happy with the wait for dental appointments. Respondents reported being happy with waits of up to two weeks (and in some cases more) for routine appointments. Waits of more than two weeks for a range of routine and non-routine treatments had lower satisfaction levels. This correlates with the LINk’s findings from its general out-reach work where respondents had generally reported being happy with the waiting times for appointments. Though in the broader out-reach some people had found it took longer to get treatment when their needs were more complex.

4. Overall satisfaction

48 respondents rated the service as very good, 33 as good, 14 as OK, and two as bad. Eight people did not answer this question.

For the two respondents who rated the service as ‘bad’ they were happy with the waiting time but did not feel that they had received clear information about the cost of treatment.

I went three years ago to have a new lower denture made. I am an OAP and asked about the NHS costs. I was not given a straight answer by the reception and I ended up paying money for each visit. In the end I stopped going even the dentures they had made were not satisfactory. It was a very business like company, not at all friendly. Now, my old denture has broken and I am having to wear the one they made. Consequently, it is quite painful to chew and I am trying to find another dentist in my area.

Over 75

I feel I have little trust left toward dental services as they become geared towards money making as opposed to caring for the client if one is on low income that is.

Female, White Other, 61 – 75

Respondents valued the high standards of care, being seen reasonably quickly and having a good rapport with staff. This correlates with the views collected in LINk’s general out-reach activity.

Those that rated the service as ‘good’ tended to have received less clear information.

Most respondents felt that their dentists did communicate with them about treatment and costs, though some respondents had found information about both of these things lacking.

There were several comments from patients who felt that dental services focussed too much on charges and not enough on care. One patient complained that her practice would not take cash payments but charged patients for using cards.

It is factory and business like, similar to podiatry. It does not feel much like care any longer. They are OK in terms of bedside manners though. It is just plain anonymous chain work.

On-line respondent, Female, French, 46 - 60

My old dentist used to explain everything she was doing to me. This dentist is like a fast food version.

On-line respondent, Female, White Irish, 46 - 60

Several respondents found costs too expensive, both the cost of NHS treatment and the costs of private alternatives. One patient reported being told that cleaning would cost £45 but insisting on receiving the cleaning on the NHS. Some patients who were on benefits were offered private treatments costing hundreds or thousands of pounds. Some respondents reported opting for private hygienist appointments because no NHS alternative was offered.

Some respondents thought that more information detailing what is available on the NHS and what is not would be helpful, particularly printed information given at the time of treatment. It was also suggested that on-line information rating different services alongside user feedback would be helpful to patients.

5. Interview with dentist

At one practice, a dentist offered to give a view on dental services. The following notes reflect the views presented by that dentist. LINk has not spoken to other dentists.

The dentist explained that most of their patients were NHS funded and not private. Most of the patients do not speak English but the dentist can speak their language and this encourages many of her patients to attend this dental practice. Some patients used to go to a dentist in another area but that dentist has now been forced to only treat private patients because of the high cost of rent, business rates, electricity and water bills. Hence some of these patients now come to this Islington-based practice.

The dentist felt that the payments received from the NHS do not cover the cost of treatment and surviving as a NHS dental practice is financially very difficult. For a programme of treatment, the dentist may have to spend three hours of treatment on different appointments with not only the cost of the dentist’s time but also materials, water and electricity. The NHS payments do not cover the actual cost of treatment.

The dentist explained that in recent months her water bill has almost doubled – the Water Board said that it had to be metered and this was the result. In a dental practice water has to be regularly running and available to patients. Also the electricity costs are always increasing and are very high for a dental practice.

The way that dentists are compensated by the NHS for the costs of dental treatment is very different than it is for doctors. Costs for dentists are always increasing but the income received from the NHS does not. The dentist interviewed believes that the NHS would like to get rid of NHS dentists and have only private practice and that is why there is not attempt to cover costs.

5. Summary of Findings

• Most respondents were satisfied with the overall experience of dental services they had used in Islington.

• Most respondents were happy with the waiting time for obtaining an appointment with a dentist.

• Most respondents felt that they had been given information about their treatment and many were clear about the cost of the services, but around 10% were not given clear information about the course of treatment and almost 20% were not given information about costs.

• The most common concerns raised about dental services related to charges for services, both the overall cost and clarity about which services were being charged.

• Some respondents felt that clinical staff were pushing them to choose private care over NHS care and in some cases patients would clearly be unable to pay these costs.

• Some respondents were not clear about their entitlement to different services on the NHS, despite the efforts of NHS Islington to promote the availability of local NHS dental appointments, through their social marketing campaign. It may be that in some cases, advice from dentists was unclear.

6. Recommendations

To dentists

• Ensure that pricing is more prominently displayed, for example on the counter in the practice, and refer all patients to this when booking and when attending their appointment.

• Ensure that pricing is clearly displayed on practice web-sites, and that there is clear information about what is not available on the NHS.

• Ensure that patients are given their dental plan before band 2 or 3 treatments (as required by the existing Dental Operating Framework) and explain any costs to patients, checking that they understand.

• Offer information about pricing of NHS and private care sensitively, bearing in mind that patients will have different abilities to pay, but without making judgement about individual patients’ ability.

To commissioners

• Ensure that dental practices display pricing more prominently, for example on the counter in the practice, and refer all patients to this when booking and when attending their appointment.

• Ensure that practices display pricing clearly on their web-sites, and that there is clear information about what is not available on the NHS.

• Be proactive in enforcing existing rules which require dentists and dental practices to provide timely, clear and accurate information to patients about prices and available dental treatments.

• Use LINk and other networks, and local publications such as Islington Life to disseminate information about patients’ entitlements to NHS dental services, and information about what treatments are available on the NHS.

• Ensure that dental practitioners are giving patients their dental plan before band 2 or 3 treatments (as required by the existing Dental Operating Framework) and talking patients through the plan, checking that they understand it.

• Ensure that practices offer information about pricing of NHS and private care sensitively, bearing in mind that patients will have different abilities to pay, but without making judgement about individual patients’ ability.

• Promote the Office for Fair Trading and British Dental Association’s Right to Smile campaign by displaying this video on TV screens in local GP practices and housing centres.

Appendix A:

Department of Health, Dental charges leaflet

Please follow the link below to access the Department of Health leaflet



This information is also available on the NHS Choices web-site (), the following text is quoted from that site.

NHS Choices, NHS Dental Treatment

If you normally pay for NHS dental treatment, the amount you pay depends on what treatment you need.

NHS dental charges

There are three NHS charge bands.

Band 1: £17.50 includes an examination, diagnosis and advice. If necessary, it also includes X-rays, a scale and polish and planning for further treatment. 

Band 2: £48 includes all treatment covered by Band 1, plus additional treatment, such as fillings, root canal treatment and removing teeth (extractions). 

Band 3: £209 includes all treatment covered by Bands 1 and 2, plus more complex procedures, such as crowns, dentures and bridges.

What if I need more treatment?

If, within two months of completing a course of treatment, you need more treatment from the same charge band or a lower one, for example another filling, you don't have to pay anything extra.

However, after two months, you will have to pay an additional band charge.

Emergency or urgent treatment

If you require urgent care, you will only need to pay one Band 1 charge of £17.50. Most urgent treatments can be done in one appointment. However, if more than one visit is required and you return to the same dentist to complete your urgent treatment, the Band 1 urgent charge is all that you should pay.

Once your urgent course of treatment is complete, you may be advised to make another appointment for a separate course of non-urgent treatment. In this case, the relevant Band charge will apply.

You don’t have to pay a dental charge:

• for denture repairs

• to have stitches removed 

• if your dentist has to stop blood loss

• if your dentist only has to write out a prescription - however, if you pay for prescriptions, you’ll have to pay the usual prescription charge when you collect your medicines (from 1 April 2012, this is £7.65) 

• if you fulfil criteria for free treatment (see below)

Personal dental treatment plan

Your dentist should give you a personal treatment plan before you have Band 2 or 3 treatment. The plan gives details of the treatment and the amount you’ll have to pay. You’ll be asked to read and sign the plan.

If you’ve discussed having private treatment with your dentist, the details and costs of this treatment will be listed separately on your treatment plan.

Before having dental treatment, talk to your dentist about the benefits of treatment and any risks involved.

Paying for treatment

Your dentist is entitled to ask for your payment at any stage of your treatment. As payment policies vary between practices, ask your dentist about when you will have to pay.

Referral to another dentist

If you're referred to another dentist to complete the treatment, you will still only pay one band charge. You will pay the full amount to the dentist who refers you.

If you’re referred to a private dentist (and you accept this option) you will:

• pay the appropriate NHS band charge to the dentist who referred you, and

• pay a fee for dental work carried out by the private dentist you are referred to.

Paying for treatment

You do not have to pay for NHS dental treatment if, when your treatment starts, you are:

• under 18, 

• under 19 and in full-time education,

• pregnant or you’ve had a baby in the 12 months before treatment starts,

• staying in an NHS hospital and the hospital dentist carries out your treatment,

• an NHS Hospital Dental Service outpatient (although you may have to pay for your dentures or bridges).

You can also get free NHS dental treatment if, when the treatment starts or when you’re asked to pay:

• you’re included in an award of Income Support, income-based Jobseeker's Allowance, income-related Employment and Support Allowance or Pension Credit guarantee credit 

• you’re named on, or entitled to, a valid NHS tax credit exemption certificate

• you’re named on a valid HC2 certificate 

If you're named on a valid HC3 certificate, you may not have to pay for all your NHS dental treatment. HC2 and HC3 certificates are issued under the NHS Low Income Scheme – see below.

You will not be exempt from paying for NHS dental treatment because you receive one of the benefits below when paid on their own:

• Incapacity Benefit

• contribution-based Jobseeker’s Allowance

• contribution-based Employment and Support Allowance

• Disability Living Allowance

• Council Tax Benefit

• Housing Benefit

• Pension Credit savings credit

Proof of your entitlement

You’ll be asked to show your dentist written proof that you’re entitled to help with dental treatment costs. This will vary depending on your circumstances. To check what documents you will need, see the NHS HC11 leaflet Help with health costs (PDF, 287.1kb).

NHS Low Income Scheme

The NHS Low Income Scheme provides income-related help to people not exempt from charges but who may be entitled to full or partial help with healthcare costs if they have a low income. Anyone can apply as long as they don’t have savings or investments over the capital limit. In England, the capital limit is £16,000 (or £23,250 if you live permanently in a care home).

Help is based on a comparison between your weekly income and assessed requirements at the time the claim is made. Entitlement broadly follows Income Support rules to decide how much, if anything, you have to pay towards your healthcare costs, including dental treatment costs.

The NHS Business Services Authority (NHSBSA) website has more information about the NHS Low Income Scheme, including how to apply.

Appendix B: Office of Fair Trading Advice to Dental Patients

The OFT is advising that if you have an NHS dentist:

• You are entitled to a wide range of treatment that you need to get your mouth, teeth and gums as healthy and pain free as possible.

• If your NHS dentist says you need a particular type of treatment, you shouldn't be required to pay for it privately. Private options may be discussed, such as cosmetic alternatives or specialist treatments like dental implants, it's your choice whether you take them. 

• Even if your treatment involves a number of visits, you will only pay one charge for each complete course of NHS treatment, unless you've had to make an emergency visit to the dentist first.

• Should NHS treatment fail within 12 months, your dentist should repair or redo most treatment free of charge, unless you were advised the treatment was unlikely to be a long-term solution.

• Details on NHS dental charges in England are available at nhs.uk.

If you opt for private dental treatment the OFT advises:

• Ask what guarantees your dentist provides. In addition to any rights you may have under guarantee, you will also have rights under the Supply of Goods and Services Act 1982.

Regardless of whether you have an NHS dentist or a private dentist you should receive a written treatment plan which includes the cost of any treatment your dentist has discussed with you, so you know in advance how much you'll be expected to pay.

Appendix C: General Dental Council ‘Conduct, Performance and Ethics’

In the autumn of 2012, the General Dental Council held a consultation on the standards of dental practitioners ‘Conduct, Performance and Ethics’.

(consultation%20Oct12)%20(Entire%20document).pdf

This consultation will inform the review of the conduct of dental staff and practitioners.

Appendix D: Dental Services, Patient Survey

We are from Islington LINk, which collects views on local services. We want to find out more about how people use NHS dental services. Would you mind answering a few questions about your visit today (start with question 2) / your most recent visit to the dentist (start with question 1)?

1. When did you last visit the dentist? [should be within the last two years]?

Within the last three months ( Within the last six months (

Within last year ( Within last two years (

Not in the last two years ( Never visited (

If the person has not visited in the last two years, please ask if there is a reason ______________________________________________, and they can contact LINk if they need help finding an NHS dentist.

2. Was any of your treatment NHS treatment?

Yes ( No ( Mix of NHS and private ( Don’t know (

a. If you had private treatment, did you know you may be entitled to NHS treatment?

Yes ( No ( Can’t remember ( Not relevant (

b. If you had private treatment, were you offered NHS treatment?

Yes ( No ( Can’t remember ( Not relevant (

c. If yes or a mix, what made you choose private treatment?

3. What service did you use?

|Check up |( |scale and polish/ cleaning |( |x-rays |( |sealant |( |

|Fillings |( |root canal work |( |Removing tooth |( | | |

|Crown |( |Dentures |( |Bridges |( | | |

|Implants |( | | | | | | |

|Other |( please state …………………………………………………… |

Note: If scale and polish / cleaning, please circle dentist or hygienist

4. Were you given clear information about the course of treatment you received?

Yes ( No ( Don’t know (

a. If no, what would have been helpful? ___________________________________

______________________________________________________________

5. Were you given information about the cost of the treatment?

Yes ( No ( Don’t know (

a. If yes, what was given? ___________________________________

______________________________________________________________

Prompt: Was the information written or spoken? _______________________

Prompt: Was information given before, during or after treatment?__________

______________________________________________________________

b. If no, what would have been helpful? _____________________

_____________________________________________________________

6. Do you feel you have ever paid privately for any treatment which you could have received on the NHS?

7. How long did you wait when booking your appointment? [between making contact and getting to see the dentist]

8. Were you satisfied with the wait?

Yes ( No (

9. How would you rate the service overall?

Very Good ( Good ( Quite Good ( Bad ( Very bad (

10. Any further comments:

You do not need to answer these questions, but this data helps us to ensure we are speaking to a diverse range of people across the borough.

|[1] |Sex |

| | |

| |( Male |( Transgender |

| |( Female |( Transsexual |

|[2] |Disability |

| | |

| |( Yes |( No |

|[3] |Sexuality |

| | |

| |( Heterosexual |( Bisexual |

| |( Gay |( Lesbian |

|[4] |Ethnicity | |

| | | |

| |( White British |( Black British |

| |( White Irish |( Black African |

| |( White Other |( Black Caribbean |

| |( British Asian |( Bangladeshi |

| |( Chinese |( Pakistani |

| | |( Indian |

| | |

| |( Other …………………………………….. |

| [5] |Age |

| | |

| |( 18 – 30 |

| |( 31 – 45 |

| |( 46 – 60 |

| |( 61 – 75 |

| |( 75+ |

|[6] |Faith, religion or belief system: |

| | |

| |( Catholic |( Spiritual |

| |( Christian |( Atheist |

| |( Buddhism |( Pagan |

| |( Hinduism |( Agnostic |

| |( Islam | |

| |( Judaism | |

| |( Sikhism | |

| | |

| |( Other ……………………………………. |

|[7] |Where does the interviewee live? |

| | | |

| |( Post code (first | |

| |part) | |

| |eg: N1 | |

-----------------------

Acknowledgements

Thank you to all the patients who took part in the survey, to the LINk Members who helped carry out the survey and to the staff at the practices visited.

Please let us know your areas of interest/ expertise in Health and Social Care:

¡% Primary Care (eg doctors, dentise survey, to the LINk Members who helped carry out the survey and to the staff at the practices visited.

Please let us know your areas of interest/ expertise in Health and Social Care:

□ Primary Care (eg doctors, dentists, podiatry, eye tests)

□ Secondary Care (eg hospitals, specialist clinics)

□ Social/ Community Care (eg Meals on Wheels/Home

Help/District nurse)

□ Residential Care and Nursing Homes

□ Emergency services (e.g. ambulance service)

□ Other (Please state below)

______________________________________________________________

Services for:

□ Children & Young People □ Older People □ Carers

□ Disabled People □ People with learning difficulties

□ People with mental health issues □ Black and Minority Ethnic (BME)

□ Lesbian, Gay, Bisexual and Transgender (LGBT)

□ Other:

Title ……………. First name …………. Surname …………………..

Organisation (if applicable) ………………………………………..

Address ……………………………………………………………………..

Post code …………… Email …………………………………………

Telephone Number ……………………………..

Contact details

Join the Islington LINk to receive our newsletter and information about LINk events and reports. You can fill in this form and post it to us (no stamp required), or phone / email us with your details (see back page for the LINk contact details).

Islington LINk Registration Form

Any information you have given us here will be treated as confidential.

We will not share your contact details unless indicated below.

□ Please tick the box to share your contact details with other LINk members

Data Protection

(

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NHS Dentistry:

Consultation on local people’s awareness and experience of dental services in Islington.

February 2013

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