The 2015/16 dental activity review focused on claims for re-attendance within 28 days of a previous course of treatment. We knew that in a small number of contracts, claims were occurring at higher than expected rates.
We wanted to understand why this was happening, identify and change any behaviours that could be contributing to those high rates and share best practice.
What the review aimed to achieve
Our aims were to:
- help raise awareness of the potential risks around 28 day re-attendance claiming
- get a better understanding of what was happening in practices and why
- tackle the potential issue of “splitting” courses of treatment identified by NHS Protect
- enable the profession to review and if necessary self-correct their claiming procedures.
The most common reason for an incorrect claim was where more than one dentist was involved in what should have been a single course of treatment and then each dentist submitted a claim separately for the element of treatment they provided.
We also discovered that:
- in many instances there was no evidence on the clinical record of a full mouth examination (14% of records didn’t have evidence of an examination for a banded course of treatment).
- often treatment appeared to be provided on an ‘ad hoc’ basis with no recorded evidence of diagnosis/treatment planning etc.
- there were multiple examples of antibiotic medication being prescribed for patients where there was no clinical justification evident in the clinical records.
- low rates of Band 1 ‘Urgent’ claims were identified in some instances, including where dentists hadn’t actually claimed for all the UDA they were entitled to. We passed this information back to the dentist.
- repeat treatment was needed (mainly Band 2 but some Band 3 CoTs) – the original treatment was unsatisfactory or the treatment provided did not resolve the patient’s signs / symptoms.
- there was often inappropriate use of the ‘Continuation’, ‘Free repair / Replacement’ and, to a lesser extent, ‘Incomplete’ claim indicators.
By positively engaging with the profession and offering support to dentists where it was needed we have been able to:
- increase understanding of how to claim correctly
- help dentists make sure they are claiming for all the treatment they’re entitled to
Our case studies look in more detail at how the NHSBSA, dentists and NHS England worked together during the review to deliver positive outcomes for dentists, patients and the profession.
The requirement to keep clinical records is enshrined in several regulations.
- Compliance with the Ionising radiation (Medical Exposure) Regulations 2000 should be recorded in clinical records where appropriate
- Care Quality Commission (CQC) outcome 21 relates to record keeping quality
- The General Dental Council requires good record keeping, the Standards for the Dental Team (September 2013) includes at 4.1.1: “You must make and keep complete and accurate patient records, including an up-to-date medical history, each time that you treat patients”.
The requirement for good record keeping is present in a provider’s contract with NHS England which requires that every course of treatment, except an urgent course of treatment, includes:
- “an examination of the patient, an assessment of his oral health, and the planning of any treatment to be provided to that patient as a result of that examination and assessment”.
- “… the contractor shall ensure that a full, accurate and contemporaneous record is kept in the patient record in respect of the care and treatment given to each patient under the agreement, including treatment given to a patient who is referred to the contractor”.
The Faculty of General Dental Practitioners Good Practice Guidelines on Clinical Examination and Record Keeping set out recommendations on what should be included and recorded for a sufficient examination of a patient for each course of treatment.