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What is next for payment reform?

The next steps in the process to payment reform implementation have been outlined by the Scottish Government. 

Given the scale of change it is fundamentally important all contractors read the detail in four key documents:
This announcement includes information on educational resources for dentists and dental teams.
The letter and PCA provide an overview of changes to aid better understanding but are described as ‘for reference only’.

We have summarised the announcement, but this is not a substitute for making a detailed assessment of these core documents. 

Regulatory change

A number of regulatory changes have been made to The National Health Service (General Dental Services)(Scotland) Regulations 2010 to support payment reform and will come into force on 1 November 2023. A copy of the Miscellaneous Amendment Regulations are also available.

An overview of the legislative changes which will be in place from 1 November 2023 are outlined in the letter from the CDO;

  • The replacement of the existing capitation and continuing care arrangements with a single capitation arrangement, regardless of the age of the patient. Payment levels will continue to be defined by the same age-related categories presently in use. Enhancements for additional support needs, resident in SIMD 1 areas and deprived areas fee enhancement are retained. In other words, continuing care and capitation is being combined into a unified capitation arrangement. The new capitation arrangement means that all care and treatment items, where appropriate will be available for both child and adult patients
  • The terms of services have been amended to reflect a capitation arrangement. There is a shift from dentists being required to ‘secure and maintain’ the oral health of the patient, instead dentists are required to ‘manage’ the oral health of the patient 
  • The removal of occasional treatment references, thus allowing non-registered patients access to the full range of NHS dental treatments, without the need to register with a contractor
  • The removal of the provision that prevents NHS and private treatment on the same tooth
  • Consequential amendments to a number of other regulations.

Amendment No.161 to the Statement of Dental Renumeration

A copy of the full Amendment No 161 to the Statement of Dental Renumeration is available.

The new fee structure is made up of 45 care and treatment items.

Patients who are required to pay a patient charge for NHS dental care and treatment will continue to pay 80% of the gross fee cost up to a maximum patient charge of £384 per course of treatment. Examination items 1 (a) and 1 (b) will continue to be free to all patients.

The prior approval limit will increase to £600. A small number of exceptions exist to this: 

  • Orthodontic items that require prior approval will continue to require prior approval from 1 November 2023. There are no changes to orthodontic specific items or orthodontic discretionary codes in the changes to Determination 1
  • The miscellaneous balancing fee – for incomplete treatment started in advance of and completing after 1 November – will also require prior approval.
A new BDA fee guide will be available to members soon. This is an invaluable resource which summarises the codes and fees listed in the new Determination 1, to use from 1 November 2023.

Pay award

The new fees include a 6% award uplift (this has also been applied to orthodontic items). From 1 November the pay award will be applied to gross item of service fees and capitation payments and will be included in the November 2023 paid December 2023 schedule. Backdated payments on gross item of service fees, capitation and continuing care payments made between 1 April 2023 and 31 October 2023 will be made December 2023 paid January 2024 schedule.

The pay award has also been applied to the VT salary, with effect from 1 April 2023.

Transitional arrangements

These arrangements were set out in PCA(D)(2023)4 and PCA(D)(2023)5.
Any active courses of treatment opened before 1 November 2023, but not completed must remain open until the course of treatment is complete. Claims should then be completed in the normal way and will be paid at the SDR rate relevant to the date of acceptance of the treatment.

Claiming arrangements for incomplete treatment and balancing fees are also outlined in PCA(D)(2023)5.

Bridging payments

The bridging payment will cease for all courses of treatment opened on or after 1 November 2023. The last payment will be included in the October 2023 paid November 2023 schedule.

A manual payment will be made in February and May 2024 to reconcile any courses of treatment where an additional 10% should have been applied to item of service fees for existing courses of treatment submitted after the October paid November schedule.

Sedation allowance

This allowance been removed, the rationale for this change is outlined in PCA(D)(2023)5.

A sedation allowance can still be claimed in the usual way, for 2023/24 if a practice has completed the required number of sedations between April 2023 and October 2023. Any sedations carried out from 1 November 2023 will not count towards the required number of sedations.

Enhanced skills in domiciliary care

The amounts of the Care and Treatment Allowance for Enhanced Domiciliary Care Dentists have been increased in line with the fee offer for ordinary domiciliary care from November 1 2023.

Update to Determination V and Determination VI

An amendment has been made to introduce an additional payment for contractors in receipt of maternity, adoptive, or long-term sickness payment, should their quarterly commitment payment level be impacted by the period of absence. The additional payment will be in respect of a maximum of two quarterly commitment payments and will only apply to the first two quarterly commitment payments impacted by the absence. If the quarterly commitment payment is not affected by the period of absence then the additional payment will not apply, examples, with illustrative calculations are included in PCA(D)(2023)5.

This change will be backdated to 1 July 2022. Any contractors that were in receipt of maternity, adoptive, or long-term sickness payment as of 1 July 2022, will be entitled to have an additional payment paid retrospectively, if the level of their commitment payment (from September paid October onwards) was affected by the period of absence.

Education and training

The Scottish Government has prepared an FAQ which it hopes will help address any queries dentists may have about applying the new items and interpretation of the provisos. 

There will be other educational resources released on Turas and notification will be sent from NHS Education for Scotland (NES) when this is live.

Webinars will be held on 12 and 25 October 2023 and NES will advise on the booking process, with further webinars to follow after 1 November, booking information will be sent in due course.

An Extraordinary CPD Allowance will be available to dentists who are listed on sub-part A of the dental list on completion of all live and recorded mandated elements of the Payment Reform training on the Turas website.

The extraordinary CPD Allowance is not subject to abatement.

A change has been made to the general CPD allowance to reinstate the additional CPD payment for remote dentists.

We will continue to support our members during this transition. At this stage, we advise members to carefully review the PCA and accompanying documents, including the detailed FAQs.

Contractors are to raise any questions in the first instance with their health board. We expect that the online training that will be provided by NES will be a valuable resource for the whole dental team. We encourage dentists to take time to review and consider all various communication and available training.

We will be launching a dedicated webpage to give members a one stop shop of access to information and to sign post where members can seek further support. Extra and Expert members can contact the team for one-to-one advice by calling 020 7935 0875 or by emailing [email protected]