Dave Cottam explains how we achieved a breakthrough on Dental Assurance Reviews, with the BSA committing to targeting genuine outliers.
Photo (c) Getty Images
Last September, the BSA announced they were launching a new set of Dental Assurance Reviews (DARs) in England. These will look at incomplete treatments (Band 2 and/or 3), Band 2 fissure sealants, Band 3 inlays and Band 1 urgent claims followed by a Band 2 claim with no examination. Despite our initial frustration that this was done without consulting the BDA, the BSA has subsequently worked constructively with us over recent months to improve the processes by which these Reviews are conducted.
In the 28-day re-attendance reviews, there was a real feeling among dentists that with each new round more and more practices, who were not by any reasonable measure real outliers were being subject to inappropriate scrutiny. We challenged the BSA to justify the process by which they identify outliers and as a result the BSA has reviewed the way it does this. This means that they will only look at a very small number of practices that are genuinely extreme outliers within these DARs. The proportion of all contracts involved in these DARs will now be less than one per cent.
Assurance review process will change
As a result of our feedback, the process for the DARs themselves will also be changed. Those contracts identified as extreme outliers will be examined against contextual information to decide whether they should be included in the DAR. This 'holistic review' would include consideration of if there are local demographic characteristics that might explain variation in treatment patterns.
Those contracts then identified for the DAR will receive a letter informing them of their outlier status, asking them to consider this and an offer from the BSA to provide additional information and support to understand why this might be the case. Contractors will then have six months to consider their claiming behaviour and implement any changes necessary.
The contract will then be reviewed and those that have brought claiming below the extreme outlier level will be moved out of the DAR without further action, subject to approval by the BSA's internal processes. Where the contract was found to be borderline after six months, the practice would be provided with this information and, subject to review, would be moved out of the DAR process.
Very few contractors will be asked to self-audit
Where there is no or an inadequate reduction in extreme outlier status, contractors will be asked to complete a self-audit. This will mean that very few contractors will be asked to complete a self-audit. Where the self-audit is satisfactorily completed within the given timeframe and inappropriate claims identified or appropriate claims justified then the BSA's internal process is likely to accept this and move the contract out of the DAR.
Where contractors fail to comply with conducting a self-audit or don't satisfactorily conduct one, the contract will then be subject to a clinical record review of a small number of claims by a NHS BSA Dental Services Clinical Adviser. The outcome of this would be provided to the contractor. If agreement is then reached, the contract would then likely be moved out of the DAR. Where no agreement could be reached on the clinical record review then a full record review would be conducted on all claims identified for the self-audit and this would likely lead to a referral to the local NHS area team. The BSA intends to give providers every opportunity to avoid this.
We believe this is a significant improvement on the DAR process that should mean that the scrutiny applied by the BSA is proportionate and reasonable and that practices are not grilled for entirely appropriate claiming.
We have also challenged the BSA's Spotlight articles, which we did not feel were entirely accurate or fair, and hope to be able to continue to work with the BSA to ensure that the advice provided is in line with the regulations and common-sense.
Chair of General Dental Practice Committee, BDA
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