"I own a mixed NHS and private practice in the West Midlands, and I'm planning to covert my practice to wholly private care and withdraw from the NHS over the coming months.
"What do I need to consider from a dento-legal perspective?"
Moving from NHS to private practice needs to be considered and planned very carefully. It probably goes without saying that this should include seeking professional advice as necessary (such as accountancy advice), as well as creating a carefully planned communications timetable, both internal and external.
This article offers a brief guide to some of the main dento-legal considerations before and after the transition - but there are plenty more things to consider. See below for more on how the DDU can help you make the change.
Before you move
Giving information to all staff about the changes and training them accordingly will be vitally important for success, so they can give patients accurate and consistent messaging.
Associates with contracts and/or agreements based either partly or wholly on NHS earnings will need to be given the required notice for terminating their existing contract, and offered new private-only contracts if they are to be retained. The DDU can provide template private-only associate contracts.
Obligations to patients under NHS contracts
It's important to understand your obligations under the NHS contract while you still have one. A patient can request NHS treatment at any time, and as you are currently a provider of NHS care you're obliged to offer it - subject only to capacity within the practice and your own capacity (if the patient wants to see you personally).
Under the current NHS GDS contract in England, patients are not registered with the practice or a particular dentist, but undergo individual courses of treatment - after which, as far as the NHS contract is concerned, they are discharged completely from the practice's care.
Before you relinquish your NHS contract, nobody at the practice should suggest to a patient that NHS treatment is unavailable when it is. Any misleading of patients over the availability, extent, or quality of NHS treatment, can result in action by NHS England (against both performer and provider) as well as action by the GDC.
While NHS dental patients in England are not registered with the practice, the GDC would consider you have an ethical obligation to ensure patients who reasonably regard themselves as patients of the practice are fully informed of your plans. This is also clearly in your interests so you can retain as many existing NHS patients as private patients. To help deliver this, you should have a carefully planned and timetabled patient communications programme.
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Having set a date for relinquishing the NHS contract and changing to wholly private care, it might be preferable to personally tell patients your plans and reasons when they attend for their regular examinations, explaining that this will be their last course of NHS treatment.
This allows you and your associates to get across the essential messages to patients face-to-face, and gives patients time to adapt. A follow-up letter can then be sent to each patient, confirming the changes and the timetable, and giving as much information as possible about the new arrangements and the options for private or independent care at your practice after the changeover date.
This might include options to join one or more private capitation schemes, and examples of private fees for routine examinations, radiographs and treatments. To comply with GDC requirements, you will also need to tell patients who don't wish to transfer to private care where they can find out about available NHS services.
Naturally, you will need to formally relinquish your NHS contract on an agreed date, and this should be negotiated with NHS England. Your associates will also need to give notice to NHSE of ceasing to perform NHS services from your practice. It may be possible to transfer your NHS contract to another practice by forming a partnership - but that is outside the scope of this article.
To comply with GDC requirements, you will also need to tell patients who don't wish to transfer to private care where they can find out about available NHS services.
After the change - giving info to patients
When treating patients privately, as under the NHS, there is a GDC requirement to give every patent a written treatment plan and cost estimate before any treatment takes place. The fact that treatment is private should be clear on the plan and cost estimate, and if either the plan or estimate changes, the patient should be given an updated one.
You will also need to give patients clear information about your arrangements for emergency care, including out of hours emergencies. There's also a GDC requirement to display a simple price list in the reception or waiting area, which should include a list of basic items including a consultation, a single surface filling, an extraction, radiographs (bitewing or pan-oral) and treatment provided by a hygienist.
For items that might vary in cost, a 'from-to' price range can be shown. Your practice website and practice information leaflet should include all the same information, and should be amended so it's clear you are a private-only practice.
Changing from NHS or mixed care to private-only care, and persuading patients to accept the change, requires careful planning and execution.
It also requires expert professional guidance. This article is only an introductory guide to some of the dento-legal considerations, but DDU practice principal members can access HR advice from Peninsula Business Services as a benefit of membership, and all members can access specialist tax and accountancy advice from Armstrong Watson at exclusive rates.
We also offer a private-only template associate contract, along with our contract checking service - see our main website for more information.