Dentist cancelled because of maternity exemption

[Acc0untant]

This isn't a huge deal in the grand scheme of things but I feel a bit put out regardless.

My dentist has cancelled my appointment next month and when I queried why the receptionist told me that they aren't seeing any patients who are exempt at the minute. In my case I have a maternity exemption certificate (runs out in March). She said it's because they aren't receiving any NHS funding for it at the minute.

The point of the maternity exemption is that due to pregnancy you can have additional things needing work (pregnant gingivitis etc) and you aren't unfairly penalised by having to visit often. In this case they're saying I can't be seen until I start paying the NHS prices again in April.

Not going to pull the discrimination card (although being told I can't use their services until I no longer have an exemption due to pregnancy certainly feels like it) but would like to hear the thoughts of others on this too!

They get paid up to around £320, sometimes for thousands of pounds of work. That's why NHS patients are at the bottom of the pile.

Blame the government - they should be funding it, or not making it an exemption You cannot expect dentist to work for free -would you work for free?

Literally every time a dentist sees/treats an NHS patient.... they lose money.
The contract is not fit for purpose and needs renegotiating.
Sadly... they cannot afford to treat you at a loss.

op had a check up 5 months ago. . Their next check up is due next month . That has been cancelled but when new funding comes in on April 1st they can make a new check up. 6 weeks after when they preferred to be seen as their exemption runs out before April.

In the meantime , there is no more money. The government told the commissioning groups in November to remove 10% extra funding , to see extra patients , from dentistry to shore up shortfalls elsewhere in the service . Practices were informed this month that money they thought was coming , isn’t.

Additionally a below inflation fee rise due April last year still hasn’t been paid .

There is no money that funds a dental practice other than what they get in fees for treatment , that pays every bill.

I can guarantee if the practice has to see patients for free despite it costing over £140 an hour just to run each room in a practice, the practice will be bankrupt and close by April 1st . Then OP will have no where to go.

Do you think banks , suppliers,utilities , laboratories and staff will agree not to be paid for February and March ? If not how do you think the practice can carry on seeing people for free?

Absolutely this. Two colleagues have handed back their NHS contracts this month because they were loosing a six figure sum each year on it and could no longer justify using their income from private patients to subsidise it.

Exactly! I have asked the question a number of times about why, if there is funding still available for OP's DH to have a check up and pay the NHS rate, they won't let OP have an appointment and pay at the NHS rate rather than at the private patient rate.

The posters with knowledge in this area have all said that this is because the dental practice has run out of NHS funding and shouldn't be expected to work for nothing. Surely if there was no funding left, OP's DH would need to wait until April as well? That's why it sounds like maternity discrimination as OP is in a worse position than her DH because she was pregnant and had a baby.

If you’d actually bothered to read the replies of some posters which have even provided links you’d know the answer to this.

So are they also refusing to see children? Another category with an exemption with a specific end date.

I thought the way it worked is they get an amount per NHS patient regardless of the number of treatments. So it's a bit like insurance - some patients need more , some less but hopefully it works out overall (the contribution from the patient is a bit like an insurance co payment - it doesn't cover the whole cost).

I guess the amount per patient isn't enough to cover any more. That's why so many practices get rid of NHS work altogether

I would get a written explanation from the practice first to confirm the reasoning. I would then find out whether what they are doing is legal/allowed under the NHS rules. If it is then complain to your MP. If not complain to the governing body of dentists.

Stay polite and understanding and then they won't have a reason to take you off the books. The bigger risk is they stop seeing NHS patients completely.

Because the amount the NHS pays on top of patient contributions is only less than a pound or a couple of pounds at most . Eg a check up etc costs £26.80 ie the patient pays that , the NHS pays, on average , another £1.20. The NHS provides no other funding to a practice other than what is earned in fees. This money pays everything from business loans, to computer systems , staff wages , materials , laboratory fees …the lot.

If the practice does not succeed in getting extra funding (it is very,very unlikely it will ) then at least it will have some money from what the patient has paid, but they will have lost the £1.20 the NHS pays . If they see an exemption patient and get no extra funding then they will, in effect, have paid to see that patient.

The NHS forms will all have been sent off for each course of treatment (it’s a breach of contract if they are not) so there is no leeway to charge OP as she will be down on system as exempt.

In other words the practice will lose a bit of money from seeing fee paying patients , it would lose a shed load seeing non fee paying patients.

No .
A dental practice only gets paid per treatment (UDA unit of dental activity in England and Wales) .

Each practice is only given a set amount of UDAs each year . Once they have done the treatment there is no more. Each UDA is worth, on average , £28, the patient pays £26.80 the NHS £1.20. There is no other money than this to fund all practice expenses.

Last year practices were promised 10% extra UDAs to see more patients. In November the government wrote to commissioning groups to say this money should be used to shore up overspends in other areas of the NHS and not dentistry. This month the commissioning groups wrote to dentists to say they would not have the funding to do the extra 10% of work.

These practices now have no more funding for the rest of the year. Not only that but a below inflation fee rise from 10 months ago has still not been paid.

It costs upwards of £140 an hour to run one surgery in a dental practice . Where a check up earns £28 , on average , a treatment with multiple fillings etc earns £84 etc very often the NHS fees do not even cover the cost of running the room , let alone pay the dentist.

Now the practice has run out of UDAs there is no more money coming in except patient fees. If a patient doesn’t pay the fee not only does the dentist not get paid but the expenses of running the room still have to be paid .

The dentist , even though the NHS is paying nothing towards treatment , still has to send off forms etc and does not have the ability to charge someone if they are exempt.

Do you think all the suppliers , utilities, staff , banks etc will let the practice off paying its bills for a couple of months ?

Here’s the links etc which explain the situation,
first what has happened with dental funding this year

KO: How do the financial challenges faced by ICBs affect dentistry?
EC: At the outset of the year, ICBs were informed that they ought to ring fence the dental budget. So, if dentists in a particular area weren’t delivering NHS dentistry at the levels that they want, the ICB could use some of the underspend to recommission services in that area. This was welcomed by the profession – the money wouldn’t be lost to other areas of the health service as it has been done previously.
But in November, NHS England wrote to ICBs and said that the government would not be bailing out overspends and if they had any unspent or unallocated money, they would be expected to use that to prop up the overspends elsewhere. It’s meant that a lot of plans for dentistry have been stopped – if they hadn’t committed the money to the projects, those projects are not going ahead – which is hugely upsetting.
One of the things suggested at the beginning of the year was that ICBs could fund more activities than the dentists had in a contract. They could fund an additional 10% activity and many colleagues believed that was an offer that they were working to.
But now the ICBs have reversed that decision. At least 12 ICBs have written to dentists about this. In some cases, they are doing no dentistry at all for one or two months before the end of the financial year because they’ve run out of funding.

second what happens when practices run out of UDAs (units of dental activity ) which are the only pay they get . https://www.bbc.co.uk/news/articles/czq5yjl7zn1o

And another link to explain situation https://www.gdpuk.com/news/latest-news/4665-birmingham-dentist-slams-talk-of-ringfencing-as-platitudes

The saddest thing is instead of supporting the few practices still soldiering on despite government and NHS cuts people are far more keen to launch complaints adding to the stress.

What would be more likely to support a practice providing NHS dentistry , asking who you can write to to support the case for extra funding that was promised, or adding an official complaint on top of the financial pressures? What course of action is more likely to have the practice still working in the NHS next year?

Rude!

The fact is that OP is being denied treatment because she is a woman who has recently given birth. No man could be denied treatment for this reason. It doesn't make it better that other people with exemptions - most of which will also be based on their having vulnerabilities or lack of privilege, even if that doesn't come with a protected characteristic - are also being denied.

They aren't even letting her pay the standard NHS amount - she either has to pay the full private rate or do without any treatment.

I do understand that the NHS is screwing over dentists, but nobody is forcing them to agree to the NHS contract.

If it really doesn't work for them as a business, they should just be honest about it and go private only - rather than claim to offer NHS services that they then refuse to honour.

Are there any benefits of their being associated with NHS treatment - maybe a very large volume of customers who couldn't ever afford to go to them at all if they had to pay full private fees, so at least they earn something - or do they solely do it out of the good of their hearts?

Maybe if enough dentists pulled out of unworkable and unreasonable NHS contracts, there would be a nationwide mutiny about it - and the government forced to do something about it. It's utterly ridiculous that the NHS will cover every part of the body except for teeth and eyes.

I do question why people will constantly rail against intolerable conditions in their jobs or with a particular business partner - but still resolutely refuse to ever look for a different job elsewhere or seek to dump a nightmare business partner, customer or supplier.

No NHS dentists in Devon? Someone’s telling porkies….

Even though the NHS is not funding the practice ,the practice still has to fill out and send in the treatment forms.
If a patient is exempt the practice cannot change the forms to allow the patient to pay.Its not the dental practice it's the NHS rules and regulations, which are reflected in the computer system the practice logs into.

The practice has offered the OP a private appointment , or to rebook their appointment a few weeks later when new funding year starts.

This practice gave her a check up 5 months ago. It is offering one , again, after April 1st yet you want to crucify them for not working at a loss? Why not direct ire towards a system which promised funding last year , then withdrew it January this year at virtually no notice?

Read the many links provided, educate yourself, and then think again. Get angry in the right direction.

This is not discrimination, OP has been cancelled just as every other person with an exemption, it happens country wide.

If you think dentistry is the only place where people are having to wait for treatment you’re in for a shock. OP is having to wait until they have funding, just like everybody else with an exemption. If there was no petrol in your car and you couldn’t put petrol in it until next month, you wouldn’t be shocked that you can’t drive your car in the meantime with no petrol, you understand that no petrol means the car can’t move. There’s no funding, so it can’t be done. This is allowed, it’s essential actually for many dentists to keep the doors open, it’s not discrimination, and happens across the country,

It is shit, but it’s not the dentists fault, and we don’t have a money tree. So unless you’re willing to work for free, don’t expect them to.

Isn’t pregnancy a protected characteristic?

She’s not pregnant

There has been a change in the UDA system so that the number of UDAs does not cover as many patients. Practices are finishing their contract target and will not receive any extra allocation this year. Any patients who have already started treatment will be included in this years target. They will have cancelled your appointment because it is a new course of treatment and will take them over target. They will receive no payment for it. Non exempt patients will generate some but not all the total UDA value if the practice continues to offer treatment at NHS prices ( they will be processed as private patients and the charge may be rounded up to avoid the NHS strict rules) but it may be short by £5-10. The practice may be willing to take the loss in order to fund practice overheads but the dentist may be making zero personal income when they do this.

So many colleagues are leaving the profession at the moment. All of my contemporaries have retired from NHS contract. We all had a pension age of 60 and because of the tax changes a few years ago, financially it was better to cash in on our pensions. Some, like me, work part time as private or as an assistant, but you have to balance income against tax so I am limited to 1-2 days.

I have loved my job but the stress since 2006, when the current contract was introduced, is immeasurable and has taken its toll on my health and mental health. I am now happy in my job again, without the responsibility of owning and running a practice and the financial and time restraints the UDA system produces, I can provide the quality dentistry I used to when NHS funding was more straightforward.

I was diagnosed with breast cancer 3 yrs ago and the treatment (ongoing) has left me with chronic fatigue and mucoskeletal problems. I plan to carry on working until my DS completes further education. But after that I’m done.

It's not the dental practice at fault. It's the was the nhs is funded.

They are not funded enough. Once the pot has been used up the dentist will be working for free. You wouldn't work for free. Why should they. They won't. Nor should they. They will just go full private like most other dentists.

Even worse than working for free as all the practice expenses still have to be covered , so effectively they will be paying to work.

It costs upwards of £140 an hour to run one room in a dental surgery , without the dentist being paid.

However the government etc will be happy because it is their continuing policies that are perpetuating this problem but fortunately they are not at the sharp end of complaints , the practices still clinging on for grim death to NHS dentistry are the ones who get the complaints , disputes , reports to GDC etc because after all the crisis in NHS dentistry is entirely the dentists fault.

@Acc0untant

Just because others are being told they can't be seen doesn't automatically mean it isn't discrimination though. The only reason I'm not being seen is because I had a baby within the last 12 months.
No. The reason you are not being seen is because you are an exemption holding patient. It's not the same thing at all.

Everyone holding exemptions will be in the same boat not just pregnant women.

What do you expect them to do? Work for free? Would you?

Actually they will be processed now as NHS patients , not private, because many commissioning groups expect dental treatment to continue even when UDAs have run out. This has been discussed in many colleagues forums.

Also because of the last minute nature of the withdrawal of the 10% extra UDAs many colleagues are still trying to get extra funding so are continuing to send forms off in desperate hope the funding promised last year will turn up.

There are some significant advantages to converting to private. It is not as lucrative as the public think though. The majority will be able to cut their patient lists by 60% and still earn the same amount of money. This is the main reason they convert not to actually earn more money.

Rather than doing a check up every 5 mins, they will see patients every 15-20 mins allowing much more time to carry out exam, radiographs, cancer screening and periodontal assessment that is expected.
The old days of commenting NAD on the notes is no longer acceptable and we are now expected to record everything and review medical history every visit. We have a patient portal for patients to record their medical history changes directly into their notes. But we have to check through this with them to confirm all changes and, in particular, medication changes.

It’s amazing how many people only list medication they think is relevant to dentistry. More than once I’ve found out a patient is in blood thinners at an extraction appointment and we’ve had to cancel. This is despite repeatedly asking for a full list of meds, patients are never happy and frequently tell us that they didn’t think it was important.

Sime of my patients are on 20+ medications and even if they have accurately recorded them for us we still need to check them in case they affect treatment.

Can they book you in for the beginning of the New financial year?
That way you'd surely get funded?

I'd get them to move your appointment till then anyway and then flash the exemption card on the day.