The National Health Service (General Dental Services) Regulations 1992

• Citation: S.I. 1992/661
• Sections: 150

Section 1 Citation and commencement

These Regulations may be cited as the National Health Service (General Dental Services) Regulations 1992 and shall come into force on 1st April 1992.

Section 2 Interpretation

(1) In these Regulations, unless the context otherwise requires—

“ the Act ” means the National Health Service Act 1977 ;

“assistant” means any dentist employed either whole-time or part-time under a contract of service by another dentist for the purpose of providing general dental services on behalf of that other dentist;

“associateship agreement” means an agreement between dentists practising as principals—

to which there are two parties, not being partners of each other, and

whereby one party is liable to provide, for financial consideration, the use of some or all premises and of some or all facilities for the provision of general dental services by the other party;

“the Board” means the Dental Practice Board;

“capitation arrangement” means an arrangement between the dentist and the patient whereby the dentist provides care and treatment in accordance with paragraph 5 of Schedule 1;

“care and treatment” means—

all proper and necessary care which a dentist usually undertakes for a patient and which the patient is willing to undergo, including advice, planning of treatment and preventive care, and

treatment;

“continuing care arrangement” means an arrangement between the dentist and the patient whereby the dentist provides care and treatment in accordance with paragraph 4 of Schedule 1;

“dental officer” means a dentist in the service of the Board, or of the Welsh Office, as the case may be;

“dental surgery” means any part of the practice premises where care and treatment is provided;

“dentist” means a registered dental practitioner;

“deputy” means a dentist acting on behalf of another dentist, otherwise than in the capacity of an assistant, for the purpose of providing general dental services;

“doctor” means a registered medical practitioner;

“Drug Tariff” means the statement prepared by the Secretary of State under regulation 18 of the National Health Service (Pharmaceutical Services) Regulations 1992 ;

“an emergency” means the circumstances set out in paragraph 6(2) of Schedule 1 in which a patient requires prompt care and treatment;

“emergency dental services” means treatment which is provided pursuant to arrangements made under regulation 14;

“estimate” means a form supplied by an FHSA , completed by the dentist and submitted to the Board in accordance with paragraph 26 of Schedule 1 for the purpose of obtaining prior approval under that paragraph;

“FHSA” means a Family Health Services Authority ;

“listed drugs” means such drugs and medicines as are included in a list for the time being approved by the Secretary of State for the purposes of section 41 of the Act ;

“Local Dental Committee”, “Local Medical Committee” and “Local Pharmaceuti cal Committee” mean the committees of those names which are recognised by the FHSA in relation to its locality under section 44 of the Act ;

“locality” means the locality for which an FHSA is established;

“mobile surgery” means any vehicle in which care and treatment is provided;

“ NHS charge” means the charge, authorised under the National Health Service (Dental Charges) Regulations 1989 , to the patient within the meaning of those Regulations;

“occasional treatment” means such treatment as is mentioned in paragraph 17 of Schedule 1;

“oral health” means such a standard of health of the teeth, their supporting structures and other tissues of the mouth, and of dental efficiency, as in the case of any patient is reasonable having regard to the need to safeguard his general health;

“patient” means a person for whom a dentist agrees to provide general dental services;

“patient record” means a form supplied by an FHSA for the purpose of maintaining a record of treatment;

“practice premises” means in relation to any dentist, any premises at which he provides general dental services, or any mobile surgery of his;

“practice record form” means a form supplied by an FHSA and completed in accordance with paragraph 27 of Schedule 1 for the purpose of obtaining general dental services in circumstances where the dentist intends to use a computer to send an estimate to the Board;

“prior approval treatment” means any item of treatment referred to in Part I of Schedule 4 or any care and treatment specified in paragraph 1 or 2 in Part II of that Schedule;

“private”, in the context of care and treatment, means otherwise than under general dental services or Part I of the Act, and “privately” shall be construed accordingly;

“salaried dentist” means a dentist employed by an FHSA who undertakes to provide general dental services at a health centre;

“Scale of Fees” means the Scale of Fees set out in Determination I of the Statement of Dental Remuneration;

“Statement of Dental Remuneration” means the Statement published by the Secretary of State pursuant to the provisions of regulation 19;

“supply”, in relation to an appliance, includes replacement;

“terms of service” means the terms of service contained, or referred to, in Schedule 1;

“trauma” means damage to teeth, gingival tissues or alveoli caused by a force arising outside the mouth, resulting in mobility, luxation, subluxation or fracture of the hard tissues or injury to the soft tissues;

“treatment” means all proper and necessary dental treatment which a dentist usually undertakes for a patient and which the patient is willing to undergo, including examination, diagnosis, preventive treatment, periodontal treatment, conservative treatment, surgical treatment, the supply and repair of dental appliances, orthodontic treatment and the taking of radiographs and the provision of general anaesthesia and sedation in connection with such treatment and the supply of listed drugs and the issue of prescriptions in accordance with paragraphs 22 and 23 of Schedule 1; and

“treatment on referral” means any care and treatment provided by a dentist under paragraph 13 of Schedule 1.

(2) In these Regulations, unless the context otherwise requires—

(a) any reference to a numbered regulation is a reference to the regulation bearing that number in these Regulations;

(b) any reference in a regulation to a numbered paragraph is a reference to the paragraph bearing that number in that regulation;

(c) any reference in a regulation to a numbered Schedule is a reference to the Schedule to these Regulations bearing that number; and

(d) any reference to a form supplied by an FHSA includes a reference to a form which, though not supplied by the FHSA, is in all material respects the same as a form which is supplied by that FHSA in its locality.

Section 3 Terms of service

The arrangements with dentists for the provision of general dental services which it is the duty of an FHSA under section 35 of the Act to make, and under section 15(1)(a) of the Act to administer, shall incorporate—

(a) in the case of a dentist undertaking to provide general dental services (other than emergency dental services), otherwise than as a salaried dentist, the terms of service contained in Parts I, II , III , IV and V of Schedule 1;

(b) in the case of a dentist undertaking to provide general dental services (other than emergency dental services), as a salaried dentist, the terms of service contained in Parts I, II, III, IV and VI of Schedule 1;

(c) in the case of the provision of emergency dental services by a dentist undertaking to provide emergency dental services, the terms of service contained in Parts I and III, paragraphs 19, 20, 21, 22, 23 and 25 of Part IV and paragraphs 39, 40, 41 and 42 of Part VI of Schedule 1.

Section 4 Dental list

(1) An FHSA shall prepare a list, to be called the dental list, of dentists who, pursuant to the provisions of regulation 5, have undertaken to provide general dental services in its locality and who are not disqualified for inclusion by virtue of the provisions of—

(a) section 36(2), 47(1) or 48(b) of the Act; or

(b) section 8(2) of the Health and Medicines Act 1988 ; or

(c) regulation 7 (restrictions on the right to be included in a dental list).

(2) The dental list shall, in addition to containing the name of a dentist,—

(a) contain—

(i) the addresses of all his practice premises and, where he provides general dental services at a mobile surgery only, the address at which correspon dence in connection with such provision may be sent to him;

(ii) particulars of the days and hours when he is or will usually be in attendance at the practice premises for the provision of general dental services and, in the case of any mobile surgery, particulars of the places visited regularly by him and the times of those visits;

(iii) the name of any other dentist in association with whom he provides general dental services at his practice premises;

(iv) the date of his registration as a dental practitioner in the register kept under section 14 of the Dentists Act 1984 , particulars of the dental qualifica tion which entitled him to be so registered, including the date on which the qualification was awarded, and particulars of any other dental qualification held by him which is registrable pursuant to section 19(1)(c) of the Dentists Act 1984 ; and

(b) indicate—

(i) whether the dentist provides only orthodontic treatment; and

(ii) whether there is access to the dental surgery without the use of stairs.

(3) The dental list may, provided that the dentist consents to their inclusion, also give particulars of any languages, other than English, spoken by the dentist.

(4) The dental list may, if an FHSA thinks fit, be so arranged as to show the part of the locality in which each dentist has undertaken to provide general dental services.

(5) A dentist whose name is included in the dental list of an FHSA shall notify the FHSA of any occurrence requiring an alteration to the information recorded in relation to him in the dental list within 14 days of the date of such occurrence.

(6) An FHSA shall—

(a) send to the Board and the Local Dental Committee a copy of its dental list; and

(b) notify the Board and the Local Dental Committee of any alteration to its dental list within 7 days of the date on which the alteration is made.

(7) Subject to paragraph (9), an FHSA shall—

(a) send, if requested to do so, a copy of the dental list to—

(i) the Secretary of State;

(ii) the Local Medical Committee;

(iii) the Local Pharmaceutical Committee;

(iv) the relevant Regional Health Authority ;

(v) a District Health Authority any part of the district of which is in the locality of the FHSA;

(vi) the Board of Governors of the Eastman Dental Hospital ;

(vii) an NHS Trust the functions of which consist of or include the management of a hospital which is situated in the locality of the FHSA; and

(viii) a person whose name is included in the list maintained by the FHSA pursuant to section 42(2)(a) of the Act; and

(b) in that event, notify them, at intervals of not less than 3 months, of any alterations made to the dental list.

(8) An FHSA shall, if necessary, prepare an updated dental list each year and send a copy—

(a) to the Board and the Local Dental Committee; and

(b) subject to paragraph (9), to any person mentioned in paragraph (7)(a) who under that paragraph requested a copy of the dental list.

(9) Where an FHSA considers that only parts of, or only some of the alterations to, the dental list are likely to concern any person mentioned in paragraph (7)(a), the FHSA may instead of sending them a copy of the list or notifying them of all those alterations send that person a copy only of those parts or, as the case may be, notify him only of those alterations.

Section 5 Application for inclusion in the dental list

(1) A dentist who wishes to have his name included in the dental list shall make an application to the FHSA in writing which—

(a) shall include—

(i) in the case of a salaried dentist or a dentist undertaking to provide only emergency dental services, the information specified in paragraphs 1, 2, 3, 4, 5 and 11 of Part I of Schedule 2 and the undertaking specified in that Part of that Schedule; and

(ii) in any other case, all the information and the undertaking specified in Part I of Schedule 2; and

(b) may include the information specified in Part II of that Schedule.

(2) The FHSA shall determine an application made by a dentist under paragraph (1) within 14 days of the date of its receipt of the application or, where the FHSA considers the proposed practice premises should be inspected, within 14 days of the date of that inspection.

Section 6 Local directory of dentists

(1) An FHSA may prepare, and thereafter maintain, in addition to a dental list, another list, to be known as the local directory of dentists, which may contain, in respect of each dentist whose name is included in its dental list—

(a) any information included in the dental list in respect of the dentist; and

(b) any other information related to the provision of general dental services which the FHSA has agreed with the Local Dental Committee to be appropriate.

(2) Where the FHSA has agreed with the Local Dental Committee that certain information is appropriate for inclusion in the local directory of dentists, it may request in writing any dentist whose name is included in its dental list to furnish the FHSA with such information as it relates to him, and the dentist shall furnish that information to the FHSA within 28 days of the date of the FHSA’s request.

Section 7 Restrictions on the right to be included in a dental list

(1) A dentist shall not be entitled to have his name included in the dental list prepared by any FHSA where the circumstances specified in paragraph (2) apply.

(2) The circumstances referred to in paragraph (1) are—

(a) if the dentist has previously withdrawn his name from the dental list prepared by any FHSA or any list prepared pursuant to section 25(2)(a) of the National Health Service (Scotland) Act 1978 in circumstances where the Secretary of State has certified for the purposes of regulation 8(7) of the National Health Service (Superannuation) Regulations 1980 or, as the case may be, regulation 10(4) of the National Health Service (Superannuation) (Scotland) Regulations 1980 that, in the interests of the efficiency of general dental services, he should cease to provide such services; or

(b) if the FHSA is not satisfied following an inspection that the proposed practice premises meet the requirements of paragraph 33 of Schedule 1.

Section 8 Removal from dental list

(1) Subject to sub-paragraph (2), where an FHSA determines that a dentist whose name is included in the dental list—

(a) has died; or

(b) subject to section 35(3) of the Act, is no longer a dentist; the FHSA shall remove his name from the dental list with effect from the date of its determination.

(2) Where a dentist has died and—

(a) for so long as his practice is carried on by his personal representatives in accordance with the provisions of the Dentists Act 1984 , and

(b) the personal representatives have appointed for that purpose a dentist whose name is included in the dental list of the FHSA,

the FHSA shall not remove the dentist’s name from the dental list.

(3) Subject to paragraph (5), where an FHSA determines, in accordance with paragraph (4), that a dentist whose name has been included for the preceding 6 months in the dental list has not during that period provided general dental services, the FHSA may remove the dentist’s name from the dental list.

(4) Before making any determination under paragraph (3) the FHSA shall—

(a) give the dentist 28 days' notice of its intention to do so;

(b) afford the dentist an opportunity of making representations to the FHSA in writing or, if he so wishes, in person; and

(c) except where the dentist is a salaried dentist, consult the Local Dental Committee.

(5) In calculating the period of 6 months referred to in paragraph (3) there shall be disregarded any period during which—

(i) the dentist was performing relevant service;

(ii) the dentist was on maternity leave; or

(iii) the dentist was unable to provide general dental services because of sickness.

(6) In this regulation—

(a) “relevant service” means—

(i) whole-time service in the armed forces of the Crown in a national emergency as a volunteer or otherwise; or

(ii) compulsory whole-time service in those forces, including service resulting from any reserve liability; or

(iii) any equivalent service by a person liable for compulsory whole-time service in those forces; and

(b) “maternity leave” means the period of one year beginning with the date of confinement.

(7) Nothing in this regulation shall prejudice any right of a dentist to have his name included again in a dental list.

Section 9 Removal from dental list on grounds of age

(1) An FHSA shall, on each of the dates specified in column (1) of the Table below, remove from the dental list the name of any dentist included in the list who has, on or before that date, attained the age specified in column (2) of the Table in relation to that date.

Table

(2) An FHSA shall, on 1st April in 1998 and in each successive year thereafter, remove from the dental list the name of any dentist included in the list who has attained the age of 65 during the period of 12 months ending on 1st April in that year.

(3) An FHSA shall give to any dentist whose name is to be removed from the dental list in accordance with paragraph (1) or (2)—

(a) notice in writing to that effect not less than 12 months nor more than 13 months before the date on which his name is to be removed; and

(b) a further such notice not less than 3 months nor more than 4 months before that date;

but failure to give notice to any dentist as required by sub-paragraph (a) or (b) of this paragraph shall not prevent the removal of that dentist’s name from the dental list in accordance with paragraph (1) or (2).

(4) An FHSA shall, no later than 7 days after the removal in accordance with paragraph (1) or (2) of the name of any dentist from the dental list, notify the Board in writing of the name, address and date of birth of the dentist in question and of the number by which his arrangement with the FHSA is identified.

Section 10 Withdrawal from dental list

(1) Where a dentist wishes to withdraw his name from the dental list—

(a) he shall give 3 months' notice in writing to the FHSA, or such shorter period as he may agree with the FHSA, before the date on which he wishes his name to be removed from the dental list; and

(b) subject to paragraph (2), the FHSA shall remove the dentist’s name from the dental list on the expiry of the period of notice given under sub-paragraph (a) of this paragraph.

(2) Where, in relation to any dentist, representations are made to the Tribunal under section 46 of the Act (disqualification of practitioners) that the continued inclusion of his name in a dental list would be prejudicial to the efficiency of general dental services, the name of the dentist shall not, except with the consent of the Secretary of State, be removed from the dental list until the proceedings in relation to those representations have been determined.

(3) Paragraph (2) shall not apply in the case of a dentist who has reached an age at which the following 1st April his name shall be removed from the dental list in accordance with regulation 9.

Section 11 Information about assistants

An FHSA shall send to the Board any information it receives under paragraph 35(5) of Schedule 1 (employment of assistants) within 7 days of the date of its receipt of the information.

Section 12 Information about associateship agreements

(1) Where an associateship agreement is made, written notice of the parties to that agreement and of the date on which the agreement was made shall be given to the FHSA within 7 days of the date on which the agreement was made.

(2) Written notice of any change in the parties to, or of the termination of, any associateship agreement shall be given to the FHSA within 7 days of the date of such change or termination.

(3) Any notice required by this regulation shall be given by the person or, if more than one, one of the persons, liable by virtue of the associateship agreement to provide the use of premises and facilities.

(4) An FHSA shall supply to the Board the information it receives under paragraphs (1) and (2) within 7 days of the date of its receipt of the information.

Section 13 Transfer of continuing care and capitation arrangements

(1) Subject to paragraph (2), where a dentist who is providing care and treatment for patients under continuing care arrangements or capitation arrangements ceases to have his name included in the dental list, the FHSA may, after consultation with the Local Dental Committee and with the agreement of the patients concerned, make arrangements with one or more dentists (whose names are included in the dental list) for the continuing care arrangements or capitation arrangements to be transferred to that or those dentists.

(2) Where a dentist has died and his name remains on the dental list in accordance with regulation 8(2), the FHSA shall, subject to the agreement of the patients concerned, make arrangements with the dentist appointed by the personal representatives of the deceased dentist for the care and treatment under any continuing care arrangements or capitation arrangements entered into by the deceased dentist to be provided by that dentist.

Section 14 Emergency dental services

(1) An FHSA may make arrangements with any dentist whose name is included in its dental list for the provision of treatment in urgent cases at a health centre when dentists in its locality or part of its locality, are not normally available to provide general dental services.

(2) In this regulation an “urgent case” means any circumstances in which, in the opinion of the dentist, a patient needs immediate treatment for an acute condition.

Section 15 Arrangements for emergency cover

It shall be the responsibility of an FHSA to make any arrangements that may be necessary to enable a salaried dentist whose name is included in its dental list to comply with his obligation under paragraph 6 of Schedule 1.

Section 16 FHSA patient information leaflets

An FHSA shall compile and, from 1st October 1992, make available to any person who may reasonably require one, a document about the provision of general dental services at any health centre in its locality (in this regulation called an “FHSA patient information leaflet”) which shall include the information specified in Schedule 6.

Section 17 Application for services

(1) A person aged 18 or over may apply to any dentist whose name appears in any dental list for general dental services by way of—

(a) care and treatment under a continuing care arrangement; or

(b) treatment on referral; or

(c) occasional treatment.

(2) Subject to paragraph (3), a person under the age of 18 may apply to any dentist whose name appears in any dental list for general dental services by way of—

(a) care and treatment under a capitation arrangement; or

(b) treatment on referral; or

(c) occasional treatment.

(3) A dentist may not enter into a capitation arrangement with a person during the month before he attains the age of 18.

(4) A person under the age of 18 may apply to a dentist for general dental services by way of care and treatment under a continuing care arrangement at any time during the month before he attains the age of 18 provided that he is not immediately before that date receiving care and treatment under a capitation arrangement with that dentist.

(5) A person who is receiving care and treatment under a capitation arrangement with a dentist may at any time after he attains the age of 17 apply for general dental services by way of care and treatment under a continuing care arrangement with that dentist from the date that he attains the age of 18.

(6) Application under this regulation shall be made in person at the practice premises unless a person is unable to attend those premises owing to illness or any other reasonable cause.

Section 18 Exercise of choice of dentists in certain cases

(1) An application to a dentist for general dental services shall be made—

(a) on behalf of any person under the age of 16, by either parent, or in the absence of both parents, the guardian or other person who has the care of the child;

(b) on behalf of any other person who is incapable of making such an application, by a relative or any person who has the care of such person; and

(c) on behalf of any person under the age of 18—

(i) in the care of an authority to whose care he has been committed under the provisions of the Children Act 1989 , by a person duly authorised by that authority;

(ii) in the care of a voluntary organisation by that organisation or a person duly authorised by them;

(d) on behalf of any person detained in a prison or a young offender institution, by the governor or, in the case of a contracted out prison within the meaning of section 84 of the Criminal Justice Act 1991 , the director or the controller, as the case may be.

(2) An application under paragraph (1) may not be made by the dentist to whom the application is made.

Section 19 Statement of Dental Remuneration

(1) The Secretary of State shall after consultation with such organisation as appears to him to be representative of persons providing general dental services make provision for each of the matters set out in column (2) of the Table below in a determination and each determination shall bear the number in column (1) of that Table which corresponds to the subject matter of the determination.

Table

(2) The Secretary of State shall publish the determinations in a statement called the Statement of Dental Remuneration.

(3) The Secretary of State—

(a) may amend the determinations, in whole or in part, after consultation with the organisation referred to in paragraph (1); and

(b) shall publish any such amendment in the Statement of Dental Remuneration.

Section 20 Approval of payments

(1) The Board shall, where it is satisfied—

(a) that a patient has been accepted by a dentist, other than a salaried dentist, under a continuing care arrangement or a capitation arrangement or for treatment on referral, make the payments which, in accordance with the Scale of Fees, fall to be made by it to the dentist in respect of such an arrangement or referral; or

(b) that a continuing care arrangement or a capitation arrangement has terminated or treatment on referral has terminated or has been completed, cease such payments to the dentist.

(2) The Board shall, where it approves a claim for remuneration made by a dentist, other than a salaried dentist, in respect of—

(a) care and treatment under a continuing care arrangement or a capitation arrangement;

(b) treatment on referral; or

(c) occasional treatment,

completed by the dentist, pay, in accordance with the Scale of Fees, the remuneration due to the dentist in respect of such care and treatment, treatment on referral, or occasional treatment.

(3) The Board shall, where it approves a claim for remuneration made by a dentist, other than a salaried dentist, in any case falling within paragraph 14 or 17(4) of Schedule 1 (inability of dentist to complete treatment), pay, in accordance with the Scale of Fees, and without prejudice to the provisions of the National Health Service (Dental Charges) Regulations 1989 , the remuneration due to that dentist, in respect of such care and treatment or occasional treatment as he has provided.

(4) The remuneration which it is the function of the Board to pay shall be paid in accordance with Determinations I, III, IV, VI, VII, VIII and IX of the Statement of Dental Remuneration.

(5) The FHSA—

(a) shall pay to a salaried dentist and a dentist providing emergency dental services remuneration in accordance with Determination II of the Statement of Dental Remuneration; and

(b) shall pay a dentist, other than a salaried dentist, remuneration in accordance with Determination V of the Statement of Dental Remuneration.

(6) In the case of orthodontic care and treatment the Board may make such payments on account as it considers appropriate pending completion of that care and treatment.

Section 21 Drugs

The fees payable by an FHSA to a dentist in respect of listed drugs supplied by him under paragraph 22(1) of Schedule 1 for use before a supply can otherwise be obtained under paragraph 23 of that Schedule shall be calculated in accordance with the provisions of the Drug Tariff.

Section 22 Recovery of overpayments

(1) Where the FHSA or the Board considers it has made a payment to a dentist owing to an error or in circumstances when it was not due, the FHSA or, as the case may be, the Board shall, except to the extent that the Secretary of State on the application of the FHSA or, as the case may be, the Board directs otherwise, shall draw that overpayment to the attention of the dentist and—

(a) where he admits the overpayment; or

(b) where he does not admit the overpayment but, the matter having been referred under regulation 7 of the National Health Service (Service Committees and Tribunal) Regulations 1992 for investigation, the FHSA, or the Secretary of State on appeal, decides that there has been an overpayment,

the amount overpaid shall be recoverable either by deduction from the remuneration of the dentist or in some other manner.

(2) Recovery of an overpayment under this regulation shall be without prejudice to the investigation of an alleged breach of the terms of service.

Section 23 Interpretation

In this Part of these Regulations, unless the context otherwise requires—

(a) “claimant” means a person claiming to be entitled to, or receiving, payments;

“erasure” means the erasure of a person’s name from the register;

“fees” does not include remuneration by way of salary;

“immediate suspension” means suspension by virtue of an order under section 30(3) of the Dentists Act 1984 except suspension which is terminated by the court under section 30(6) of that Act;

“interim suspension order” means an order under section 32 of the Dentists Act 1984 ;

“payment” means a payment under this Part of these Regulations;

“register” means the register kept under section 14 of the Dentists Act 1984 and “registration” means registration in that register;

“suspension date” means the date on which suspension of a person’s registration takes effect;

a reference to a direction or an order of the Health Committee is to a direction or an order of that Committee under the Dentists Act 1984 .

Section 24 Entitlement to payments

(1) Payments shall be made as provided for by this Part of these Regulations to a person whose registration is suspended by an interim suspension order or by a direction or an order of the Health Committee.

(2) Subject to paragraph (3), no payment shall be made to a person—

(a) whose registration has been suspended by a direction or an order of the Health Committee once he has received payments in respect of twelve months' such suspension, whether in respect of the same or a previous period of such suspension and whether or not those twelve months formed a continuous period;

(b) in respect of any part of a period of suspension where in the period of two years immediately preceding the suspension date he received no fees for the provision of general dental services.

(3) In calculating whether a person has received payments in respect of twelve months, suspension under paragraph (2)(a), no account shall be taken of any payment made in consequence of the suspension of his registration by a direction or order of the Health Committee more than five years previously.

(4) No payment shall be made to a person for a period (whether the whole or part of a period of suspension)—

(a) earlier than eight weeks before the date on which an application for payments is received by the FHSA, unless the FHSA is satisfied that the lateness of the application is due to illness or some other reasonable cause;

(b) during which his name is not included in the dental list of an FHSA;

(c) during which he is absent from the United Kingdom;

(d) for which he is entitled to any benefit under a contract of insurance against the risk of the suspension of his registration or of the circumstances which led to it or for which the FHSA is satisfied he could have been so entitled but for his failure to enter into such a contract or to pay any premium due under such a contract;

(e) during which he is serving a term of imprisonment;

(f) during which he is remanded in custody in connection with a criminal offence for which he is (then or later) convicted; or

(g) during which he is in breach of any condition of bail in connection with a criminal offence for which he is (then or later) convicted.

Section 25 Application for payments

(1) An application for payments shall be made to the FHSA in whose dental list the claimant’s name was included immediately before the suspension date; and where his name was then included in the list of more than one FHSA, the application shall be made to the FHSA by whom the larger or largest amount of remuneration was payable to him in the two years immediately preceding that date.

(2) An application for payments shall—

(a) be made in writing;

(b) be made by the claimant or, where he is incapable of applying, on his behalf; and

(c) contain or be supported by such information as the FHSA may reasonably require for the purpose of establishing the claimant’s entitlement to payments.

Section 26 Amount and time of payments

(1) An FHSA to whom an application for payments is made in accordance with regulation 25 shall, having made such enquiries as it considers relevant, if satisfied that the claimant is entitled to payments by virtue of regulation 24, determine that he shall, in respect of any period for which he is so entitled, receive payments which, subject to paragraphs (2) to (6), shall be of the following amounts—

(a) where his registration is suspended by a direction or an order of the Health Committee—

(i) £2,984 per month for each of the first six months for which payments are made to him, whether in respect of that or a previous period of such suspension and whether or not those six months form a continuous period, and

(ii) £1,492 per month thereafter;

(b) where his registration is suspended by an interim suspension order—

(i) where the period of interim suspension ends with an order for erasure or immediate suspension, £1,492 per month, and

(ii) in any other case, £2,984 per month.

(2) Where in the period of two years immediately preceding the suspension date the total amount of a claimant’s gross fees received for the provision of general dental services was less than £142,242, the amount of payments made to him shall (subject to any further reduction under paragraph (3)) be the same proportion of the amount otherwise payable in accordance with paragraph (1) as that total amount of fees is of £142,242.

(3) Where a claimant’s name was included in the dental list of an FHSA for a period of less than two years immediately preceding the suspension date the amount of payments made to him shall be the same proportion of the amount otherwise payable in accordance with paragraph (1) or paragraph (2) as the number of complete months in that lesser period is of 24.

(4) Where a claimant’s registration has been suspended by an interim suspension order or by a direction or an order of the Health Committee within a period of two years after the expiry of a previous period of any such suspension, the references in paragraphs (2) and (3) to the suspension date shall be taken as references to the suspension date as respects that previous period.

(5) Where the FHSA has to make a determination as to payments at a time when it does not know whether or not the period of a person’s interim suspension will end with an order for erasure or immediate suspension, or whether or not he will be convicted of a criminal offence, it shall make that determination as though his period of interim suspension did so end or he was convicted of the offence; but it shall review that determination and determine that a claimant is entitled to an appropriate payment of any arrears if subsequently that period does not so end or he is not convicted of the offence.

(6) Where the FHSA determines that a claimant is entitled to a payment, it shall inform the Board of the amount of that payment and authorise the Board to make the payment to the claimant.

(7) The Board shall make to the claimant any payments authorised by the FHSA.

(8) Payments under paragraph (7) shall be made monthly in arrears, and an appropriate proportion of the amount for a full month shall be paid where the claimant is entitled to a payment for part only of a month.

Section 27 Changes of circumstances

(1) A claimant shall notify the FHSA in writing immediately of any changes in his circumstances which he might reasonably be expected to know might affect his entitlement to, or the amount of, any payment made or to be made to him, and in particular of any erasure, immediate suspension, or termination of suspension, of his registration.

(2) Where the FHSA considers, whether or not following a notification under paragraph (1), that there has been a change of circumstances affecting a claimant’s payments it shall determine the adjustment as respects those payments which is appropriate to take account of that change and notify the Board accordingly.

Section 28 Overpayments

Where the Board considers that a payment has been made to a person owing to an error or in circumstances where it was not due it shall, except to the extent that the Secretary of State on the Board’s application directs otherwise, draw the overpayment to the attention of that person and—

(a) where he admits the overpayment; or

(b) where he does not admit the overpayment but, the matter having been referred under regulation 7 of the National Health Service (Service Committees and Tribunal) Regulations 1992 for investigation, the FHSA, or the Secretary of State on appeal, decides that there has been an overpayment,

the overpayment shall be recoverable either by deduction from that person’s remuneration or payments or in some other manner.

Section 29 Prior approval — patterns of treatment

(1) Where it appears to the Board that a dentist’s pattern of treatment in respect of all or any particular description of treatment, provided as part of general dental services in the locality of any FHSA, differs so substantially from the local or national pattern of treatment of other dentists as to warrant, in the opinion of the Board, further investigation, the Board may write to the dentist—

(a) giving details of his pattern of treatment in respect of all or any particular description of treatment and stating the extent to which it differs from the local or national pattern of treatment of other dentists;

(b) inviting him to submit to the Board in writing the reasons why his pattern of treatment differs to the extent identified by the Board under sub-paragraph (a) of this paragraph, from that local or national pattern; and

(c) giving notice to him that if—

(i) he fails to reply within 28 days; or

(ii) his reply discloses no reasonable grounds, in the opinion of the Board, for his pattern of treatment to differ, to the extent identified by the Board under sub-paragraph (a) of this paragraph, from that local or national pattern of treatment,

the Board may give a direction as mentioned in paragraph (2).

(2) Where the dentist fails—

(a) to reply within 28 days; or

(b) to disclose the reasonable grounds as mentioned in paragraph (1)(c)(ii),

the Board may direct the dentist that he may not, for a period of not less than 3 months nor more than 9 months specified in the direction, carry out treatment, or a description of treatment specified in the direction, without first obtaining approval of an estimate from the Board, but nothing in any such direction shall prevent the dentist, without such approval, from giving treatment following trauma or in an emergency, any private treatment or, in the course of any single consultation, treatment of a patient consisting of one examination and the taking of no more than two small radiographs, each of a size not exceeding 16 square centimetres.

(3) Where the Board gives a direction under paragraph (2), the direction shall inform the dentist of his right of appeal under regulation 19 of the National Health Service (Service Committees and Tribunal) Regulations 1992 and shall have no effect until the expiry of the period allowed by that regulation for the bringing of an appeal and, if such an appeal is brought, until the determination of the appeal.

(4) The Board shall not give a direction to a dentist under paragraph (2) in consequence of having written to him under paragraph (1) more than 12 months previously.

(5) Where the Board gives a direction to a dentist under paragraph (2), the Board shall not give a further direction under that paragraph in relation to that dentist in respect of any treatment specified in the earlier direction for a period of 9 months beginning with the expiry of the period specified in the earlier direction or, where the dentist appeals that earlier direction and the appeal is allowed, the date on which the appeal is allowed.

(6) Paragraphs (1) and (2) shall not apply to any treatment for which a dentist is remunerated in accordance with Section X (treatment under capitation) of Determination I of the Statement of Dental Remuneration dated 1st June 1991 and amended on 9th January 1992 and for which he receives no remuneration other than a capitation payment.

(7) Where, on the date on which the Board gives a direction under paragraph (2), the name of the dentist in respect of whom the direction is given is not included in any dental list the period specified in the direction shall not begin until the next day on which his name is again included in a dental list.

(8) For the purpose of computing the date on which the period specified in any direction given under paragraph (2) comes to an end, no account shall be taken of any day on which the dentist’s name is not included in any dental list.

(9) In this regulation—

(a) “pattern of treatment” means—

(i) the number of instances in which an item or items of treatment are provided by or on behalf of a dentist, or

(ii) the ratio which the number of instances relating to one such item bears to the number of instances relating to another such item;

(b) “local”, in relation to pattern of treatment, means throughout the locality of an FHSA; and

(c) “national”, in relation to a pattern of treatment, means throughout England and Wales.

Section 30 Surveys

The Board may conduct or commission surveys or other research relating to the provision of general dental services.

Section 31 Publication of documents

(1) An FHSA shall make available for inspection at its offices copies of:—

(a) the dental list;

(b) the local directory of dentists;

(c) these Regulations including the terms of service;

(d) the Statement of Dental Remuneration; and

(e) the list of listed drugs,

and keep them up-to-date.

(2) An FHSA shall make the documents referred to in paragraph (1) available for inspection at such other places in its locality as appear to the FHSA to be convenient for informing all persons interested.

Section 32 Service of documents

Any notice or other document which an FHSA is required or authorised by these Regulations (including the terms of service) to give or send to a dentist may be given or sent by delivering it to the dentist or by sending it by post to the dentist at his usual or last-known address.

Section 33 Signatures

Any signature by a dentist required by these Regulations (including the terms of service) shall be handwritten in ink with his initials, or forenames, and surname in his own handwriting, and not by means of a stamp.

Section 34 Revocations

The Regulations specified in column (1) of Schedule 7 are hereby revoked to the extent specified in column (3) of that Schedule.

Section 35 Transitional provisions

Until 1st July 1992 paragraph 17 of Schedule 1 shall have effect as if in sub- paragraph (2) of that paragraph—

(a) head (a) were omitted;

(b) in head (k) the words “or the removal of the fractured portion of a natural crown, where its dissection from supporting soft tissues is necessary prior to the provision of a permanent restoration” were omitted; and

(c) in head (s) for “(a)” there were substituted “(b)”.

Section 1

Interpretation.

Section 1 Interpretation

In these terms of service, unless the context otherwise requires—

(a) “ the Regulations ” means the National Health Service (General Dental Services) Regulations 1992;

(b) any reference to a numbered regulation is a reference to the regulation bearing that number in the Regulations;

(c) any reference to a numbered paragraph is a reference to the paragraph bearing that number in these terms of service, and any reference in a paragraph to a numbered sub-paragraph is a reference to the sub-paragraph bearing that number in that paragraph; and

(d) any reference to a numbered Schedule is a reference to the Schedule to the Regulations bearing that number.

Section 2

Incorporation of provisions of regulations etc.

Section 2 Incorporation of provisions of Regulations

Any provisions of the following affecting the rights and obligations of dentists shall be deemed to form part of the terms of service—

(a) the Regulations;

(b) so much of Part II of the National Health Service (Service Committees and Tribunal) Regulations 1992 as relates to—

(i) the investigation of questions arising between dentists and their patients, and other investigations to be made by the dental service committee, the joint services committee and the denture conciliation committee, and the action which may be taken by the FHSA as a result of any such investigation;

(ii) any decision of the Secretary of State (whether on appeal or otherwise) in connection with any investigation referred to in head (i) of this sub-paragraph or with any decision of the Board; and

(iii) the investigation of record keeping;

(c) regulations 4(4) and 6(2) of the National Health Service (Dental Charges) Regulations 1989 .

Section 3

General dental services.

Section 3 General dental services

(1) In providing general dental services for any person under the Regulations, a dentist shall provide–

(a) for a person aged 18 or over with whom he has entered into a continuing care arrangement, care and treatment under that arrangement; or

(b) for a person under the age of 18 with whom he has entered into a capitation arrangement, care and treatment under that arrangement.

(2) A dentist may provide general dental services under the Regulations by way of–

(a) treatment on referral for a person who is receiving dental services from another dentist (whether or not pursuant to the Act); or

(b) occasional treatment for any person–

(i) who is receiving care and treatment with another dentist under an arrangement mentioned in sub-paragraph (1)(a) or (b); or

(ii) who does not wish to enter into an arrangement mentioned in sub-paragraph (1)(a) or (b); or

(iii) with whom he is not prepared to enter into an arrangement mentioned in sub-paragraph (1)(a) or (b); or

(iv) who is referred to him under paragraph 18(1).

Section 4

A continuing care arrangement.

Section 4 A continuing care arrangement

(1) A dentist who accepts a person for care and treatment under a continuing care arrangement shall—

(a) at the time at which he accepts the patient, provide him with the information about care and treatment under general dental services which is set out in Schedule 3 and with a form of acceptance supplied for that purpose by the FHSA which shall specify—

(i) the name of the patient;

(ii) the name of the dentist;

(iii) particulars of the places where the patient will receive care and treatment; and

(iv) the telephone number at which the dentist or a deputy may be contacted during normal surgery hours, or at other times in an emergency if different;

(b) at the time of his first examination of the patient, provide the patient with a plan for treatment on a form supplied for that purpose by the FHSA which shall specify—

(i) details of the care and treatment (if any) which in the opinion of the dentist, at the date of that examination, is necessary to secure and maintain the oral health of the patient;

(ii) the approximate period following which a further examination is recommended by the dentist;

(iii) his estimate of the NHS charge, if any, in respect of that care and treatment; and

(iv) any proposals he may have for private care and treatment as an alternative to the care and treatment proposed under general dental services, including particulars of the cost to the patient;

(c) where at any time during the currency of a continuing care arrangement—

(i) the circumstances specified in sub-paragraph (2) apply; or

(ii) in the opinion of the dentist, the care and treatment included in a plan for treatment provided under head (b) or this head of this sub-paragraph needs to be varied,

provide the patient with a new plan for treatment or, as the case may be, a revised plan for treatment in accordance (except as to the time of its provision) with head (b) of this sub-paragraph;

(d) complete the care and treatment (if any)—

(i) which is referred to in head (b)(i) of this sub-paragraph; and

(ii) where sub-paragraph (2)(a) to (c) do not apply, any care and treatment which is, in the opinion of the dentist at the date of any examination of the patient, necessary to secure and maintain his oral health;

(e) provide the patient with emergency cover in accordance with paragraph 6; and

(f) repair or replace, in accordance with paragraph 7, any restoration which requires repair or replacement.

(2) The circumstances referred to in sub-paragraph (1)(c)(i) are that—

(a) the patient requests a new plan for treatment; or

(b) the patient and the dentist have agreed that all or part of the treatment which is necessary to secure and maintain oral health is to be provided privately; or

(c) the care and treatment which is to be provided includes any of the items of treatment mentioned in sub-paragraph (3).

(3) The items of treatment referred to in sub-paragraph (2)(c) are—

(a) non-surgical treatment of chronic periodontal diseases which is likely to involve three or more visits;

(b) provision of three or more permanent fillings;

(c) endodontic treatment;

(d) provision of a veneer, inlay, pinlay, crown or bridge;

(e) any surgical treatment, other than the extraction of teeth;

(f) the extraction of—

(i) more than two teeth, or

(ii) any tooth which, in the opinion of the dentist, is likely to present special difficulty;

(g) provision of general anaesthesia or sedation in connection with any item of treatment;

(h) provision of a prosthetic appliance;

(i) orthodontic care and treatment.

(4) Where a dentist accepts the transfer of a continuing care arrangement, he shall provide the patient with the information specified in sub-paragraph (1)(a)(ii) to (iv) and assume the obligations set out in sub-paragraph (1)(c) to (f).

(5) Where a dentist is informed that the dentist to whom a patient has been referred under paragraph 12 has died and is aware that the particular care and treatment for which the patient was referred has not been completed, he shall inform the patient and refer him to another dentist in accordance with paragraph 12 for the completion of that care and treatment.

(6) Where a dentist accepts a person, who is detained in a prison or a young offender institution, for care and treatment under a continuing care arrangement, he shall at the time at which he accepts the patient examine him.

Section 5

A capitation arrangement.

Section 5 A capitation arrangement

(1) A dentist who accepts a person for care and treatment under a capitation arrangement shall—

(a) at the time at which he accepts the patient, examine him and chart the patient’s decayed, missing or filled teeth on the form supplied for that purpose by the FHSA;

(b) at the time of his first examination of the patient, provide the patient with the information about care and treatment under general dental services which is set out in Schedule 3 and with a form of acceptance supplied for that purpose by the FHSA which shall specify—

(i) the name of the patient;

(ii) the name of the dentist;

(iii) particulars of the places where the patient will receive care and treatment; and

(iv) the telephone number at which the dentist or deputy may be contacted during normal surgery hours, or at other times in an emergency if different;

(c) at the time of his first examination of the patient, provide the patient with a plan for treatment on a form supplied for that purpose by the FHSA which shall specify—

(i) details of the care and treatment (if any) which in the opinion of the dentist, at the date of that examination, is necessary to secure and maintain the oral health of the patient;

(ii) the approximate period following which a further examination is recommended by the dentist; and

(iii) any proposals he may have for private care and treatment as an alternative to the care and treatment proposed under general dental services, including particulars of the cost to the patient;

(d) where at any time during the currency of a capitation arrangement—

(i) the circumstances specified in sub-paragraph (2) apply; or

(ii) in the opinion of the dentist, the care and treatment included in a plan for treatment provided under head (c) or this head of this sub-paragraph needs to be varied,

provide the patient with a new plan for treatment, or as the case may be, a revised plan for treatment in accordance (except as to the time of its provision) with head (c) of this sub-paragraph;

(e) complete the care and treatment (if any)—

(i) which is referred to in head (c)(i) of this sub-paragraph; and

(ii) where sub-paragraph (2)(a) to (c) do not apply, any care and treatment which is, in the opinion of the dentist at the date of any examination of the patient, necessary to secure and maintain his oral health; and

(f) provide the patient with emergency cover in accordance with paragraph 6.

(2) The circumstances referred to in sub-paragraph (1)(d)(i) are that—

(a) the patient requests a new plan for treatment; or

(b) the patient and the dentist have agreed that all or part of the treatment which is necessary to secure and maintain oral health is to be provided privately; or

(c) the care and treatment which is to be provided includes any care and treatment for which the dentist is remunerated otherwise than in accordance with Section X (treatment under capitation) of Determination I of the Statement of Dental Remuneration dated 1st June 1991 and amended on 9th January 1992.

(3) Where a dentist accepts the transfer of a capitation arrangement he shall provide the patient with the information specified in sub-paragraph (1)(b)(ii) to (iv) and assume the obligations set out in sub-paragraph (1)(d) to (f).

(4) Where the dentist is informed that the dentist to whom a patient has been referred under paragraph 12 has died and is aware that the particular care and treatment for which the patient was referred has not been completed, he shall inform the patient and refer him to another dentist in accordance with paragraph 12 for completion of that care and treatment.

Section 6

Emergency cover.

Section 6 Emergency cover

(1) Subject to regulation 15, in providing emergency cover under a continuing care arrangement or a capitation arrangement, a dentist shall make reasonable arrangements to secure that a patient requiring prompt care and treatment will receive such care and treatment as soon as appropriate either from himself or from another dentist.

(2) For the purposes of sub-paragraph (1) a patient requires prompt care and treatment where, in the opinion of a dentist—

(a) the patient’s oral health is likely to deteriorate significantly without such care and treatment; or

(b) the patient is in severe pain by reason of his oral condition;

but the provision of emergency cover does not include any obligation to repair or replace dentures.

(3) The obligation to provide emergency cover begins on the date on which the patient and the dentist enter into the continuing care arrangement or the capitation arrangement and ceases when that arrangement lapses or is terminated.

Section 7

Repair or replacement of restorations.

Section 7 Repair or replacement of restorations

(1) Subject to sub-paragraph (3), in repairing or replacing a restoration in the course of a continuing care arrangement, a dentist shall repair or replace at no charge to the patient any restoration specified in sub-paragraph (2) which he or another dentist, acting on his behalf or from whom the continuing care arrangement was transferred, has provided under general dental services—

(a) under that continuing care arrangement; or

(b) under a capitation arrangement with or transferred to the dentist, where on termination of that arrangement the patient has immediately entered into the continuing care arrangement.

(2) The restorations referred to in sub-paragraph (1) are any filling, root filling, inlay, pinlay or crown which, within 12 months of the date on which it was provided, has to be repaired or replaced to secure oral health.

(3) A dentist shall not be under an obligation to repair or replace any restoration under sub- paragraph (1) where—

(a) within 12 months of the date on which the restoration was provided—

(i) a dentist has provided private treatment, or

(ii) another dentist has provided occasional treatment otherwise than of a temporary nature,

on the tooth in respect of which the restoration was provided;

(b) the dentist advised the patient at the time of the restoration and indicated on any plan for treatment provided to the patient in accordance with paragraph 4(1)(b) or (c) or 5(1)(c) or (d) and on the patient record—

(i) that the restoration was intended to be temporary in nature; or

(ii) that, in his opinion, a different form of restoration was more appropriate to secure oral health but, notwithstanding that advice, the patient insisted on the restoration which was provided;

(c) in the opinion of the dentist, the condition of the tooth in respect of which the restoration was provided is such that the restoration cannot satisfactorily be repaired or replaced and different treatment is now required; or

(d) the repair or replacement is required as a result of trauma.

(4) The obligation to repair or replace any restoration under sub-paragraph (1) begins on the date on which the patient and the dentist enter into the continuing care arrangement and ceases when that arrangement lapses or is terminated.

Section 8

Duration and extension of a continuing care arrangement.