Many dental patients 'given wrong price info'

Around 500,000 people a year may be wrongly told they cannot have NHS dental treatment, says a new report by the Office of Fair Trading. This could lead to them paying more for private treatment.

The report has featured heavily in today’s newspapers, and provides a top-to-bottom examination of where dental services need to be reformed. The OFT found that most dental patients are largely satisfied with the services provided by their dentist, although there are several areas of concern. These include a lack of clear information about the dental treatments patients receive and the existence of regulations that prevent new dentists from starting new practices, thereby limiting patient choice. The report also looked at the private sector, and found that around one in five patients who started a payment plan to cover dental costs felt pressured into doing so.

Why have dentists been examined?

The Office of Fair Trading is a government department set up to protect consumers by ensuring that markets operate openly and fairly. As well as overseeing financial services, the OFT monitors certain health services, including dentistry.

In response to several issues the OFT launched a study into NHS and private dentistry in September 2011. These issues included:

concerns about the accuracy of pricing and treatment information provided to patients, potentially causing them unnecessary costs
the high number of dentistry complaints reported to Consumer Direct (a consumer feedback service operated by the OFT)
concerns about patients not being able to access dental services directly (such as seeing a dental hygienist), and instead having to access services through their dentist first, incurring additional charges by doing so

What did the OFT find?

The report looked both at patients’ everyday experiences when visiting the dentist and at the wider problems with the way the dental industry is structured.

To look at patient experience, the OFT did a market survey of 3,400 people in England, Wales, Scotland and Northern Ireland and found that many patients were provided with insufficient information. In particular:

39% reported that NHS prices were not displayed
56% reported that private charges were not displayed in practices that provide some private dental work
82% of patients who received treatment which they had to pay for did not receive a written treatment plan

The OFT also estimated that approximately 500,000 patients a year may be told incorrectly that they are not entitled to NHS treatment and are liable to pay private charges for their treatment. It was also reported that 20% of patients who joined a dental payment plan to pay for private dental treatment felt that they were put under pressure by their dentist to do so.

The OFT found the procedure for raising complaints to be complex, and left many patients without adequate compensation. The OFT states in the report that, in their opinion, there is no reason to restrict patients’ access to dental care professionals such as dental hygienists.

The OFT found that most NHS dentistry contracts have been granted on an indefinite basis. Consequently, only a few new contracts are available each year. The OFT identifies this as a barrier both to the establishment of new practices and to the expansion of successful ones.

What does the OFT recommend?

The OFT has made several recommendations, and says that:

NHS commissioning bodies, the General Dental Council and the Care Quality Commission should enforce existing legislation to ensure that patients are provided with clear, accurate and timely information. In particular, there is a need for clear accurate information on prices and available dental treatments.
Patients should be allowed to make appointments to see dental care professionals such as hygienists directly, without the need for a referral from a dentist.
The NHS dental contract should be redesigned to allow new dental practices to be set up and existing practices to expand. This will increase competition and patient choice.
The complaints procedure should be modified to make it simpler, easier and less time-consuming.
A code of practice should be set up to cover the sale of dental payment plans.

How do NHS dental charges work?

Dentistry is one of the few NHS services you have to pay for, although your contributions towards a particular course of treatment are capped. These are capped at three different levels, depending on the NHS treatments that your dentist thinks are necessary for good oral health and its maintenance. The three different treatment levels are:

band 1 treatments (£17.50) – this covers examination, diagnosis, advice about how to prevent future problems, a scale and polish if needed, application of fluoride varnish or fissure sealant
band 2 treatments (£48.00) – this covers the treatments listed above plus fillings, root canal work and extraction (removal)
band 3 treatments (£209.00) – this covers the treatments listed above plus crowns, dentures and bridges

Only one charge applies for each course of treatment, even if multiple appointments are required. For example, if you visit a dentist who thinks you need both a band 2 treatment (such as an extraction) and a band 3 treatment (such as a crown) you would only be charged for the highest band, meaning a total of £209 for the two treatments. Even if these treatments are given at two separate appointments they should still not exceed £209 if they are given as part of a single course of treatment.

However, free dental care is available if you are:

aged under 18 years
aged under 19 years and in full-time education
pregnant or have had a baby in the previous 12 months
staying in an NHS hospital
an NHS hospital dental service outpatient
on Income Support, income-related Employment and Support Allowance, income-based Jobseeker’s Allowance, Pension Credit guarantee credit or you are entitled to an NHS tax credit exemption certification or an HC3 certificate

For more information see our information on free dental treatment.

How can I give feedback on my dental treatment?

You can use the NHS Choices site to leave feedback on the dental services you have received, both negative and positive. To do so simply use our dentist finder and enter relevant details to find your dentist. You can then give detailed feedback on how you rate your treatment, find other nearby dentists or read what other people have experienced.

How can I complain about my dental treatment?

If you want to raise a complaint, you should first contact the dental practice where the treatment was performed. If a complaint is not adequately resolved by the dental practice, complaints about NHS dental treatment are handled by:

primary care trusts and the Parliamentary Health Service Ombudsman, in England
NHS boards and the Scottish Public Services Ombudsman, in Scotland
local health boards and the Public Service Ombudsman for Wales, in Wales
The Health and Social Care Board and Northern Ireland Ombudsman, in Northern Ireland

The Dental Complaints Service deals with complaints about private dental treatment across the UK.

The General Dental Council deals with fitness to practise cases (both NHS and private).

If a course of treatment comprised both NHS and private dental work a complaint is handled by the relevant ombudsman and the Dental Complaints Service.

NHS dental treatment is guaranteed against failure for 12 months. There is no equivalent guarantee for private dental treatment, although the Supply of Goods and Services Act 1982 covers dental work and means that work should be carried out with care and skill, and that dentures, fillings and crowns, for example, should be of an acceptable standard.