Unto the Breach

Breach Notice Issued

For many of us a breach notice is something we dread.  It can be related to under-delivery of  of UDA’s, or related to other areas of the contract such as quality of care, infection control, or opening hours.  A practitioner approached the LDC having received a breach notice following a BSA audit.  This breach notice was to “reclaim money from inappropriate claims” on the basis of “poor clinical quality”.

The dentist reviewed the report from the BSA, outlining the failures in the clinical notes regarding certain band 3 claims.  These claims were then deemed invalid and the quality of the treatment called into question.  On the basis of this report NHS England issued a breach notice and wanted the money for these claims returning.

The practitioner disagreed with the findings

Appealing the Breach Notice

The practitioner disagreed with the findings.  There were a couple of administrative errors in the notes, but substantively the practitioner felt the claims were justified in the record.  A couple of the items criticised had been missed off the print outs due to the software system they used, meaning they had been inadvertently unavailable to the BSA at the time of the report.  It’s important to check that what you send the BSA is the complete record, don’t rely on administrative staff solely, we can all make mistakes.  This can make life easier down the line.

The practitioner contacted the LDC who looked over the clinical notes, alongside the report.  The LDC agreed with the practitioners perspective and helped them to appeal the breach notice.  Of particular note the practitioner did not think the standard of clinical care fell below the expected level.  The performers in question had not been through performance procedures with NHS England so their standard of care had not properly been considered, nor had they had chance to defend themselves.  NHS England considered the appeal and withdrew the breach notice, without any further meetings.

If you get a breach notice, which you do not agree with, don’t accept it.  Contact the LDC, we’ll be happy to meet with you and look over the documentation, supporting you in writing an appeal.