Take Careful Note
The NHS dental system is challenging
A course of treatment has a capped cost meaning often delivering the care puts you under time pressure. As dentists we’ve magically become 4% more efficient year on year for the last few years, or so our paymasters would convince themselves. The reality is we’ve accepted successive pay cuts and those have led to reduced profits. Now you have to keep a very careful eye on time to ensure you’re not drifting from just about making money, to losing it. Now for many “profit” is a dirty word when associated with our National Health Service, however if we can’t pay the team it’s not long before the service ceases to be viable. Successive “efficiencies” have led to underinvestment in practices and the short term fixes are really beginning to take their toll.
Soft splints pay well
As we work away under enormous pressure, we occasionally get those items of treatment that are remunerated well. One such example that springs to mind is the soft splint. As a band 3 treatment item it involves far less preparation than most others, and the laboratory fee isn’t too bad either. This has led to this particular item being singled out for careful scrutiny by the NHS. Practitioners regularly approach the LDC having been invited to contract review meetings where they’re expected to repay the money given by the NHS for provision of these appliances. Why? you may ask. Have these singled out practitioners been pretending to provide the splints? Have they been providing them to patients who don’t exist? The answer, thankfully, is almost always no. Usually they are “outliers” on the statistics. They’ve provided one or two more splints than average and flagged on the BSA system. Many practitioners provide splints privately to paying patients, therefore if you’re in a mainly exempt are you’re more likely to look like you’re potentially over prescribing.
This then results in net payback to the NHS for the work you’ve actually done!
When the BSA examine a set of records, note records NOT patients, they are looking for “sufficient justification” for a particular treatment item. If, in their opinion, you’ve not given enough information for them to deem it a band 3 claim – simply ticking band 3 is not deemed sufficient – then they will downgrade your claim to something else. This then results in net payback to the NHS for the work you’ve actually done!
What are the BSA looking for?
It seems that when considering if a splint is justified they’re expecting a few things to be present in the notes.
- Diagnosis eg. TMJPDS to justify some treatment.
- Consideration of other treatment options, why you’ve selected this option, and the patient consent.
- Notes that the appliance has been fitted, not, for example, left at reception for the patient to collect.
- A copy of the laboratory prescription.
- Follow up to see if the symptoms have resolved, and any further action you’ve taken.
If you find yourself in this situation it’s really important you contact the LDC. We are happy to look over your notes and express a peer opinion as to whether the treatment appears justified. Remember, it may be that the notes are poor, or you missed sending them some items, but the treatment was actually appropriate and there is evidence it was provided. The LDC will support you through any NHS England meetings, and help you make the necessary changes to avoid similar situations in future.
Remember – notes are the easiest way to demonstrate you’ve fulfilled your contractual obligations to the NHS to make a claim – ensure they’re complete and contemporaneous.