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21st January 2015

See through!

Lie. Pinocchio with a long nose.Following on from the recent blog on being frank and honest with patients, recent news articles have prompted the need to highlight transparency too. Although many of us, as individual practitioners, make big efforts to keep patients fully informed about prices and treatment choices, as a profession we seem to be failing.

The consumer magazine Which? has published a survey of 1,000 people in England and found that one in five were overcharged for treatment, while 50 per cent said that no price list for treatment was displayed. Quite rightly Which? said that dentists should be "upfront with patients about costs". In addition, it points out that patients should only be asked to pay one charge for a course of NHS treatment, even if that means several visits to the dentist, yet 19 per cent of NHS patients said they paid more than once for the same course of NHS treatment. There was also evidence of confusion about how NHS and private treatments differ.

Without wishing to be smug, because my previous blog was concerned with the use of ‘secret shoppers’ by the press, Which? undercover researchers visited 25 dental practices in England, and rated 12 of them as poor or very poor at explaining both NHS and private costs. Which? Executive Director, Richard Lloyd, said that some dentists were failing to provide clear information: "A visit to the dentist is an essential health check for millions of people across the country. Most of us will need dental treatment throughout our lives and it's important that when that happens people feel clear about the nature of the treatment and what it will cost upfront.” He is absolutely right to be concerned about this.

Up front and open

NHS England provides all dental practices with posters, that they should clearly display in the waiting area, detailing NHS banding and charges. This is a contractual obligation. The CQC expects private charges to be displayed and made clear in the same way.

General Dental Council Standards expect us to provide all the information that patients need to make proper choices, and this includes costs as stated in Section 2.4 – Give patients clear information about costs. This is expanded into several sections dealing with displaying basic fees in waiting areas and giving clear information on websites. Estimates for both NHS and private treatment plans should be for the total amount of work required to reach good oral health, and not broken up in such a way that patients are confused about how much they may end up paying over a period of time.

These tenets are outlined in the Quality Compliance Systems Treatment Planning Policy and Procedure which gives a comprehensive guide to treatment planning and giving estimates. The QCS Fees Policy and Procedure goes into more detail:

  • The practice must be transparent in the information about fees, who is contributing (and how much) if a third party is involved, and what the terms and conditions may be.
  • Most complaints and disputes in dental practice involve problems with payment and fees. The best way of avoiding these disputes is to be open and honest with patients and give them as much information about fees and payment as possible.

There is also the issue of mixing NHS and private treatment. Patients should be given full information on proposed treatment and costs. Specifically:

  • Patients should be informed at all times if they are being treated under the NHS or privately.
  • Where NHS patients opt to pay for additional private treatment, they must be made aware if the treatment planned is also available under the NHS and of the exact breakdown in costs.

Patients should not be pressured into taking treatment options. Wherever possible they should be given time to consider, and under no circumstances should they be given the impression that a treatment is only available privately if it is also available under NHS regulations.

What’s the worst that can happen?

OK, problems occur when we start to think about ourselves in a marketing context because we want to sell particular treatments or, worse, don`t suggest certain treatments because it is financially not to our benefit to do so. Many complaints are being generated from poor periodontal care. The current NHS contract makes it difficult to provide cost-effective gum treatment. However, we should all be aware of the GDC Standards which say (Section 1.7.1) “You must always put your patients’ interests before any financial, personal or other gain”.

You must treat every patient with respect, with honesty and with transparency. If not, you are inviting trouble, as one dentist recently did. They told popular journalist, Antonia Hoyle, that she could not receive periodontal treatment under the NHS and she was quoted for private treatment with a hygienist. However, as she found out, that is incorrect: the treatment falls into the second tier of NHS dentistry’s three-band treatment and should have been offered. If a treatment is available on the NHS, to deny that treatment and offer it only as a private option is a breach of contract. She does say in her article in The Telegraph: “Because the majority of NHS dentists also offer their services privately, the temptation either to tell patients NHS treatment is not available or to persuade them to choose a better, private service – under which prices are not regulated – must be enormous.”

Transparency is the best policy. There are a number of examples of poor practice in this area discussed in the full article, including one patient whose GDP refused to provide three crowns under one course of treatment. These are all examples of behaviour in breach of contract and the standards expected by the CQC and the General Dental Council.

As I said in a previous blog, it’s best to approach every patient as though they are a journalist, a clinical negligence barrister or your own mum – whichever of these you are most afraid of!

Dr John Shapter – QCS Expert Dental Contributor

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