GDS requirements in Scotland

The GDS regulations in Scotland - the National Health Service (General Dental Services) (Scotland) Regulations - require dentists (and dental bodies corporate) providing GDS care (contractors) to hold their own contract with the Health Board (HB). Therefore, the associate also has their own contract with a health board to provide NHS care. The associate will be listed on sub-part A of the first part of the health board’s dental list. NHS patients are registered directly with the associate, under the associate’s list number.

Locums

Although this is a widely used term, the regulations do not use the term locum; a locum is referred to as a deputy or an assistant. An associate intending to engage a deputy or an assistant to provide cover should ensure that the dentist is either on sub-part A of the first part (deputy) or the second part (assistant) of the HBs dental list.

We believe that is reasonable for an associate to ask the practice owner for help in finding a suitable locum. Our view is that if the practice owner is involved in finding a locum, it is reasonable for the practice owner to charge the associate a reasonable ‘admin fee.’

If an associate has difficulty in finding a suitable locum, this should be brought to the practice owner’s attention as soon as possible. The parties should then work together to find a suitable solution.

If a contractor intends to be absent for more than 28 days, the health board must be informed who will be responsible of their patients. If the associate engages an assistant and the absence is likely to exceed eight weeks, permission must be given by the HB for the assistant to continue to work past the eight weeks.

Deputies are appointed, for example, to ensure continuity of patient care when a contractor is absent from a practice. The contractor’s patients are transferred to the deputy, albeit temporarily.

Assistants must have joined the second part of the health board’s dental list, but patients cannot be registered with them. They must be employed – usually by the practice owner. An associate is unlikely to engage a locum as an assistant because the practicalities of managing and remunerating an employed assistant will be complex.

Assistants can join the NHS superannuation scheme. The employing contractor should check with the Scottish Public Pensions Agency that the assistant is appropriately registered and has not opted out.

Assistants are not entitled to any payments, grants and allowances set down in the SDR, except for commitment payments. Commitment payments due to an assistant included on the second part of the dental list should be claimed by the contractor (dentist or DBC), who’s list number the assistant works under, and passed in full to the assistant.

Leaving a practice

The associate must provide the HB with three months’ notice if they wish to leave the dental list (give up their list number). The associate is also required to provide three months’ notice to any patient that may need to deregister as a result leaving.

Non-fee payments

Several GDS payments are payable in specific circumstances. For example:

Seniority payments, which compensate for an age-related decline in earning capacity. These payments are usually split in the same way as treatment related income to compensate the practice owner for a reduced contribution from the associate.
Postgraduate course allowances, which contribute towards practice overheads that continue when the associate is absent. Our view is that if a course is attended during normal working hours, the allowance should be shared but it should be retained in full by the associate if the course is outside normal working hours.
Long-term sickness payments are payable after four weeks’ sickness and are paid for up to a maximum of 22 weeks in any sickness absence period. While this payment could be shared, between the practice owner and associate, to provide some income to the practice and encourage the practice owner to keep the job open for the associate’s return. However, if the associate appoints a locum to cover their absence and maintains a similar income to the practice, we believe the associate should retain the sickness payments. If an associate is off sick with a disability related illness, advice from the BDA should be sought.
Maternity, adoption and paternity arrangements – our view is that associates should ideally receive their NHS maternity leave payments in full; but they are also responsible for the patients on their list. Associates should either appoint a locum or arrange for another dentist at the practice to look after their list. If it is not possible to arrange cover, though, they should discuss how this affects the practice. Maybe the associate would need to compensate the practice owner, but the practice owner must exercise caution to avoid discrimination claims; demands that leave the associate unable to afford to take leave could be seen as discriminatory. Generally, the capitation payments should go to the dentist providing cover; the only other source of revenue the associate might have whilst on leave is probably the NHS parental leave payments. Any further financial arrangement agreed should not leave the associate with nothing of their NHS parental leave payments. Perhaps practices should ask for no more than the agreed percentage apportionment for normal NHS payments?