Barriers to care are a daily feature of working in the community dental services (CDS). All NHS dentists are facing increasing pressures of bureaucracy and administration, but in the CDS, we are facing one extra level of stress: exemption status.
This has become a real headache for us as dental professionals, and can be a nightmare for our patients.
We've highlighted that more than 40,000 dental patients a year in England are being fined £100 from an automated system. I've see it happen, many patients are not deliberately trying to 'fraud' the NHS, they are just struggling to understand a very complex system of declarations.
In England, a 'Practice Record Form – Patient Declaration' (PR form) must be signed by the patient or their representative for each new course of treatment. The first part is about consent, allowing the dentist to examine the patient and give them the care and treatment they are willing to have done under the NHS.
The second part of the form is an agreement that allows the NHS BSA or other bodies to examine the patients or their dental records. Patients must declare that all the information on the form is correct and complete and if not, they may be fined.
For those who wish to claim for free or reduced costs for their NHS dental care, there is a list on the form of qualifying benefits. There is a warning on the form that says that checks are done to ensure that you are entitled to reduced/free costs and if you are incorrectly claiming, you may be fined up to £100, in addition to the cost of the dental services you've received.
In theory, this all sounds reasonable – patients shouldn't be claiming if they aren't entitled. But the day to day reality for some of these patients is more complex.
Should we really expect every patient to be able to check they are definitely, absolutely, eligible. And particularly, when they are being asked to fill out a complex form, sometimes on the spot, and remembering all of their financial affairs and legal status?
In the community service, we see a lot of vulnerable patients. People with learning disabilities. People with dementia. Can these people, or their representatives, feel confident they can tick that box, or are they going to be frightened by the thought of a fine (particularly for those who are living on reduced finances), and not bother? Or feel mortified that they might be labelled as 'fraudulent'?
Carers are often unwilling to make a declaration on behalf of the patient, because they don't know, or don't have access to this type of information.
Myself and colleagues are spending valuable clinical time, trying to ensure that if patients are exempt, they are claiming correctly and won't be fined.
Does this make them at risk of being 'excluded, discriminated against and left behind?
I say yes, because I've seen it happen.
Is this acceptable? I say no. Because I've seen what happens when patients are left behind.
And I've seen this happen daily, but I wanted to find out the scale of the problem. Working with the BDA, we contacted other CDS in England and asked them if they were experiencing the same issues. Dentists from 17 services shared their concerns, and many echoed what I'd been experiencing.
We took these issues to NHS BSA and NHS England and it feels like they are listening. We invited members of the NHS BSA to attend a CDS clinic, so they could see first-hand the difficulties we and our patients were experiencing with the system.
There is no easy solution to this.
We want a simpler scheme, whereby patients (or their carers) can feel more at ease accessing the care they need regardless of their financial situation.
But we know that patient charge revenue is essential for helping to fund the CDS and with our budgets being squeezed, and we can't afford to lose any potential income.
We'll continue to push for better for our patients – no-one should feel afraid or unable to access their care they need.
Vice-Chair, BDA England Community Dental Services Committee
A tax on teeth? Patients charges in NHS dental services
We've said that children and vulnerable patients in England risk losing out on access to free NHS dental treatment because of poor promotion and signposting of charge exemptions. Polling shows that just 74% of parents are aware that routine check-ups are free for children aged under 18. Read our report.