Your NHS contractual obligations

De-registering patients

You will need to deregister your NHS patients, either with three months' written notice if you do not have the patient's agreement, or immediately with the patient's agreement; as long as the appropriate form from the HB is filled in and signed by both the patient and the dentist consenting to this.

Practices with many patients may find it easier to give them all three months' notice rather than seek agreement from every single patient.
At the same time, a contractor should advise the HB, in writing, that such notice has been given, and give details to the HB of any case and treatment which it has been agreed the patient will receive and is outstanding at the date of the notice, including any arrangement made for completion of that care and treatment.

A GP200 Form ‘Notice of withdrawal from a capitation arrangement’ should be completed for each patient. The Form is available from the relevant HB.

Our template letters are designed to help you deliver this news to patients in an appropriate way. When communicating with patients, it is essential that you are not negative about the quality of NHS clinical care.

Letter template: Less than Three months’ notice for patients of move from NHS to private practice, Scotland
Letter template: Three months’ notice for patients of move from NHS to private practice, Scotland

Mention can be made of the difficulties you perceive with government policy, but do not major on this. It is not appropriate, and your patients will be more concerned about the care they can receive and the cost to them. Avoid mentioning the following as patients will not be sympathetic:

Any desire to achieve higher earnings
Need to comply with increasing GDS regulations
High costs and expenses
High levels of stress and long hours.

Instead, you may wish to mention some of the benefits of private care including staying with your current dentist, access to a broader choice of treatments, improved facilities, more flexibility in appointment times, less rushed appointments and prompt treatment.

We recommend that wherever possible, you use our template letters and tailor the advantages mentioned to the needs and aspirations of individual patients. This way they are more likely to see the benefits as relevant to them.

Leaving the dental list

A contractor is required to provide the HB with three months’ notice in writing, if they wish to leave the dental list. Providing the HB with three months’ notice is only necessary when a Contractor is ceasing to provide all NHS dental care.

Communication is key

Before providing the HB with notice, we recommend discussing the decision to change the practice model with the HB. We advise you to agree what communication will be going out to patients from the practice. The HB may ask for details of the communication that will be going to patients. This is not unreasonable.

Follow up any phone conversations with the HB in writing. If you are on the same page with the HB, any patient complaints should be easier dealt with. It is also worth checking if there will there be any communication from the HB to the patients, for example, to advise patients of their options/of other local practices.

If a large number of patients are to be de-registered, then it may be worthwhile contacting the local MSPs and discussing the change. This is because unhappy patients may well reach out to their MSP to complain. An MSP who understands the reasons behind the change, may well be more supportive.

Completing treatments

A contractor who is leaving the dental list must complete any open treatments. If treatments cannot be completed, then the contractor will need to consider how to deal with that patient, for example, offer a refund or continue with the treatment under NHS until treatment is completed, offer to complete on private basis and only charge the patient an equivalent NHS fee.

Advice may need to be sought from the indemnity provider in the case of any complex cases that run over the three-month period. The three months’ period is a minimum so, longer notice may be offered.

Moving a patient to private care

A capitation arrangement may be terminated without the need to provide the patient with three months’ notice, if the patient agrees to transfer the whole of the care and treatment, which might have otherwise been provided under the capitation arrangement, such that the treatment will then be provided privately.

This process involves speaking with each patient to seek their agreement, and so this option may only be practicable for a small number of patients, to do this for a large number of patients could be quite problematic, administratively heavy and time consuming.

You should keep paper records which demonstrate that the patient was doing this voluntarily and aware that they were entitled to three months’ notice. If the patient agrees to be deregistered without the full three months’ notice, then the capitation payment will also cease at the time they are deregistered. It may be worth also considering the financial advantage/disadvantage of deregistering patients early vs continuing to be paid capitation payments for three months.

Out Of Hours provision

Consideration will need to be given how any increase in private patients may impact how a dentist will provide care to patients in an emergency as access to the local NHS out of hours rota hours may be restricted. Dentists are advised to check with their HB.