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1 1P P Floor NHS: PCA(D)(2010)6 Primary and Community Care Directorate Primary Care Division abcdefghijklmnopqrstu Dear Colleague GENERAL DENTAL SERVICES 1. Clinical Audit Arrangements 1 August Listing of Dental Bodies Corporate- clarification 3. Listing of locums - clarification 4. Definition of contractor clarification 5. NHS Low Income Scheme Summary 1. This letter advises NHS Boards and Practitioner Services of the arrangements for Clinical Audit which take effect from 1 August It also: provides clarification on the listing of Dental Bodies Corporate and the dentists who work for or in arrangement with such bodies, the listing of locums and the definition of contractor in the NHS (General Dental Services) (Scotland) Regulations 2010; and reminds NHS Boards of the need to retain stocks of the NHS Low Income Scheme application form (HC1) and refund claim form (HC5) for order by dentists. 21 July 2010 Addresses UFor action Chief Executives, NHS Boards Director, Practitioner Services UFor informationu Chief Executive, NHS Education for Scotland Chief Executive, NHS National Services Scotland Enquiries to: Lynne Morrison Primary Care Division st Rear St Andrew s House EDINBURGH EH1 3DG Tel: Fax: HTULynne.A.Morrison@scotland.gsi.gov.ukUTH Background UClinical Audit Arrangements 1 August 2010U 2. Paragraph 30 of HTUNHS: PCA(D)(2010)4UTH, issued on 16 June, advised that the arrangements for clinical audit were being simplified and that further information about this would be issued. The following changes are being made to clinical audit: St Andrew s House, Regent Road, Edinburgh EH1 3DG abcde abc a

2 a line will be drawn under the current scheme and NHS Boards have been advised to take no action against any dentists who have not undertaken the required 15 hours of clinical audit activities under regulation 31E of the NHS (General Dental Services) (Scotland) Regulations 1996 ( the 1996 Regulations ); a new 3 year clinical audit period will begin on 1 August 2010 and end on 31 July 2013, with each subsequent period running for each successive period of 3 years thereafter; if a dentist joins a dental list in Scotland for the first time after 1 August in a new 3 year audit period he/she will only have to undertake a pro-rata amount of clinical audit activities in that period. The pro-rata period would start from 1 August following the dentist joining the list, e.g. if the dentist joined a list in January 2011 he/she would have to undertake 10 hours of clinical audit activities starting from 1 August 2011 and ending on 31 July 2013; all local audit schemes, which are not approved by NHS Education for Scotland (NES), have to be submitted by NHS Boards to NES which will hold a central database of NES approved and completed audits as well as NHS Board approved and completed audits. NHS Boards will be able to request a report from NES for the dentists in their area to check compliance with the dentist s terms of service; NHS Boards should check the audit activities undertaken by all dentists in their area at the end of the second year in each audit period so that they can alert any dentists who have not at that time undertaken the required 15 hours, or pro-rated hours, to remind them of their terms of service requirement; approval and verification of local audit schemes have to be comparable to the NES system; all clinical audit activities must be approved by the relevant NHS Board or NES and must be certified as completed to count towards the required 15 hours of clinical audit activities; clinical audit activities must be completed within 6 months of the start date, i.e. within 6 months of the audit activities commencing; on joining a dental list for the first time a dentist will be required to undertake 5 hours of clinical audit activities in the first year of their audit period; where a dentist did not undertake the required 15 hours of clinical audit activities under the 1996 Regulations he/she will require to complete 5 hours of clinical audit activities before 31 July 2011.

3 3. The names of those dentists who have taken part in local audit schemes should be sent by NHS Boards to NES once the relevant audit activities have been certified, along with a note of the number of hours that each dentist has completed. The information should be sent to Tony Anderson, Director of Postgraduate GDP Education, Lauriston Place, Edinburgh, EH3 9HA, who can also provide information on NES s clinical audit system. 4. An amendment to the Statement of Dental Remuneration, Amendment No 117, to reflect the changes to clinical audit is attached to the Memorandum to this letter. 5. NHS Boards and Practitioner Services should note that: claims for a clinical audit allowance can only be made by or in respect of clinical audit activities undertaken by dentists; claims for clinical audit activities undertaken by dentists who are assistants require to be made by the contractor, whether a dentist or dental body corporate. The GP217 (application for a clinical audit allowance) is being revised and will be sent to NHS Boards once available. Supplies of the form should be copied locally and issued to dentists on request. The existing version of the GP217 should be destroyed. HC1 NHS Low Income Scheme Application Forms 6. The NHS Low Income Scheme application form (HC1) and refund claim form (HC5) have been amended following an increase in the capital limits used in calculating entitlement to help with health costs. Old stocks can continue to be used and will be processed based on the revised limits. NHS Boards are asked to ensure that they retain stocks of the HC1 and 5 for order by dentists. 7. Supplies of the HC1 and 5 can be obtained from APS Group Management Services by to Stockorders.dppas@apsgroup.co.uk by fax to or or by phone to Action 8. NHS Boards and Practitioner Services are asked to note the: 8.1 new clinical audit arrangements which are outlined at paragraphs 2 to 5 above and Amendment No 117 to the Statement of Dental Remuneration, which is attached to the Memorandum to this letter; 8.2 the clarification on the listing of dental bodies corporate detailed in paragraphs 5 to 9 of the Memorandum to this letter; and 8.3 the clarification on the listing of locums detailed in paragraphs 10 and 11 to the Memorandum to this letter.

4 9. NHS Boards are asked to: 9.1 ensure that the approval and verification of local clinical audit schemes are comparable to the NES system; 9.2 provide NES with details of those dentists who have completed approved local audit schemes; 9.3 check the audit activities undertaken by all dentists in their area at the end of the second year in each audit period; 9.4 copy and issue the revised GP217, once received, to dentists on request; 9.5 note the information about HC1 and HC5 forms above and to ensure that supplies are retained for order by dentists; 9.5 urgently copy and issue the Memorandum to this letter to all dentists on their dental list. Yours sincerely FRANK STRANG Deputy Director

5 MEMORANDUM TO NHS; PCA(D)(2010)6 DENTISTS NATIONAL HEALTH SERVICE GENERAL DENTAL SERVICES 1. Clinical Audit Arrangements 1 August Listing of Dental Bodies Corporate- clarification 3. Listing of locums - clarification 4. Definition of contractor - clarification 5. NHS Low Income Scheme 1. This Memorandum advises dentists of the arrangements for Clinical Audit which take effect from 1 August It also: provides clarification on the listing of Dental Bodies Corporate and the dentists who work for or in arrangement with such bodies, the listing of locums and the definition of contractor in the NHS (General Dental Services) (Scotland) Regulations 2010; and reminds dentists of the need to retain stocks of the NHS Low Income Scheme application form (HC1) and refund claim form (HC5). Clinical Audit Arrangements 1 August Paragraph 35 of the Memorandum to NHS: PCA(D)(2010)4, issued on 16 June, advised that the arrangements for clinical audit were being simplified and that further information about this would be issued. The following changes are being made to clinical audit: a line will be drawn under the current scheme and NHS Boards will take no action against any dentists who have not undertaken the required 15 hours of clinical audit activities under regulation 31E of the NHS (General Dental Services) (Scotland) Regulations 1996 ( the 1996 Regulations ); a new 3 year clinical audit period will begin on 1 August 2010 and end on 31 July 2013, with each subsequent period running for each successive period of 3 years thereafter; if a dentist joins a dental list in Scotland for the first time after 1 August in a new 3 year audit period he/she will only have to undertake a pro-rata amount of clinical audit activities in that period. The pro-rata period would start from 1 August following the dentist joining the list, e.g. if the dentist joined a list in January 2011 he/she would have to undertake 10 hours of clinical audit activities starting from 1 August 2011 and ending on 31 July 2013;

6 NHS Boards will check the audit activities undertaken by all dentists in their area at the end of the second year in each audit period so that they can alert any dentists who have not at that time undertaken the required 15 hours, or pro-rated hours, and remind them of their terms of service requirement; all clinical audit activities must be approved by the relevant NHS Board or NES and must be certified as completed to count towards the required 15 hours of clinical audit activities; clinical audit activities must be completed within 6 months of the start date, i.e. within 6 months of the audit activities commencing; on joining a dental list for the first time a dentist will be required to undertake 5 hours of clinical audit activities in the first year of their audit period; where a dentist did not undertake the required 15 hours of clinical audit activities under the 1996 Regulations he/she will require to complete 5 hours of clinical audit activities before 31 July An amendment to the Statement of Dental Remuneration, Amendment No 117, to reflect the changes to clinical audit is attached. 4. Claims for clinical audit activities undertaken by dentists who are assistants require to be made by the contractor, whether a dentist or dental body corporate. A revised GP217 (application for a clinical audit allowance) is being produced for this purpose and will be available on request from your NHS Board in due course. Listing of Dental Bodies Corporate- clarification 5. Paragraph 29 of the Memorandum to NHS: PCA(D)(2010)4 provided information on the relationship between listed dental bodies corporate (DBC) and those dentists working for or in arrangement with a DBC. The decision as to whether a DBC should be listed to provide general dental services rests with the individual DBC and is not mandatory. However, where a DBC does choose to be listed to provide general dental services then the dentists who work for or in arrangement with that DBC will be on the second part of the list, as they will be assisting the DBC in the provision of GDS. Therefore if a DBC chooses to be listed then any dentists who before 2 July 2010 worked for or in arrangements with the DBC and were principal dentists will move to the second part of the list and become assistants when the DBC s name is added to the dental list. The reason for this is that there cannot be two contractors providing general dental services for the same patients, i.e. registering and receiving payment for the same patients.

7 6. Paragraph 34 of NHS: PCA(D)(2010)4 advised of the arrangements for registering patients. Patients can only be registered by contractors. Therefore where a new patient is registered and receives care and treatment on the same day from an assistant two GP17s will require to be submitted, one to register the new patient, which has to be signed by the contractor or in the case of a DBC by an authorised signatory, and the other to claim payment for the care and treatment undertaken, which has to be signed by the assistant who undertook the care and treatment. Once a patient has been registered by a contractor only one form will require to be submitted each time a patient attends for and receives care and treatment, as patients are no longer required to be re-registered at set intervals. Listing of locums clarification 7. Dentists who intend to provide or assist in the provision of GDS in a NHS Board s area as a locum must join the relevant part of the NHS Board s dental list before they can undertake any GDS in the area. Most locums will join the second part of the dental list as they will be assisting in the provision of GDS, e.g. covering for annual or sick leave and treating patients registered with the dentist they are providing cover for, but could join sub-part A of the first part of the list if they are providing a longer period of cover, e.g. if a locum is covering for a dentist who is leaving and the patients of the departing dentist are to be transferred, even temporarily, to the locum. 8. Any contractor intending to engage a locum to provide cover should therefore ensure that the locum is either on sub-part A of the first part or the second part of the dental list for the area. Definition of contractor - clarification 9. The definition of contractor in regulation 2(1) of the NHS (General Dental Services) (Scotland) Regulations 2010 is a person who has undertaken to provide general dental services and whose name is included in sub-part A of the first part of a Health Board s dental list. It has been suggested that this definition excludes DBCs. This is not the case. Schedule 2 of The Scotland Act 1998 (Transitory and Transitional Provisions) (Publication and Interpretation etc. of Acts of the Scottish Parliament) Order 1999 includes a definition of Person which is includes a body of persons corporate or unincorporated. NHS Low Income Scheme 10. The NHS Low Income Scheme application form (HC1) and refund claim form (HC5) have been amended following an increase in the capital limits used in calculating entitlement to help with health costs. Old stocks can continue to be used and will be processed based on the revised limits. Dentists are asked to ensure that they retain stocks of the HC1 and 5 and that these are made available to patients on request. 11. Supplies of the HC1 and 5 can be obtained from your NHS Board.

8 Enquires 12. Any enquiries arising from this Memorandum should be taken up with your NHS Board. Scottish Government Health Directorates 21 July 2010

9 AMENDMENT NO 117 STATEMENT OF DENTAL REMUNERATION Pursuant to Regulation 22(3) of the National Health Service (General Dental Services) (Scotland) Regulations 2010 Scottish Ministers have amended on 1 August 2010 the Statement of Dental Remuneration Amendment No This amendment shall take effect from the date set out below: (i) The amendment to Determination XI shall take effect from 1 August 2. This amendment shall not affect any rights or liabilities acquired or incurred under or by virtue of any provisions of the Statement of Dental Remuneration amended or replaced by this Amendment. 3. The attached replacement pages should be inserted in Amendment No 115. Existing corresponding pages should be destroyed.

10 Statement of Dental Remuneration DETERMINATION XI CLINICAL AUDIT ALLOWANCES Interpretation 1. (1) In this Determination, unless the context otherwise requires: "approved project" means a project of clinical audit activities which has been approved by NHS Education for Scotland and "first approved project" means the first such project undertaken in the relevant period; "assistant" has the meaning given in regulation 2(1) of the Regulations; "clinical audit activities" has the meaning given in paragraph 40(4) of Schedule 1 to the Regulations, namely activities which involve the systematic and critical analysis of the quality of dental care provided (including the processes used for diagnosis, intervention and treatment and use of resources) which have a defined start and end date, no more than 6 months apart; "contractor" means a person who has undertaken to provide general dental services and whose name is included in sub-part A of the first part of a dental list; "the CSA" means the Common Services Agency for the Scottish Health Service constituted under Section 10 of the National Health Service (Scotland) Act 1978; "dentist" means a registered dental practitioner whose name is included in either sub-part A of the first part or the second part of a dental list; "dental list" means a dental list prepared by a Health Board in accordance with regulation 4(1) of the Regulations; "relevant period" has the meaning given in paragraph 40(4) of Schedule 1 to the Regulations, namely where a dentist's name is included in a dental list and he is providing or assisting in the provision of general dental services the three year period from 1 st August 2010 until 31 st July 2013 (inclusive) and each successive period of three years thereafter, "the Regulations" means the National Health Service (General Dental Services) (Scotland) Regulations 2010; (2) In this Determination, any reference to a numbered paragraph is to the paragraph bearing that number in this Determination and a reference in a paragraph to a numbered sub-paragraph is to the sub-paragraph bearing that number in that paragraph. Conditions of Entitlement 2. (1) A contractor who is a dentist who: (a) satisfies the conditions specified in sub-paragraph (2); and (b) makes a claim to the CSA in accordance with paragraph 4, shall be entitled to an allowance of an amount ascertained in accordance with paragraph 3. (2) The conditions are that: 124.

11 (a) (b) at the time of undertaking an approved project, and at the time of making the claim, the contractor's name is included in sub-part A of the first part of a dental list and he is providing general dental services, and the first approved project undertaken by the dentist is one of not less than 5 hours' duration except where NHS Education for Scotland has approved a shorter first project. (3) A contractor who: (a) (b) employs an assistant and who satisfies the conditions specified in subparagraph (4); and makes a claim to the CSA in accordance with paragraph 4 in respect of an assistant of his, shall be entitled to an allowance of an amount ascertained in accordance with paragraph (4). (4) The conditions are that:- (a) (b) at the time an assistant undertakes an approved project the assistant s name is included in the second part of the dental list, and at the time of making the claim in respect of the assistant, the contractor's name is included in sub-part A of the first part of a dental list and he is providing general dental services, and subject to sub-paragraph (4), the first approved project which the assistant undertakes is of not less than 5 hours' duration except where NHS Education for Scotland has approved a shorter first project. (4) The conditions specified in sub-paragraph (3)(b) shall not apply where an assistant was previously employed as such by another contractor and undertook an approved project in that previous employment of not less than 5 hours' duration. Amount of Allowance 3. (1) Subject to the following sub-paragraphs, the allowance payable for undertaking approved projects in the relevant period is to be calculated at an hourly rate of (2) After the first approved project is completed a contractor who is a dentist may claim in respect of periods of not less than half an hour which he has spent undertaking an approved project. (3) The number of hours for which an allowance is payable to any contractor who is a dentist, in respect of his undertaking any approved project over the relevant period, is 15 hours. (4) Subject to sub-paragraph (5), where an assistant undertakes any approved project the number of hours for which the allowance is payable to the contractor in respect of that assistant is 15 hours in the three year period in question. (5) Where in a three year period an assistant who was previously employed as such by another contractor undertook an approved project in that previous employment for which a claim was made in accordance with this Determination, the number of hours for which an allowance is payable is 15 hours, less the number of hours in respect of which any earlier claim was made. (6) After an assistant has participated in a first approved project a contractor may claim in respect of the assistant's participation in subsequent approved projects for periods of not less than half an hour. 125.

12 Claims for Allowance 4. (1) A contractor shall make a claim for an allowance on a form supplied by the Health Board for the purpose, or a form to like effect, and shall include with the claim a certificate of completion of the approved project in respect of which the claim is made, signed by a member of NHS Education for Scotland which approved the project. (2) Where a contractor makes a claim in respect of an assistant of his he shall include a signed statement from the assistant to the effect that the assistant's payments under the contract of employment with the contractor were not reduced on account of his participation in the approved project in respect of which the claim is being made. (3) Where in a three year period the assistant was previously employed as such by another contractor and undertook an approved project in that previous employment for which a claim was made in accordance with this Determination, the statement referred to at sub-paragraph (2) shall also specify the number of hours in respect of which any earlier claim was made. (4) Where a contractors name is included in the dental list of more than one Health Board he shall make the claim in respect of the Health Board for whom he provides the greater or greatest proportion of general dental services at the date of the claim. 126.