The British Dental Association (BDA) has responded to news of the judgement in Lucy Williams’ recent case at the Court of Appeal, which confirmed that “top- up” private fees in addition to band three NHS charges - in this case for a more aesthetic ceramic crown - were permitted by the relevant NHS regulations.
This appeal was brought by the General Dental Council (GDC) following a judgement by the High Court, which overturned the original professional conduct committee (PCC) decision of the GDC in January 2022, which had resulted in Lucy’s erasure. The High Court ruled that the PCC was wrong to have found that Lucy was not permitted to charge ‘top-up’ fees in the way she did for three patients. The court replaced the erasure with a nine-month suspension.
The BDA stress that there is no doubt that dentists can mix on the same tooth, e.g., an NHS crown with a private root filling, and that this has been the case since 2006, notwithstanding dental guidance issued to practitioners throughout the intervening 17 years to indicate otherwise.
The association notes that the GDC must also reflect on whether this interpretation of the regulation has implications for other historic fitness to practise cases. In many cases, that will not be a straightforward assessment, given that there will often have been multiple charges of dishonesty brought. The BDA says the regulator has an obligation to review previous approaches.
NHS England now needs to confirm whether the guaranteed treatment provisions along with the two-month charging rule apply where patients have agreed to top up their treatment with private fees. The professional body stress that officials must now provide clarity on multiple fronts, and until that point, practitioners should familiarise themselves with the relevant regulations again, read this judgement carefully and ensure they do the following to avoid any misunderstanding:
- Discuss with your patient their treatment options under the NHS and privately, explaining the outcomes, differences and costs clearly.
- Provide a treatment plan and ensure where private treatment is agreed upon, the patient signs the FP17DC or equivalent.
- Ensure that you carefully document in the clinical notes the conversations you have with your patient regarding the options available to them.
Len D’Cruz, head of BDA Indemnity, said, “Lucy Williams has faced lengthy and traumatic regulatory court processes.
“Lawyers engaged by both sides in the original GDC hearing failed to recognise regulations removing ‘same tooth’ mixing landed in 2006. It might well have saved much anguish and a significant amount of heartache, not to mention cost for everybody concerned, had they done so.
“The GDC must now reflect on every FTP case and erasure from the last 17 years that did not acknowledge these changes.
“Judges have recognised that dentists shouldn’t be left out of pocket when providing a private crown alongside other NHS treatment on this, and that this is closer to “the spirit of free dental services. That’s progress.
“But there are many unknowns. What we need now from NHS England is clarity across the piece.”