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Follow the guidance for:

Claiming emergency appointments

If the patient is already undergoing an NHS band 1, 2, or 3 CoT and presents with a problem that needs Unscheduled Care, the additional treatment must be provided as part of the existing CoT as a variation of the treatment plan.

If a patient attends for an unscheduled appointment outside of an existing CoT and treatment is provided to either relieve pain or prevent deterioration of the patient's dental health, this will be provided as an Unscheduled Care claim.

Treatment required

The regulations state the treatment provided should only be what is needed to prevent significant deterioration or address the severe pain.

An Unscheduled Care claim may be spread across more than one appointment. A single Unscheduled Care claim would still be appropriate.

It would not be appropriate to submit an Unscheduled Care claim until the treatment to resolve the pain has been provided.

Claim for prescribing antibiotics

There are few situations where only the prescription of antibiotics by a dental practitioner is justifiable.

Faculty of General Dental Practice (FGDP) guidelines relating to prescription of antibiotics describe situations where antibiotics may be used as an adjunct to therapy.

It would be unusual to have a situation where an appropriate Unscheduled Care claim would be submitted that indicated only prescription of antibiotics.

Examination

An 'Examination' is listed as an item which could be provided as part of an Unscheduled Care claim.

An assessment of the patient’s presenting complaint is needed to diagnose and plan a patient’s Unscheduled Care without other elements of an examination.

A medical history update and soft tissue examination is usually expected as part of the patient assessment.

Claiming 'Permanent filling' and 'Extraction'

Where a permanent filling or extraction is provided as part of Unscheduled Care and no examination is provided, an Unscheduled Care claim is appropriate.

An examination must be provided as part of a band 2 claim and would normally include:

  • the recording of a dental chart
  • soft tissue examination
  • periodontal examination
  • other diagnostic tests as appropriate
  • treatment plan
  • risk assessment
  • a recall interval

For a band 2 claim, all parts of the planned treatment must be provided, unless the patient withdraws. This includes all necessary band 2 items.

Providing Unscheduled Care and submitting the claim before opening a band 1, 2, or 3 CoT

There may be times where Unscheduled Care is followed by other treatment which would be a separate CoT.

The initial care given for a patient's immediate presenting complaint or symptoms may also be considered the first visit of a CoT to provide all necessary treatment.

The patient must understand the treatment plan and give appropriate consent which should be recorded in the clinical records.

The treatment provided should be based on the patient needs and expectations following discussion with them and a clinical decision made by the practitioner. There is also an expectation that all patients are treated equally irrespective of their payment status.

Patients who receive Unscheduled Care may return for a further CoT. It would not normally be expected that patients treated under a contract to provide mandatory services would initially be provided with an Unscheduled Care CoT before progressing to further care with the same contractor.

If this happens, a contractor may need to justify this to the Local Dental Commissioners.

Providing Unscheduled Care and submitting the claim after submitting a band 1, 2, or 3 CoT

This depends on why the patient has returned after submitting the band 1, 2, or 3 claim.

An Unscheduled Care claim may be appropriate for a patient presenting with pericoronitis and requiring associated Unscheduled Care shortly after submitting the band 1, 2, or 3 claim.

It would be inappropriate to submit a claim for aftercare.

Aftercare

Aftercare is care provided as a consequence of treatment recently provided. The care is recognised as an expected complication.

A clinician may have submitted a claim for the CoT and it would be considered inappropriate for the same contract to submit another claim for the aftercare element of the treatment, even if it was a different clinician working under the same contract that provided the aftercare element of treatment.

Examples of this include but are not limited to:

a) A denture was recently provided, and a claim submitted. The patient returns for an ease of the denture. This ease would be considered as aftercare and part of the CoT already submitted. Submission of another claim would be inappropriate.

b) A filling was provided and a claim submitted. The patient returns because of a sharp edge/premature contact and the same filling was smoothed. This would be considered as aftercare and part of the CoT already submitted. Submission of another claim would be inappropriate.

c) An extraction was provided and a claim submitted. The patient returns for an infected socket. Treatment related to the socket would be considered as aftercare, and part of the CoT already submitted. Submission of another claim would be inappropriate.

Patient attends with dry or infected socket

If the extraction was provided under the same contract, which could include a different clinician under the same contract, any treatment for dry or infected socket would be aftercare and no claim should be made.

If the initial extraction was carried out at a different practice under a different provider contract, the second practice could claim Unscheduled Care for treating the infected socket as they would not have carried out the original treatment.

The same principle applies for ease of a denture.

Key points

  • an examination is not needed for an Unscheduled Care CoT
  • an Unscheduled Care CoT may be spread across more than one appointment
  • treatment is provided that is necessary to prevent significant deterioration or address the severe pain

Appendix

The National Health Service (Dental Charges) Regulations

SCHEDULE 4. Unscheduled Care under Band 1 Charge.

(a) examination, assessment and advice

(b) radiographic examination and radiological report

(c) dressing of teeth and palliative treatment

(d) pulpectomy or vital pulpotomy

(e) re-implantation of a luxated or subluxated permanent tooth following trauma including any necessary endodontic treatment

(f) repair and refixing of inlays and crowns

(g) refixing a bridge

(h) temporary bridges

(i) extraction of not more than 2 teeth

(j) provision of post-operative care including treatment of infected sockets

(k) adjustment and alteration of dentures or orthodontic appliances

(l) Unscheduled Care for acute conditions of the gingivae or oral mucosa, including treatment for pericoronitis or for ulcers and herpetic lesions, and any necessary oral hygiene instruction in connection with such treatment

(m) treatment of sensitive cementum or dentine

(n) incising an abscess

(o) other treatment immediately necessary as a result of trauma

(p) not more than 1 permanent filling in amalgam, composite resin, synthetic resin, glass ionomer, compomers, silicate or silico-phosphate including acid etch retention

Reference

  1. FGDP standards: Antimicrobial Prescribing for Practitioners, 2nd edition, May 2012, FGDP (UK) Updated 2016. 
Keywords: Late Submitted, Incomplete, Emergency, Antibiotics, Examination, Urgent, Aftercare, Dry Socket, Infected Socket