The contractor must comply with the requirement to allow an authorised representative to enter and view premises and observe the carrying-on of activities on those premises in accordance with regulations made under section 225 (duties of services-providers to allow entry by Local Healthwatch organisations or contractors) of the Local Government and Public Involvement Health Act 2007.

Entry and inspection by the Care Quality Commission

PART 5A — COMPLAINTS RECEIVED ON OR AFTER 1ST APRIL 2009

46B

As regards complaints relating to any matter reasonably connected with the provision of services under the agreement which are received on or after 1st April 2009, the contractor must have in place a complaints procedure which meets the requirements of the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009.

Variation of contractual terms in respect of election to enter into a Capitation and Quality Scheme Agreement

20A

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Variation of contractual terms in respect of election to enter into a Capitation and Quality Scheme 2 Agreement

20B

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Notifications to the Board

Notice provisions specific to an agreement with a dental corporation

42A

(1) Where a company limited by shares is a party to the agreement, it shall give notice in writing to NHS England forthwith when—

(a) it passes a resolution or a court of competent jurisdiction makes an order that the contractor be wound up;

(b) circumstances arise which might entitle a creditor or a court to appoint a receiver, administrator or administrative receiver for the contractor;

(d) the contractor is unable to pay its debts within the meaning of section 123 of the Insolvency Act 1986 (definition of inability to pay debts); or

(e) changes take place in relation to the ownership of shares in the company.

(2) A notice under sub-paragraph (e) must—

(a) provide the name of any person ceasing to own a share in the company;

(b) provide the name of any new person acquiring a share in the company; and

(c) confirm that following any changes in share ownership, that the company continues to meet the conditions in section 108(1A) of the 2006 Act.

Notice provisions specific to an agreement with a company limited by shares

42B

(1) Where a limited liability partnership is a party to an agreement it shall give notice to NHS England forthwith when—

(a) it passes a resolution or a court of competent jurisdiction makes an order that the contractor be wound up;

(b) circumstances arise which might entitle a creditor or a court to appoint a receiver, administrator or administrative receiver for the contractor;

(d) the contractor is unable to pay its debts within the meaning of section 123 of the Insolvency Act 1986 (definition of inability to pay debts); or

(e) any membership changes are notified in accordance with section 9 of the Limited Liability Partnership Act 2000 (registration of membership changes) to the registrar (within the meaning of that Act) in relation to a person who becomes or ceases to be a member or designated member (within the meaning of that Act) and the notice must specify the date on which that person becomes or ceases to be a member or designated member (as the case may be).

(2) A notice under sub-paragraph (e) must confirm—

(a) that any new member joining the partnership meets the conditions imposed by regulation 4 (general conditions relating to all agreements); and

(b) following the membership changes, that sub-sections 108(1B) or 108(1C) of the 2006 Act continue to apply to the partnership.

Notifications to patients following a variation of the agreement

Entry and inspection by the Board

Entry and inspection by members of Patients' Forums

Entry and inspection by the Care Quality Commission

Entry and viewing by Local Healthwatch organisations

Action the Board can take following a mid-year review

Termination by the Board: general provisions

Termination by the Board: notice

Termination by the Board for the provision of untrue etc. information

Termination by the Board on grounds of suitability etc.

Termination by the Board: patient safety and material financial loss

Termination by the Board: remedial notices and breach notices

Termination by the Board: additional provisions specific to contracts with dental corporations, companies limited by shares and limited liability partnerships

Duty as to education and training

77A

The contractor must co-operate with the Secretary of State in the discharge of the Secretary of State's duty under section 1F of the 2006 Act (duty as to education and training), or co-operate with NHS England where NHS England is discharging that duty by virtue of section 97 of the Care Act 2014.

Quality assurance system

Insurance: negligent performance

Public liability insurance

Gifts

Compliance with legislation and guidance

Third party rights

Signing of documents

2A

In the case of an agreement with a company limited by shares—

(a) whether or not it is a company limited by shares;

(b) the names of the directors, chief executive and secretary of the company, in so far as those positions exist in relation to the company; and

2B

In the case of an agreement with a limited liability partnership—

(a) whether or not it is a limited liability partnership;

(b) the names of the members of the partnership; and

Friends and Family Test

5A

(1) The contractor must give all patients who use the contractor's practice the opportunity to provide feedback about the service received from the practice through the Friends and Family Test.

(2) The contractor must—

(a) report the results of completed Friends and Family Tests to NHS England; and

(b) publish the results of such completed tests,

in the manner approved by NHS England.

(3) In this paragraph, “Friends and Family Test” means the arrangements that the contractor is required by NHS England to implement to enable its patients to provide anonymous feedback about the patient experience at the contractor’s practice.

Units of dental activity for contractors who elect to enter into a prototype agreement

14A

(1) Subject to paragraph (3), where a contractor has elected to enter into a prototype agreement, the prototype agreement must specify the number of units of dental activity to be provided by the contractor—

(a) where the prototype agreement begins on 1st April, in each financial year; or

(b) where the prototype agreement begins on a date other than 1st April, in the remainder of the financial year in which the prototype agreement begins, and in each financial year thereafter.

(2) A prototype agreement must contain terms which have the effect of those specified in Schedule 2A in relation to the calculation of the number of units of dental activity to be provided by the contractor under the prototype agreement.

(3) This regulation does not apply where the contractor is a CDS prototype contractor.

Capitated patient figures for contractors who elect to enter into a prototype agreement

14B

Where a contractor has elected to enter into a prototype agreement, except where the contractor is a CDS prototype contractor, the prototype agreement must specify the number of patients to whom the contractor is expected to have provided primary dental services (known as the capitated patient figure) by the end of each financial year.

Capitated patients

14C

(1) Subject to paragraph (3), where a contractor has elected to enter into a prototype agreement, on any day (“the relevant day”) a patient is a capitated patient if that patient has been provided with a banded course of treatment by the contractor (C1) within a period of three years immediately preceding that day, provided that—

(a) the banded course of treatment has not been provided by a foundation trainee;

(b) the patient has not been referred to C1 for the banded course of treatment by another primary dental services contractor; and

(c) the patient was not subsequently provided with a banded course of treatment before the relevant day by another primary dental services contractor (C2), unless the patient was referred to C2 by C1 for that banded course of treatment.

(2) For the purposes of this regulation—

(a) a banded course of treatment does not include the provision of an urgent course of treatment; and

(b) “foundation trainee” has the meaning given in Section 12 of the General Dental Services Statement of Financial Entitlements 2013 (glossary of terms).

(3) This regulation does not apply where the contractor is a CDS prototype contractor.

Under-provision of units of dental activity or units of orthodontic activity

Domiciliary services and sedation services

Finance

Fees, charges and financial interests of the contractor

Arrangements on termination

Other contractual terms

Variation of contractual terms in respect of election to enter into a Capitation and Quality Scheme Agreement

Variation of contractual terms in respect of election to enter into a Capitation and Quality Scheme 2 Agreement

20C

(1) Subject to paragraph (6), this regulation applies where the contractor and NHS England elect to enter into a prototype agreement.

(2) Where this regulation applies, the terms of the agreement which have the same effect as the provisions specified in paragraph (3) must be varied in accordance with paragraphs (4) and (5) with effect from the day on which the prototype agreement commences and for the period ending at the end of the day which is the date of termination of the prototype agreement, which must be no later than 31st March 2022.

(3) The provisions specified in this paragraph are—

(a) regulation 13 (units of dental activity);

(b) regulation 15 (under provision of units of dental activity or units of orthodontic activity), in relation to units of dental activity only;

(d) Part 1 of Schedule 2 (units of dental activity); and

(e) in Schedule 3 (other contractual terms)—

(i) paragraph 33(2) (patient records), which is a contractor’s discretion to keep patient records in electronic form,

(ii) paragraph 58 (mid-year reviews), and

(iii) paragraph 61(1)(a) and (3)(a) (variation of an agreement: activity under the agreement), which relate to units of dental activity.

(4) The agreement must include terms that have the effect of temporarily releasing the contractor and NHS England from all of the obligations, conditions, payments, rights and liabilities relating to those terms (and only those terms) which have the same effect as the provisions specified in paragraph (3), including any right to enforce those terms.

(5) The agreement must also include terms that have the effect of providing that, immediately after the date of the termination of the prototype agreement, the terms of the agreement that subsisted between the parties immediately before—

(a) in the case of a contractor who held both a Capitation and Quality Scheme Agreement and a Capitation and Quality Scheme 2 Agreement, the Capitation and Quality Scheme Agreement commenced;

(b) in the case of a contractor who held a Capitation and Quality Scheme 2 Agreement but not a Capitation and Quality Scheme Agreement, the Capitation and Quality Scheme 2 Agreement commenced; or

and from which the parties were temporarily released in accordance with paragraph (4), must apply from the day after the date of termination, and all obligations, conditions, payments, rights and liabilities relating to those terms are to be enforceable from that day.

(6) Sub-paragraphs (b) and (d) of paragraph (3) do not apply where the contractor is a CDS prototype contractor.

SCHEDULE 2A — PROVISION OF SERVICES: UNITS OF DENTAL ACTIVITY WHERE A CONTRACTOR HAS ELECTED TO ENTER INTO A PROTOTYPE AGREEMENT

1

(1) Where a contractor holding a Blend A prototype agreement provides a banded course of treatment, for the purposes of the agreement the contractor is to be regarded as providing the number of units of dental activity specified in the appropriate row of Table A.

(2) Where a contractor holding a Blend B prototype agreement provides a banded course of treatment, for the purposes of the agreement the contractor is to be regarded as providing the number of units of dental activity specified in the appropriate row of Table B.

(3) Where a banded course of treatment is commenced under a prototype agreement but not completed for whatever reason, the appropriate number of units of dental activity provided is to be calculated on the basis of the components of the course of the treatment which have been —

(a) completed; and

(b) commenced but not completed.

(4) Where a patient is referred by the contractor for advanced mandatory services to another provider of primary dental services, the appropriate number of units of dental activity provided by—

(a) that contractor; and

(b) the other provider of primary dental services, if that provider is also a contractor,

must be calculated on the basis of the components of the course of treatment which each contractor actually provides, notwithstanding that the treatment constitutes a single banded course of treatment for charging purposes.

(5) Where the contractor provides a charge exempt course of treatment, for the purposes of the prototype agreement the contractor provides the number of units of dental activity specified in the appropriate row of Table C.

(6) For the purposes of this paragraph, “Blend A prototype agreement” and “Blend B prototype agreement” have the same meaning as in the Prototype SFE.

(7) This Schedule does not apply where the contractor is a CDS prototype contractor.

Type of course of treatment	Units of dental activity provided
Band 1 course of treatment (excluding urgent treatment)	0.0
Band 1 course of treatment (urgent treatment) where the patient is a capitated patient of the practice	0.0
Band 1 course of treatment (urgent treatment) where the patient is not a capitated patient of the practice	1.2
Band 2 course of treatment	2.0
Band 2 course of treatment where a patient is referred for advanced mandatory services by another provider	3.0
Band 3 course of treatment	11.0
Band 3 course of treatment where a patient is referred for advanced mandatory services by another provider	12.0
Type of course of treatment	Units of dental activity provided
---	---
Band 1 course of treatment (excluding urgent treatment)	0.0
Band 1 course of treatment (urgent treatment) where the patient is a capitated patient of the practice	0.0
Band 1 course of treatment (urgent treatment) where the patient is not a capitated patient of the practice	1.2
Band 2 course of treatment	0.0
Band 2 course of treatment where a patient is referred for advanced mandatory services by another provider	3.0
Band 3 course of treatment	9.0
Band 3 course of treatment where a patient is referred for advanced mandatory services by another provider	12.0
Type of charge exempt course of treatment	Units of dental activity provided
---	---
Issue of a prescription	0.0
Repair of a dental appliance (denture) where the patient is a capitated patient of the practice	0.0
Repair of a dental appliance (denture) where the patient is not a capitated patient of the practice	1.0
Repair of a dental appliance (bridge) where the patient is a capitated patient of the practice	0.0
Repair of a dental appliance (bridge) where the patient is not a capitated patient of the practice	1.2
Removal of sutures where a patient is a capitated patient of the practice	0.0
Removal of sutures where a patient is not a capitated patient of the practice	1.0
Arrest of bleeding where the patient is a capitated patient of the practice	0.0
Arrest of bleeding where the patient is not a capitated patient of the practice	1.2

Notification provisions specific to prototype agreements

43A

Where the contractor has elected to enter into a prototype agreement, except for CDS prototype contractors, the contractor shall—

(a) send to NHS England details of any private treatment provided to a capitated patient attending the practice, in electronic form, whether or not this treatment is associated with services that are provided under the prototype agreement; and

(b) provide to all patients attending for treatment at its practice a privacy notice in a form approved by NHS England notifying them about the obligation referred to in sub-paragraph (a).

Entry and inspection by the Board

Entry and inspection by members of Patients' Forums

Entry and inspection by the Care Quality Commission

Entry and viewing by Local Healthwatch organisations

Publication of information about earnings

17A

(1) Using the information that it has obtained to make the payments to contractors mentioned in regulation 17(1)(a), NHS England must publish the information specified in paragraph (2).

(2) The information specified in this paragraph is, in respect of each agreement—

(a) the number of dental performers who during the previous financial year performed services under the agreement;

(b) a figure representing the aggregate net pensionable earnings in respect of the previous financial year of those dental performers under the agreement, taking into account the amount by which the employing authority of those performers would reduce those earnings to take account of expenses; and

(c) an average figure of net pensionable earnings of each performer based on the figures referred to in sub-paragraphs (a) and (b).

(3) In relation to the financial year ending on 31st March 2015, the information specified in paragraph (2) must be published by 31st May 2016; and for each subsequent financial year, it must be published before the end of the financial year following the financial year to which the information relates.

(4) The NHSBSA is directed to perform NHS England’s functions under this regulation, and must publish the information on its website in such form and such manner as it sees fit.

(5) For the purposes of this regulation, net pensionable earnings are to be calculated in accordance with paragraph 3(2B) (meaning of pensionable earnings) of Schedule 2 (medical and dental practitioners) to the National Health Service Pension Scheme Regulations 1995, regulation 3.A.7(4) (meaning of pensionable earnings) of the National Health Service Pension Scheme Regulations 2008 and paragraph 3 (dental practitioner) of Schedule 10 (practitioner income) to the National Health Service Pension Scheme Regulations 2015.

(6) For the purposes of this regulation—

“dental performer” means a dental practitioner whose name is included in the dental performers list;

“employing authority” has the meaning given in—regulation A2 (interpretation) of the National Health Service Pension Scheme Regulations 1995;regulation 2.A.1 (interpretation: general) of the National Health Service Pension Scheme Regulations 2008; andregulation 33(6) (contributions by employing authorities) of the National Health Service Pension Scheme Regulations 2015; and

“the NHSBSA” means the NHS Business Services Authority (Awdurdod Gwasanaethau Busnes y GIG).

Fees, charges and financial interests of the contractor

Arrangements on termination

Other contractual terms

Variation of contractual terms in respect of election to enter into a prototype agreement

Suspension of agreement terms or of enforcement of agreement terms while a disease is or in anticipation of a disease being imminently pandemic etc.

20D

(1) Any term that is part of an agreement (including a prototype agreement) as a consequence of action taken under this Part or by agreement between the parties is temporarily not part of that agreement, in the particular circumstances mentioned in sub-paragraph (c)(ii) and during the period mentioned in sub-paragraph (c)(iii), in the following circumstances—

(a) as a consequence of a disease being, or in anticipation of a disease being imminently—

(i) pandemic, and

(ii) a serious risk or potentially a serious risk to human health,

NHS England with the agreement of the Secretary of State has made an announcement in respect of the prioritisation of services to be provided in, or in any part of, England as part of the health service;

(b) the prioritisation is in order to assist in the management of the serious risk or potentially serious risk to human health;

(c) as part of the announcement, NHS England with the agreement of the Secretary of State has issued advice to the effect that contractors are not to comply with a specified type of term of personal dental services agreements (including prototype agreements)—

(i) in the area to which the announcement relates,

(ii) in the particular circumstances specified in the announcement, and

(iii) during the period specified in the announcement; and

(d) the contractor is situated in the area to which the announcement relates and compliance with the term (it being of the specified type) would, but for the effect of this paragraph, be a requirement of the contractor’s agreement.

(2) NHS England must not take enforcement action, as provided for in an agreement (including a prototype agreement), in respect of a breach of a term of the agreement in the following circumstances—

(a) as a consequence of a disease being, or in anticipation of a disease being imminently—

(i) pandemic, and

(ii) a serious risk or potentially a serious risk to human health,

(b) the prioritisation is in order to assist in the management of the serious risk or potentially serious risk to human health;

(c) as part of the announcement, NHS England with the agreement of the Secretary of State has issued advice to the effect that contractors need not comply with a specified type of term of personal dental services agreements (including prototype agreements)—

(i) in the area to which the announcement relates,

(ii) in the particular circumstances specified in the announcement, and

(iii) during the period specified in the announcement; and

(d) the contractor—

(i) is situated in the area to which the announcement relates, and

(ii) has not complied with the term (it being of the specified type) in the particular circumstances mentioned in sub-paragraph (c)(ii) and during the period mentioned in sub-paragraph (c)(iii).

PART 1A — Band 2 courses of treatment – sub-bands

Sub-band 2a treatments

2A

The following Band 2 courses of treatments are within sub-band 2a—

(a) non-surgical periodontal treatment including root-planing, deep scaling, irrigation of periodontal pockets and subgingival curettage and all necessary scaling and polishing;

(b) surgical periodontal treatment, including gingivectomy, gingivoplasty or removal of an operculum;

(c) surgical periodontal treatment, including raising and replacement of a mucoperiostal flap, curettage, root planing and bone resection;

(d) free gingival grafts;

(e) sealant restorations;

(f) pulpotomy;

(g) apicectomy;

(h) transplantation of teeth;

(i) oral surgery including surgical removal of cyst, buried root, unerupted tooth, impacted tooth or exostosed tooth and alveolectomy;

(j) soft tissue surgery in relation to the buccal cavity and lips;

(k) frenectomy, frenoplasty and frenotomy;

(l) relining and rebasing dentures including soft linings;

(m) addition of tooth, clasp, labial or buccal flange to dentures;

(n) splints (other than laboratory fabricated splints) in relation to periodontally compromised teeth and in connection with external trauma;

(o) bite raising appliances (other than laboratory fabricated appliances);

(p) permanent fillings in amalgam, composite resin, synthetic resin, glass ionomer, compomers, silicate or silico-phosphate, including acid etch retention, if delivered to less than 3 teeth in single course of treatment;

(q) extraction of one or two teeth; and

(r) endodontic treatment of any retained deciduous teeth.

Sub-band 2b treatments

2B

The following Band 2 courses of treatments are within sub-band 2b—

(a) permanent fillings in amalgam, composite resin, synthetic resin, glass ionomer, compomers, silicate or silico-phosphate, including acid etch retention, if delivered to 3 or more teeth in single course of treatment;

(b) endodontic treatment of any permanent teeth, excluding molar teeth; and

(d) extraction of three or more teeth.

Sub-band 2c treatments

2C

The Band 2 course of treatment within sub-band 2c is endodontic treatment of permanent molar teeth.

Information about the contractor’s practice

35A

(1) The contractor must ensure that a comprehensive and accurate profile in respect of its practice is provided to NHS England for the purpose of display on the NHS.uk website.

(2) The contractor must review the information contained in the profile referred to in paragraph (1) at least once in every period of 90 days from the date the profile is provided in accordance with paragraph (1).

(3) If, on such a review, it appears to the contractor that any of that information is inaccurate or incomplete, the contractor must provide NHS England with an updated profile in respect of its practice.

Provision of and access to information: the Board

Requests for information from Patients' Forums

Inquiries about prescriptions and referrals

Notification of a course of treatment, orthodontic course of treatment etc.

Annual report and review

Notifications to the Board

Notice provisions specific to an agreement with a limited liability partnership

Notifications to patients following a variation of the agreement

Notification provisions specific to prototype agreements

Entry and inspection by the Board

Entry and inspection by members of Patients' Forums

Entry and inspection by the Care Quality Commission

Entry and viewing by Local Healthwatch organisations

Variation of an agreement: rebasing for persistent under performance

61A

(1) In this paragraph—

“contracted activity” means the number of units of dental activity or units of orthodontic activity the contractor is required to provide under the agreement,

“Covid years” means the financial years ending on 31st March 2021 and 31st March 2022,

“rebasing” means a permanent variation of the agreement pursuant to sub-paragraph (2) and “rebase” is to be read accordingly,

“rebasing date” means the date, notified by NHS England under a rebasing notice, from which the rebasing takes effect,

“rebasing notice” means a notice in writing sent by NHS England to the contractor, notifying the contractor of the wording of a proposed rebasing and the rebasing date,

“relevant financial years” means any three consecutive financial years, save for the Covid years, which—are not before the financial year ending on 31st March 2020, andimmediately precede the financial year in which the rebasing notice is served on the contractor.

(2) If all the conditions in sub-paragraph (3) are met, NHS England may rebase the agreement to—

(a) reduce the contracted activity, and

(b) carry out any related variations of the agreement, including in relation to the monies to be paid to the contractor under the agreement,

but the rebasing must not result in the contracted activity being reduced to less than the highest number of units of dental or orthodontic activity provided by the contractor in any one of the relevant financial years.

(3) The conditions referred to in sub-paragraph (2) are—

(a) in respect of each relevant financial year—

(i) NHS England invited the contractor to participate in a mid-year review of its performance under the agreement, pursuant to paragraph 58(5)(b), whether the contractor has engaged with this procedure or not,

(ii) the contractor provided less than 96% of contracted activity,

(iii) there have not been force majeure circumstances under the agreement, which have caused the under delivery pursuant to sub-paragraph (ii),

(iv) NHS England issued a breach notice to the contractor by reason of under delivery pursuant to sub-paragraph (ii), which has not been set aside, and no formal dispute is pending in respect of the circumstances that have given rise to the breach notice, and

(b) NHS England has not been able to agree with the contractor a permanent variation of the agreement under paragraph 61(3).

(4) If NHS England decides to rebase a contract—

(a) it must serve a rebasing notice on the contractor and allow a minimum of 28 days, starting with the day the rebasing notice is served on the contractor, before taking any action pursuant to that notice, and

(b) it must specify in the rebasing notice a rebasing date it considers appropriate, which must be no earlier than 1st April in the financial year immediately following the financial year in which the rebasing notice is served on the contractor.

Termination by agreement

Termination on the death of an individual

Termination by the contractor

Late payment notices

Termination by the Board: general provisions

Termination by the Board: notice

Termination by the Board for the provision of untrue etc. information

Termination by the Board on grounds of suitability etc.

Termination by the Board: patient safety and material financial loss

Termination by the Board: remedial notices and breach notices

Termination by the Board: additional provisions specific to contracts with dental corporations, companies limited by shares and limited liability partnerships

Agreement sanctions

Agreement sanctions and the NHS dispute resolution procedure

Termination and the NHS dispute resolution procedure

Provision of and access to information: NHS England

Notifications to NHS England

Entry and inspection by NHS England

Action NHS England can take following a mid-year review

Termination by NHS England: general provisions

Termination by NHS England: notice

Termination by NHS England for the provision of untrue etc. information

Termination by NHS England on grounds of suitability etc.

Termination by NHS England: patient safety and material financial loss

Termination by NHS England: remedial notices and breach notices

Termination by NHS England: additional provisions specific to contracts with dental corporations, companies limited by shares and limited liability partnerships

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