The National Health Service (Dental Charges) Regulations 2005

Made: 19th December 2005

Coming into force: 1st April 2006

In accordance with section 126(1A) of that Act[^f00002], a draft of this instrument was laid before Parliament and approved by a resolution of each House of Parliament.

Citation, commencement and application

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• (1) These Regulations may be cited as the National Health Service (Dental Charges) Regulations 2005 and shall come into force on 1st April 2006.

• (2) These Regulations apply in relation to England.

Interpretation

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• (1) In these Regulations—

• “the Act” means the National Health Service Act 1977;

• “the 2006 Act” means the National Health Service Act 2006;

• “the 2012 Act” means the Health and Social Care Act 2012;

• ...

• “bridge” means a fixed or a removable bridge which takes the place of any teeth;

• “Capitation and Quality Scheme 2” means the scheme of that name, introduced by the Secretary of State on 1st April 2013, following the termination of the Capitation and Quality Scheme on 31st March 2013, that the Secretary of State has developed to assist in continuing to promote and secure improvement in the provision of dental services in accordance with the 2006 Act;”;

• “Capitation and Quality Scheme 2 Agreement” means an Agreement which forms a temporary part of a GDS contract or a PDS agreement and which is entered into as part of the Capitation and Quality Scheme 2 and in accordance with Directions made under section 114A of the 2006 Act;

• “course of treatment” means— an examination of a patient, an assessment of that patient’s oral health, and the planning of any treatment to be provided to that patient as a result of that examination and assessment; andthe provision of any planned treatment (including any treatment planned at a time other than the time of the initial examination) to that patient up to the date on which—each and every component of the planned treatment has been provided to the patient, orthe patient either voluntarily withdraws from, or is withdrawn by the provider from, treatment,by one or more providers of relevant primary dental services, except that where the course of treatment is an interim care course of treatment provided under a prototype agreement or a Capitation and Quality Scheme 2 Agreement in the context of regulation 12A, it does not include the treatment mentioned in sub-paragraph (a).

• “dental appliance” means a denture or bridge and for the purposes of this definition, a denture includes an obturator;

• “Dental Charges Regulations 1989” means the National Health Service (Dental Charges) Regulations 1989[^f00003];

• “dental public health services” means services provided under section 16CB(4)(c) of the Act;

• “GDS Contract” is a contract within the meaning of section 100 of the 2006 Act (general dental services contracts: introductory);

• “General Dental Services Regulations 1992” means the National Health Service (General Dental Services) Regulations 1992[^f00004];

• “NHS England” means the body corporate established under section 1H of the 2006 Act;

• “orthodontic appliance” means a device used in the mouth to move or immobilise the teeth in order to correct or prevent malocclusion;

• “orthodontic treatment” means treatment of, or treatment to prevent, malocclusion of the teeth and jaws, and irregularities of the teeth;

• “patient” includes (when the context requires) a person who pays or undertakes to pay a charge on behalf of a person to whom a dental appliance is supplied or to whom some other relevant primary dental service is provided;

• “patient record” means a form supplied by NHS England for the purpose of maintaining a record of treatment, and may include an electronic form;

• “Primary Care Trust” means the body which until the date section 34 (abolition of Primary Care Trusts) of the 2012 Act comes into force, was—where the Primary Care Trust was a party to the GDS contract or the PDS agreement, that Primary Care Trust;where the Primary Care Trust was providing primary dental services under section 99(2) of the 2006 Act, the Primary Care Trust in whose area those services were provided; orwhere the Primary Care Trust, NHS Trust, or NHS foundation trust supplied dental appliances other than as part of relevant primary dental services, that Primary Care Trust, or the Primary Care Trust in whose area all or most of the hospitals, establishments and facilities of the NHS Trust or NHS foundation trust, were situated;

• “PDS Agreement means an agreement within the meaning of section 107 of the 2006 Act;

• “prison” includes a young offender institution but not a secure training centre or a naval, military or air force prison, and for the purposes of this definition—“secure training centre” means a place in which offenders subject to detention and training orders within the meaning given by section 233 of the Sentencing Code may be detained and given training and education and prepared for their release, and“young offender institution” means a place for the detention of offenders sentenced to detention in a young offender institution or to detention in a young offender institution as part of a longer custodial sentence, including custody for life;

• “prisoner” means a person who is detained in a prison in which medical, dental, ophthalmic, pharmaceutical or nursing services are provided under the Act under arrangements made by NHS England;

• “prototype agreement” means a GDS contract or PDS agreement temporarily varied as part of the Prototype Agreements Scheme which contains—the terms and conditions required under the National Health Service (Dental Services) (Prototype Agreements) Directions 2015; andthe terms and conditions required under the National Health Service (General Dental Services Contracts) Regulations 2005 or the National Health Service (Personal Dental Services Agreements) Regulations 2005;

• “relevant primary dental services” means dental treatment (including urgent treatment and orthodontic treatment) provided and dental appliances and orthodontic appliances supplied— under section 56(2) of the National Health Service (Wales) Act 2006 provided by a Local Health Board;under a general dental services contract; or under arrangements made under section 107 of the 2006 Act”

• ...

• “restoration” means a filling, root filling, inlay, porcelain veneer or crown;

• “trauma” means damage to teeth, gingival tissues or alveoli caused by a force arising outside the mouth, resulting in mobility, luxation, subluxation or fracture of the hard tissues or injury to the soft tissues;

• “treatment” means all proper and necessary dental treatment which a provider of relevant primary dental services usually undertakes for a patient and which the patient is willing to undergo, including examination, diagnosis, advice on and planning of treatment, preventive care and treatment, periodontal treatment, conservative treatment, surgical treatment, the supply and repair of dental appliances and orthodontic appliances, orthodontic treatment, the taking of radiographs, the provision of sedation in connection with such treatment, the supply of listed drugs and the issue of prescriptions whether or not provided on referral to the provider of relevant primary dental services;

• “urgent treatment” means one or more of the treatments listed in Schedule 4 that are provided to a person in circumstances where—prompt care and treatment is provided because, in the opinion of the dental practitioner, that person’s oral health is likely to deteriorate significantly, or the person is in severe pain by reason of his oral condition; andcare and treatment is provided only to the extent that is necessary to prevent that significant deterioration or address that severe pain,and “urgent course of treatment” shall be construed accordingly;

• (2) A reference to the Secretary of State includes a reference to a Special Health Authority or NHS England exercising functions on the Secretary of State’s behalf.

Charges for the provision of dental services

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• (1) Subject to paragraph (2) below, a charge of the amount provided for in, and calculated in accordance with, regulation 4 or 12A(2) may be made and recovered in respect of—

• (a) the provision of relevant primary dental services; and

• (b) the supply of dental appliances under the Act otherwise than as part of relevant primary dental services.

• (2) No charge shall be made and recovered under paragraph (1) in respect of—

• (a) a supply under the Act, otherwise than as part of relevant primary dental services, of dental appliances to a person who has undergone operative procedures affecting the mandible, the maxilla or the soft tissues of the mouth as part of treatment for invasive tumours;

• (b) a prisoner;

• (c) the provision of dental public health services;

• (d) the removal of sutures; or

• (e) the examination and assessment of a patient leading to—

• (i) the issue of a prescription,

• (ii) the repair of a dental appliance,

• (iii) the arrest of bleeding, or

• (iv) the removal of sutures,

if, at the same time, no other treatment listed in Schedule 1, 1A, 2 or 4 is provided and no dental appliances listed in Schedule 3 are supplied.

Calculation of charges

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• (1) Subject to paragraph (6), a Band 1 charge, that is to say a charge of £27.40, may be made and recovered in respect of any course of treatment, the entirety of the components of which are set out in Schedule 1, provided as part of relevant primary dental services irrespective of whether any of the components of the course of treatment are also set out in Schedule 1A.

• (2) Subject to paragraph (6), a Band 2 charge, that is to say a charge of £75.30, may be made and recovered in respect of any course of treatment, one or more of the components of which are set out in Schedule 2, provided as part of relevant primary dental services, irrespective of whether the remainder of the components of the course of treatment are set out in Schedule 1 or 1A.

• (3) Subject to paragraph (6), a Band 3 charge, that is to say a charge of £326.70, may be made and recovered in respect of any course of treatment, one or more of the components of which are set out in Schedule 3, provided as part of relevant primary dental services, irrespective of whether the remainder of the components of the course of treatment are set out in Schedule 1 , 1A or 2.

• (4) A Band 3 charge, that is to say a charge of £326.70, may be made and recovered in respect of dental appliances supplied under the Act otherwise than as part of relevant primary dental services.

• (5) A Band 1 charge, that is to say a charge of £27.40, may be made and recovered in respect of any urgent course of treatment, the entirety of the components of which are set out in Schedule 4, provided as part of relevant primary dental services.

• (6) For the purposes of paragraphs (1) to (3) and (5) above, only one charge may be made for any one course of treatment or urgent course of treatment provided, notwithstanding that a number of individual treatments may be provided or dental appliances or orthodontic appliances supplied during that course of treatment and a number of individual treatments may be provided during that urgent course of treatment.

• (7) Where—

• (a) during a course of treatment a patient voluntarily withdraws from, or is withdrawn by the provider from, treatment; and

• (b) at least one of the components of that course of treatment has not been completed,

the charge which may be made and recovered for that course of treatment is the charge which is payable under paragraphs (1) to (3) and (5) of this regulation for the components of the course of treatment which have been completed but not for any components which are incomplete.

• (8) Where a dental appliance, an orthodontic appliance or a type of dental treatment is not listed in one of Schedules 1 to 4, the Secretary of State shall determine into which of the Schedules that appliance or treatment should fall so that the charge for a course of treatment or urgent course of treatment, or the supply of a dental appliance under the Act otherwise than as part of relevant primary dental services, can be determined in accordance with paragraphs (1) to (5) above.

Effect of referral to another provider of dental services on the calculation of charges

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Where a patient has commenced a course of treatment or urgent course of treatment with one provider of relevant primary dental services but is referred to—

• (a) an alternative provider of relevant primary dental services for part of the course of treatment or urgent course of treatment; or

• (b) a hospital or other service provider under Part 1 of the Act for the supply of a dental appliance as part of the course of treatment,

only one charge for the course of treatment or urgent course of treatment calculated in accordance with regulation 4 or 12A(2) may be made and recovered from the patient.

Circumstances in which charges cannot be made for treatment that occurs after a course of treatment is completed

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• (1) Subject to paragraphs (2) and (3), where a provider of relevant primary dental services has provided a restoration to a patient as part of a course of treatment or an urgent course of treatment for which the relevant charge calculated in accordance with regulation 4 has been made, or would have been made if the patient was not exempt from being charged, and within the relevant period that restoration has to be repaired or replaced to secure oral health, no charge may be made or recovered for the repair or replacement of the restoration.

• (2) Paragraph (1) shall not apply where—

• (a) within the relevant period, a person other than the provider of relevant primary dental services who carried out the original restoration has provided treatment on the tooth in respect of which the restoration was provided;

• (b) the patient was advised at the time of the restoration, and it was recorded on the patient record, that—

• (i) the restoration was intended to be temporary in nature, or

• (ii) a different form of restoration was more appropriate but, notwithstanding that advice, the patient insisted on the restoration that was provided; or

• (c) the repair or replacement is required as a result of trauma.

• (3) In this regulation, “the relevant period” means the 12 month period beginning on the date on which the restoration was provided and ceasing 12 months after that date.

• (4) Where a provider of relevant primary dental services has completed a course of treatment other than an urgent course of treatment but, within 2 months of that course of treatment being completed, the same provider determines that the patient requires further treatment which falls within the same or a lower charging band, calculated in accordance with paragraphs (1) to (4) of regulation 4 or regulation 12A(2), as the previous treatment and that further treatment is provided (whether or not within 2 months of that course of treatment being completed) by the same provider, no charge may be made or recovered in respect of that further treatment.

• (5) In paragraph (4), “completed” means the patient has been provided with each and every component of the course of treatment.

Conditions for exemption under the Act

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• (1) It is a condition of the exemption under paragraph 1(1) of Schedule 12ZA to the Act in respect of the provision of relevant primary dental services or a supply of a dental appliance under the Act otherwise than as part of relevant primary dental services—

• (a) that a written declaration on a form provided for that purpose by NHS England shall be made to the effect that that person is, at the relevant date, within one of the specified categories; and

• (b) where the Secretary of State, an NHS trust, an NHS foundation trust or NHS England so requires, that the specified evidence shall be supplied by or on behalf of that person.

• (2) In this regulation “the relevant date” means—

• (a) where a dental appliance is supplied under the Act otherwise than as part of relevant primary dental services, the date of the examination leading to the supply of the appliance; or

• (b) where relevant primary dental services are provided, the date of the initial examination and assessment leading to the provision of a course of treatment.

• (3) The declaration referred to in paragraph (1) shall be made by the person to whom the services are to be provided, except that where the request for services is made by another person on his behalf it shall be made instead by the person who requests the services.

• (4) Nothing in paragraph (1)(b) prevents the Secretary of State, an NHS trust, an NHS foundation trust or NHS England from accepting evidence other than the specified evidence as establishing that a person is within one of the specified categories.

• (5) In this regulation “the specified categories” means the categories of person specified in column 1 of Schedule 5 and “the specified evidence”, in relation to any of those categories, means the evidence specified in relation to it in column (2) of that Schedule.

Making and recovery of charges

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• (1) Where any charge is payable under regulation 4(4) in respect of the supply of a dental appliance under the Act otherwise than as part of relevant primary dental services, NHS England, NHS trust or NHS foundation trust —

• (a) may, on arranging to supply it, make the appropriate charge;

• (b) may, on supplying it or having it available for supply, recover the appropriate charge from the patient (if it has not previously been paid); and

• (c) shall, on receiving a sum for payment (in full or in part) of the charge payable under these Regulations, give a receipt for it on—

• (i) a paper form provided for that purpose by NHS England; or

• (ii) an electronic form which identifies the person who supplied the dental appliance, the patient, the amount of the charge paid and the date on which it is paid.

• (2) A provider of relevant primary dental services, in providing relevant primary dental services for which a charge may be made under regulations 4(1) to (3) , (5) or 12A(2) —

• (a) may, on arranging to provide a course of treatment or urgent course of treatment, make the appropriate charge;