Fees reclaimed from dentists amid ‘climate of fear’
Regulator to investigate activities of Practitioner Services
The recovery of fees paid to dentists by NHS NSS Practitioner Services Division (PSD) is under scrutiny as the result of a referral to the General Dental Council (GDC).
The referral will centre on the activities of the PSD, Scottish Government policy regarding the funding of fees paid to dentists, and the conduct of two dentists in the division in helping to recover millions of pounds from practitioners over the past 15 years. The activities are claimed to include:
- The PSD working to a minimum recovery target of £200,000 a year
- The use of sampling, whereby a decision on the validity of thousands of treatments carried out over many years is based on the result of checking a very small number of patient records
- Dentists being threatened with referral to the GDC if they did not cooperate with the PSD and agree to repay fees
- The PSD’s handling of the 80 per cent ‘patient contribution’ portion of recovered fees, amounting to several hundred thousand pounds, which should have been returned to patients.
Now, two officials who work and have worked at the PSD have been referred to the GDC by Glasgow-based dentist Hugh Taggart. The move follows the PSD ‘walking away’ from a case, due to be heard at Edinburgh Sheriff Court in October last year, in which they were attempting to recover fees paid to Taggart, and the loss by the PSD of another case, at the Court of Session two years ago, involving disputed recoveries from an Edinburgh-based dentist.
Investigators at the GDC are likely to examine the email exchanges, public statements, and legal submissions of the PSD officials which form the basis of their referral to the GDC, so they can investigate the veracity of Taggart’s allegations and rule on the officials’ conduct.
The minutes of the Scottish Dental Practice Board, in which the activities of the PSD in recovering payments are detailed, will also be scrutinised. Dentists contacted by this magazine have spoken of a “climate of fear” being created by PSD during their interactions with the division over contested payments.
A spokesperson for the PSD said that the division did not work to a target or a minimum recovery amount. “This is a clear misunderstanding of how the system works,” he said. “The figure [of £200,000] is an expected outcome in a system in which it is accepted by all stakeholders that overpayments can occur. It represents less than 0.02 per cent of payments made.
“The Regulations [enacted by legislation in 2010] and the Payment Verification Protocol published by the Scottish Government accept that overpayments can occur and when they do, they should be recovered to the public purse. Practitioner Services would want the actual recovery figure to be zero, since it would mean all claims complied with the rules. This is not achievable, so some figure needs to be assessed so that we can report actual recoveries and whether they are within the expected levels.”
The spokesperson added that the Court of Session judgment “made clear that a robust system of sampling and extrapolation is a rational basis for recovering overpayments”. He said that in the case of Hugh Taggart, there was “no evidence” to support the claim that the dentist had been threatened with referral to the GDC if he did not cooperate with demands for repayment. A complaint was investigated at the time, he said, and not upheld.
He disputed the contention that demands for the return of fees paid more than five years previously was invalid under Scottish law. “Payments made under the Regulations are not subject to the five-year short prescription period. NSS has multiple opinions from senior QCs which advise that this is the case.”
It is understood, however, that in his referral to the GDC Taggart will point to the PSD’s initial attempt to examine 20 years’ worth of payments and, when challenged, the PSD subsequently restricted the contested period to five years – and agreed to repay fees it had reclaimed going back further than five years.
Regarding the 80 per cent patients’ portion of fees recovered, the spokesperson said: “We have a protocol for this and normally reach agreement with the dentist on how patient charges will be returned. In this particular case, we did not get as far as needing to invoke the protocol since we did not recover any patient contributions either in the court proceedings or otherwise.”
The spokesperson said that the two court cases involving contested fee recoveries should not be conflated. “The cases are not similar and decisions made in the Sheriff Court case were based on counsel advice and the Scottish Public Finance Manual, since the irrecoverable cost of the court case would be more than the value pursued in court.”
However, he added that as the result of the Court of Session judgment, the PSD is “updating [its] processes and expects to publish a new protocol by July”.
Read more: GDC to probe Practitioner Services