GDC probes Practitioner Services

17 February, 2020 / indepth
 Will Peakin  

Regulator to investigate allegations that dentists were forced to repay fees ‘under duress’

As outlined in our news story, 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 case centres on the activities of the PSD 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
  • Demands for the return of fees paid more than five years previously; an invalid claim under Scottish law
  • Repayment of contested treatment fees being taken from current earnings, without consent; which is not permitted under Scottish law
  • PSD’s handling of the 80% ‘patient contribution’ portion of recovered fees, amounting to several hundred thousand pounds, which should have been returned to patients
  • Historical attempts by the Scottish Government to part-fund an increase in fees paid to dentists in 2015-16 using money previously recovered.

Publicly available details of PSD’s recovery activities go back as far as 2010. The annual report of the Scottish Dental Practitioners’ Board (SDPB) for 2010/11 notes: “Throughout the year, PSD – working to the policies of the SDPB – has challenged or declined prior approval requests of some £5m and recovered circa £900,000 from practitioners.”

Minutes from a meeting of the SDPB in August 2016 record the recovery of more than £500,000 from dentists over the previous year. In November 2017, committee members were informed: “Historically PSD had been baseline funded to recover £200k [a year]”. In May 2018, the minutes noted: “A baseline recoveries value of £200,000 had been agreed with the Scottish Government.”

Dentists contacted by this magazine have spoken of a “climate of fear” created by PSD during their interactions. “I felt that I was only agreeing to repay fees under duress,” said one. “It was a case of ‘co-operate, or we’ll start digging deeper’. Worse still, there was the constant threat of being referred to the GDC and possibly losing my livelihood.”

Now, two officials who work and have worked at the PSD have themselves been referred to the GDC. The move follows the loss by the PSD of a case at the Court of Session two years ago involving disputed recoveries and the PSD’s ‘walking away’ from another similar case at Edinburgh Sheriff Court in October last year.

In 2018, after a four-year dispute, Edinburgh dentist Joanna Adamczak-Gawrychowska successfully challenged the PSD’s attempt to recover more than £70,000. Following a Judicial Review at the Court of Session, Lord Arthurson described the case against her as “irrational and unfair” and based on a “miniscule sampling” of 33 patient record cards.

By the time she launched proceedings, PSD had recovered £48,000 from Ms Adamczak-Gawrychowska. Last October, the PSD walked away from a scheduled hearing at Edinburgh Sheriff Court at which they were attempting to recover £16,000 from Glasgow dentist Hugh Taggart. It was the culmination of an eight-year dispute in which Taggart was forced to sell two practices he owned, cash in pensions, and feared he would need to sell his home.

At one point during the dispute, PSD said that he was liable to repay more than £53,000 after initially being identified in 2011 as an “outlier” concerning the use of a particular treatment (the provision of acrylic occlusal splints). At the time, he provided 11 patient records cards, as requested by the PSD, but heard nothing until 2014 – when he was told that he had again been identified as an outlier.

On this second occasion, he was given 14 days to go through 20 years’ worth of patient record cards and submit each one involving the disputed treatment. Taggart challenged the demand and the PSD responded by asking for just 20 cards instead.

At the beginning of 2015, he attended two meetings at the PSD in Edinburgh where he had expected to go through the cards and discuss the validity of the treatment. Instead, he said, he was threatened with a wider investigation by the PSD – and referral to the GDC – if he did not repay the £50,000-plus sum demanded.

Without his consent, the PSD began deducting between £1,200 and £2,100 a month from future fee payments. Taggart lodged a writ at Edinburgh Sheriff Court challenging the deductions and they stopped. But the PSD’s legal team told Taggart’s lawyer that, while they believed his claims for payment were neither fraudulent nor inappropriate, he had not complied with “the spirit of the rules and regulations”; a claim which Taggart said would have been contested by an expert witness prepared to give evidence on his behalf.

Taggart was told that he would be reimbursed – but that legal action would then be taken to recover the sum all over again. His lawyer countered by arguing that the PSD had unlawfully taken money off future earnings without his consent and had breached the five-year limit on reclaiming a debt, by seeking money going back 20 years. The PSD backed down and agreed to repay Taggart, including interest, a sum of £27,000.

Bizarrely, the PSD continued with its counterclaim to recover the money. On three occasions a hearing date was set, but each time the PSD delayed proceedings. Finally, a four-day hearing was scheduled for 21 October last year, by which time the amount the PSD was seeking had fallen to £16,000.

A few days before the case was due to start, the PSD walked away – stating that there was no “public interest” in pursuing Taggart for such a small amount. It also agreed to pay him £18,000 in expenses. Investigators at the GDC are now likely to examine closely the email exchanges, public statements, and legal submissions of the PSD officials which form the basis of the referral to the GDC, in order that they can investigate the veracity of Taggart’s allegations and rule on the officials’ conduct. The minutes of the Scottish Dental Practice Board will also be scrutinised. They detail discussions about:

  • The practice of the PSD recovering patient contributions at the same time as expecting dentists to refund patients directly. In Taggart’s case the PSD was reclaiming around £2,700 in patient contributions before he issued his writ
  • The linking of recoveries to the future funding of dentists’ fees
  • The failure of the PSD to publish “plain English” guidance for dentists to reduce “mis-claiming and the need for recoveries”.

In his referral to the GDC, Taggart states: “The public has an expectation that dentists who are employed in a managerial position will act in accordance with the rules and regulations which all dental professionals are expected to adhere to and in addition will act to safeguard them.

“I feel that their conduct towards the general public and the dental profession, as illustrated in the minutes of the SDPB, and their conduct towards me is redolent of individuals who, on having had a public office conferred on them, abuse the authority that attends to the office.”

In addition to the responses to claims outlined in our news story, a spokesperson for the PSD said that, while publication of a guide for dentists had been discussed by the SDPB, it had been “agreed with the BDA/SDPC that a face to face approach would be more effective. Since then, we have run nine evening roadshows, 12 mandatory training sessions for dentists coming to Scotland, and increased engagement with vocational trainees.”

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