Financial threshold for general dentistry to be removed
It will replaced with a new prior approval system that focuses on clinical considerations.
The Scottish Government has announced that the current financial threshold for general dentistry will be removed and replaced with a new prior approval system that focuses on clinical considerations.
In 2023, the Government introduced significant reforms to the NHS dental payment system, moving to a high-trust, low bureaucracy model, which focuses on modernised service provision through clinical discretion and patient-centred care based on need.
Changes were made to the fee structure, designed to incentivise dentists to provide more NHS care and, in turn, improve patient access to services. At the time, the Government said that payment reform was intended as a first step in ensuring sustainability of NHS dental services.
Currently, the system includes a requirement on dentists to submit for prior approval any course of treatment where the cost will exceed £660. But following the introduction of payment reform, there has been an increased volume of low clinical risk treatment plans being submitted for prior approval as they exceed the financial limit.
As well as creating a higher workload for NSS clinical advisers, it has also made it more laborious for dentists to undertake treatment plans and can result in delays to necessary treatment for patients due to a financial limit rather than for any clinical considerations.
In a letter to NHS Board Chief Executives and Directors of Dentistry, Gillian Leslie, Scotland’s Chief Dental Officer (CDO), said that from 1 November, the Government will remove the current financial threshold for general dentistry, as set out in Schedule 4 of the Regulations.
It will be replaced with a new prior approval system that focuses on clinical considerations. Other methods of prior approval, such as the requirement for prior approval based on a practitioner’s patterns of treatment, will still remain in place.
“We have consulted the British Dental Association Scottish Dental Practice Committee on the amendments to the regulations and we will continue to engage with them during the implementation phase,” said the CDO.
The changes to prior approval do not apply to orthodontic services, and orthodontic courses of treatment will continue to be subject to the current financial threshold of £660.
New prior approval system
The new system will require prior approval for courses of treatment which contain those treatments, or combinations of treatment, which are considered to be higher clinical risk.
The CDO said that the Government had also taken the opportunity to explore the clinical risk that may exist where a clinician has limited experience of working within the Scottish primary care system. It has introduced a tiered system for individual clinicians, which will be applied to the basic clinical risk model. The treatment items and combination of treatments will be the same for both tiers, but the threshold limits may be different for each tier.
She added: “Ministers hope that by making these changes the provision of NHS dental services will be less onerous for dental teams, by removing the need to submit for prior approval for lower risk treatments whilst still ensuring there is appropriate governance for higher risk treatment plans. Ministers view this change as the next step in reform programme for NHS dental services, building on the successful fee reform changes in November 2023.”
“Practitioner Services will be leading on the implementation of the new prior approval arrangements. Further communications will follow as we move toward the implementation date and educational materials will be available through Turas in advance of the new system coming into effect.”