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The National Health Service (General Dental Services) (Scotland) Regulations 2010

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Appeals from decisions of the SDPB

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29.—(1) This regulation applies to appeals which are permitted by paragraph (2) against decisions of the SDPB.

(2) Subject to paragraph (3), an appeal may be made to a Health Board in whose dental list the name of the contractor or dentist concerned is included—

(a)by any person aggrieved by a decision of the SDPB concerning the treatment or intended treatment by the dentist concerned of a patient; or

(b)by any contractor aggrieved by a decision of the SDPB concerning fees in respect of that contractor’s provision or intended provision of general dental services; or

(c)by any dentist aggrieved by a decision of the SDPB under regulation 27 (prior approval - patterns of treatment).

(3) Where the name of the contractor or dentist concerned in any appeal under paragraph (2) is included in the dental list of more than one Health Board, the appeal may be made—

(a)in the case of an appeal under paragraph (2)(a), to the appropriate Health Board in whose area the treatment or intended treatment of the patient is or would be provided;

(b)in the case of an appeal by a contractor under paragraph (2)(b) to the appropriate Health Board in whose area the treatment or intended treatment of the patient is or would be provided;

(c)in the case of an appeal by a dentist under paragraph (2)(c)—

(i)in which the decision of the SDPB under regulation 27 was based on its opinion that the dentist’s pattern of treatment in question differed substantially from the local pattern of treatment of other dentists, to the appropriate Health Board in whose area the pattern of treatment of other dentists has been the subject of comparison; or

(ii)in which the decision of the SDPB under regulation 27 was based on its opinion that the dentist’s pattern of treatment in question differed substantially from the pattern of treatment of other dentists throughout Scotland, to any of the Health Boards in whose dental list the dentist’s name is included,

and the Health Board to which the appeal is made is referred to in this regulation as “the relevant Health Board”.

(4) For the purposes of this regulation, the parties to an appeal are the SDPB and the appellant, being the aggrieved person, or contractor or dentist as the case may be.

(5) Notice of appeal shall—

(a)be given to the relevant Health Board in writing;

(b)except where the relevant Health Board is satisfied that the lateness of the appeal is due to illness or other reasonable cause, be given within 4 weeks from the date on which the appellant received notice of the decision of the SDPB;

(c)state the date on which the appellant was informed of that decision; and

(d)contain a concise statement of the facts and contentions upon which it is intended to rely.

(6) The relevant Health Board shall, within 4 weeks from the date of receipt of the notice of appeal, request from the SDPB a written statement of the reasons for its decision and the SDPB shall, within 4 weeks from the date of receipt of that request, send such a statement to the relevant Health Board.

(7) Subject to paragraph (8), the relevant Health Board shall consider the notice of appeal and the statement of the SDPB and—

(a)where the appeal is against a refusal of the SDPB to approve an estimate or claim for remuneration on the ground that the services to which the estimate or claim relate cannot be provided as part of general dental services, it shall refer the notice of appeal and the SDPB’s statement to the Scottish Ministers, and on referring the appeal the relevant Health Board shall inform the parties of the referral;

(b)where, in an appeal by a contractor against a decision of the SDPB concerning fees, the SDPB certifies in its statement that it authorised those fees and that they were fees or maximum fees prescribed by Determination I of the Statement of Dental Remuneration for the services provided or to be provided, the relevant Health Board shall dismiss the appeal forthwith unless it is of the opinion that it involves a dispute as to the item or sub-item of treatment in that Determination applicable to those services;

(c)except where an appeal is dismissed or referred in accordance with the preceding provisions of this paragraph, the relevant Health Board shall, within 4 weeks from the date of receipt of the SDPB’s statement, appoint—

(i)where the appeal is made under paragraph (2)(c), 3 dentists, and where such an appeal is made in connection with orthodontic treatment, one of the dentists shall be an orthodontist;

(ii)in an appeal under paragraph (2)(a) or (b), 2 dentists, and where such an appeal is made in connection with orthodontic treatment, one of the dentists shall be an orthodontist; and

(iii)a chairperson who is not a dentist and who may be legally qualified,

as referees to determine the appeal.

(d)the relevant Health Board shall select one of the dentists from a panel of dental practitioners who are engaged in the provision of general dental services and who is nominated by the area dental committee, failing which the area dental committee for the area of another Health Board.

(8) Where, after considering the notice of appeal and the statement of the SDPB, the relevant Health Board is of the opinion that the notice of appeal discloses no reasonable grounds of appeal or that the appeal is otherwise trivial or vexatious, the relevant Health Board may determine the appeal by dismissing it forthwith.

(9) Where the relevant Health Board dismisses an appeal under paragraph (7) or (8), it shall—

(a)send the parties a copy of the decision together with its reasons for it; and

(b)in the case of a dismissal under paragraph (7)(b), send the appellant a copy of the SDPB’s statement.

(10) Where an appeal is referred to the Scottish Ministers under paragraph (7)(a), the Scottish Ministers shall—

(a)determine the appeal in such manner as they think fit; and

(b)as soon as may be practicable after they have determined the appeal, which shall be final and conclusive, send the parties and the relevant Health Board a copy of their decision together with their reasons for it.

(11) Where, under paragraph (7)(c), the relevant Health Board appoints referees to determine the appeal, the Health Board shall—

(a)fix a date for the hearing of the appeal;

(b)at least 2 weeks before the hearing (or within such shorter period as the parties may agree), give notice in writing to the parties of the date, time and place of the hearing and of the names of the referees;

(c)at least 7 days before the hearing (or within such shorter period as the parties may agree), provide—

(i)the referees and the appellant with a copy of the SDPB’s statement; and

(ii)the referees and the SDPB with a copy of the notice of appeal.

(12) Where the parties to an appeal, to whom notice of a hearing has been sent under paragraph (11), notify the relevant Health Board in writing prior to the date of the hearing, that they do not intend to make oral representations at a hearing—

(a)the relevant Health Board shall inform the referees forthwith; and

(b)the referees shall thereafter determine the appeal without holding a hearing.

(13) Subject to paragraph (14), if in the course of a hearing a party introduces any issue which in the opinion of the referees was not sufficiently disclosed in the notice of appeal by the appellant or statement by the SDPB, the referees may as they think fit admit or refuse to admit such issue.

(14) Where the referees intend to admit an issue under paragraph (13), the hearing shall be adjourned for such period as the referees consider necessary unless the other party requests that the hearing should proceed and the referees agree to do so.

(15) As soon as may be practicable after being informed that—

(a)a hearing is not necessary; or

(b)a hearing has been held,

the referees shall determine the appeal and notify the relevant Health Board in writing of their decision, which shall be final and conclusive, and their reasons for it.

(16) After the relevant Health Board receives notice of the referees’ decision under paragraph (15), they shall, within 2 weeks from the date of receipt of that notice, send a copy of it to each of the parties.

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