The National Health Service (Service Committees and Tribunal) Regulations 1992

Appeals from decisions of the Board

19.—(1) Where—

(a) any person is aggrieved by a decision of the Board concerning the treatment or intended treatment of a patient as part of general dental services; or

(b) any dentist is aggrieved by a decision of the Board concerning fees payable to him in respect of his provision or intended provision of general dental services,

that person or, as the case may be, that dentist may, in accordance with paragraphs (3) and (4) appeal against the Board’s decision to the FHSA administering the arrangements under which the services were, or were intended to be, provided.

(2) Any dentist who is aggrieved by a decision of the Board under regulation 29 of the Dental Regulations (prior approval — patterns of treatment) may, in accordance with paragraphs (3) and (4), appeal against that decision—

(a) where the name of the dentist is included in the dental list of only one FHSA, to that FHSA;

(b) where the name of the dentist is included in the dental list of more than one FHSA, to any such FHSA.

(3) An appeal under paragraph (1) or (2) shall be brought by giving notice of appeal in writing to the FHSA within 30 days of the date on which the decision of the Board was sent to the aggrieved person.

(4) A notice of appeal under paragraph (3) shall—

(a) contain a concise statement of the facts and contentions upon which the appellant intends to rely; and

(b) be given by or with the authority of the aggrieved person, unless—

(i) the aggrieved person is, by reason of age, sickness or other infirmity, incapable of acting, in which case notice of appeal may be given by some other person on his behalf although without his authority;

(ii) the appeal is brought under paragraph (1)(b) and concerns the fees of a dentist who has died, in which case the notice of appeal may be given by the personal representatives of that dentist.

(5) The FHSA shall, within 30 days of receiving a notice of appeal, request from the Board a written statement of the reasons for its decision, and the Board shall within 30 days of being sent the request send such a statement to the FHSA.

(6) The FHSA shall consider the notice of appeal and the Board’s statement and—

(a) where, after consulting the Local Dental Committee, the FHSA is of the opinion that the notice discloses no reasonable grounds of appeal, or that the appeal is otherwise vexatious or frivolous, it may dismiss it forthwith;

(b) where the appeal is against a refusal of the Board to approve a claim for remuneration or an estimate on grounds that the services to which the claim or estimate relates cannot be provided as part of general dental services, the FHSA shall refer the notice of appeal and the Board’s statement to the Secretary of State, and shall inform the parties in writing that it has done so;

(c) where—

(i) an appeal is brought under paragraph (1)(b) against a decision of the Board concerning a dentist’s fees, and

(ii) the Board has certified in its statement under paragraph (5) that it has authorised those fees and that they were the fees or maximum fees prescribed by Determination I of the Statement of Dental Remuneration for the services provided or to be provided,

the FHSA shall dismiss the appeal forthwith unless it is of the opinion that the appeal involves a dispute as to the item or sub-item of treatment in that Determination applicable to the services provided or intended to be provided;

(d) except where an appeal is dismissed or referred in accordance with the preceding provisions of this paragraph, the FHSA shall, within 30 days of being sent the Board’s statement under paragraph (5), appoint, in accordance with paragraph (7)—

(i) where the appeal is brought under paragraph (2), three dentists,

(ii) in any other case, two dentists,

as referees to determine the appeal.

(7) One of the dentists appointed for the purposes of paragraph (6)(d) shall be selected from a panel of dentists who—

(a) are, or have been, engaged in the provision of general dental services; and

(b) have been nominated to the panel by the Local Dental Committee or by the Local Dental Committee constituted for another locality.

(8) Where the FHSA dismisses an appeal under paragraph (6) it shall give notice in writing to the person who brought the appeal and to the Board that the appeal has been dismissed, and, where the appeal is dismissed under sub-paragraph (c) of that paragraph, the FHSA shall include with the notice to the appellant a copy of the Board’s statement under paragraph (5) and a statement of its reasons for dismissing the appeal.

(9) Where an appeal is referred to the Secretary of State, he shall determine it in such manner as he thinks fit, and shall give notice of his decision, and of the reasons for it, to the appellant, the Board and the FHSA.

(10) Where referees are appointed under paragraph (6)(d) they shall, subject to paragraph (12), hear the representations of the parties on a date appointed by the FHSA for that purpose, and the FHSA shall—

(a) not less than 14 days before that date (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; and

(b) not less than 7 days before that date (or within such shorter period as the parties may agree), provide the referees and the appellant with a copy of the Board’s statement and the notice of appeal.

(11) A party to an appeal which is to be determined by referees following a hearing shall not be entitled to rely upon any facts or contentions not contained in the notice of appeal or the statement of the Board unless—

(a) that party gives notice in writing of those facts or contentions to the referees and to the other party to the appeal at least 7 days before the date of the hearing; or

(b) the referees consent (either before or during the hearing).

(12) Where both parties to an appeal have given written notice to the FHSA that they do not intend to make representations at a hearing, the FHSA shall inform the referees accordingly, and the referees shall determine the appeal without a hearing.

(13) The referees shall within 7 days after determining an appeal give notice in writing to the FHSA of their decision and of the reasons for it, and the FHSA shall within 14 days of receiving the notice send copies of it to the parties.

(14) For the purposes of this regulation, the parties to an appeal are the Board and the appellant, that is to say the aggrieved person or, where another person has given notice of appeal in accordance with paragraph (4), that other person.