The National Health Service (General Dental Services Contracts) Regulations 2005

Citation, commencement and application1

Interpretation2

• “the Act” means the National Health Service Act 1977;

• F41“the 2006 Act” means the National Health Service Act 2006;

• F41“the 2012 Act” means the Health and Social Care Act 2012;

• “the 1990 Act” means the National Health Service and Community Care Act 1990;

• “additional services” means one or more of—

  1. a

     advanced mandatory services;

  2. b

     dental public health services;

  3. c

     domiciliary services;

  4. d

     orthodontic services; and

  5. e

     sedation services;

• “adjudicator” means the Secretary of State or a person or persons appointed by the Secretary of State under section 4(5) of the 1990 Act (NHS contracts) or paragraph 55(4) of Schedule 3 (NHS dispute resolution procedure);

• “advanced mandatory services” means any primary dental service that would fall within the services described in regulation 14 (mandatory services), but by virtue of the high level of facilities, experience or expertise required in respect of a particular patient, is provided as a referral service;

• “Band 1 course of treatment” means a course of treatment, including a course of treatment consisting of urgent treatment, provided to a patient in respect of which a Band 1 NHS Charge is payable pursuant to the NHS Charges Regulations, or would be payable if the patient was not an exempt person;

• “Band 2 course of treatment” means a course of treatment provided to a patient in respect of which a Band 2 NHS Charge is payable pursuant to the NHS Charges Regulations, or would be payable if the patient was not an exempt person;

• “Band 3 course of treatment” means a course of treatment provided to a patient in respect of which a Band 3 NHS Charge is payable pursuant to the NHS Charges Regulations, or would be payable if the patient was not an exempt person;

• “banded course of treatment” meansF99, subject to regulation 18C, a Band 1, Band 2 or Band 3 course of treatment;

• “bank holiday” means any day that is specified or proclaimed as a bank holiday in England pursuant to section 1 of the Banking and Financial Dealings Act 1971 M4;

• F145...

• “bridge” means a fixed or removable bridge which takes the place of any teeth;

• F100“capitated patient” has the meaning given in regulation 18C;

• F15“Capitation and Quality Scheme Agreement” means an agreement containing such terms and conditions relating to the provision of primary dental services as are required by, and which is made in accordance with, directions given by the Secretary of State under section 8 of the National Health Service Act 2006;

• F42“Capitation and Quality Scheme 2 Agreement” means an agreement containing such terms and conditions relating to the provision of primary dental services as are required by, and which is made in accordance with, directions given by the Secretary of State under section 114A of the 2006 Act 2006;

• F19“Care Quality Commission” means the body established by section 1 of the Health and Social Care Act 2008 (The Care Quality Commission);

• “case assessment”, in respect of an orthodontic course of treatment, means a clinical examination of the patient, including the taking of such radiographs, colour photographs and models as are required in order to determine what orthodontic treatment (if any) is to be provided to the patient;

• F105“CDS prototype contractor” means a contractor who has elected to enter into a prototype agreement under which primary dental services are secured for, and provided to, persons who cannot easily access such services;

• “charge exempt course of treatment” means a course of treatment that involves the examination and assessment of a patient leading to—

  1. a

     the issue of a prescription;

  2. b

     the repair of a dental appliance;

  3. c

     the arrest of bleeding; or

  4. d

     the removal of sutures,

  which, by virtue of regulation 3(2)(d) or (e) of the NHS Charges Regulations, is provided free of charge to the patient;

• “charity trustee” means one of the persons having the general control and management of the administration of a charity;

• “child” means a person who has not attained the age of 16 years;

• “complete”, in relation to—

  1. a

     a course of treatment, means that—

     1. i

        where no treatment plan has to be provided in respect of a course of treatment pursuant to paragraph 7(5) of Schedule 3 (treatment plans), all the treatment recommended to, and agreed with, the patient by the contractor at the initial examination and assessment of that patient has been provided to the patient; or

     2. ii

        where a treatment plan has to be provided to the patient pursuant to paragraph 7 of Schedule 3, all the treatment specified on that plan by the contractor (or that plan as revised in accordance with paragraph 7(3) of that Schedule) has been provided to the patient; and

  2. b

     an orthodontic course of treatment, means that—

     1. i

        where the contractor determines in accordance with paragraph 4(3) of Schedule 1 (patients to whom orthodontic treatment may be provided) that no orthodontic treatment should be provided following the case assessment, the completion of the case assessment; or

     2. ii

        where the contractor has determined that orthodontic treatment should be provided following the case assessment, all of the orthodontic treatment specified on the orthodontic treatment plan by the contractor pursuant to paragraph 6 of Schedule 1 (orthodontic treatment plans) (or that plan as revised in accordance with paragraph 6(3) of that Schedule) has been provided to the patient,

  and “completed” shall be construed accordingly;

• “contract” means, except where the context otherwise requires, a general dental services contract under section 28K of the Act M5 (general dental services contracts: introductory);

• F81“course of treatment” means—

  1. a

     an examination of a patient, an assessment of that patient’s oral health, and the planning of any treatment to be provided to that patient as a result of that examination and assessment; and

  2. b

     the provision of any planned treatment (including any treatment planned at a time other than the time of the initial examination) to that patient up to the date on which—

     1. i

        each and every component of the planned treatment has been provided to the patient, or

     2. ii

        the patient either voluntarily withdraws from, or is withdrawn by the provider from, treatment,

  by, unless the context otherwise requires, one or more providers of primary dental services, except that it does not include the provision of orthodontic services or dental public health services and, F101where the course of treatment is an interim care course of treatment provided under a prototype agreement or a Capitation and Quality Scheme 2 Agreement in the context of regulation 12A of the NHS Charges Regulations (charges in respect of primary dental services provided under a prototype agreement or under a Capitation and Quality Scheme 2 Agreement), it does not include the treatment mentioned in sub-paragraph (a);

• “dental appliance” means a denture or bridge and for the purposes of this definition, a denture includes an obturator;

• “dental care professional” means a person whose name is included in the register of dental care professionals or on the appropriate roll for dental auxiliaries established in accordance with Part II of the Dental Auxiliaries Regulations 1986 M6;

• “dental corporation” means a body corporate carrying on the business of dentistry in accordance with the Dentists Act;

• F43“dental performers list”, means the list of dental practitioners maintained by F147NHS England in accordance with regulations made under section 106 of the 2006 Act;

• “dental public health services” means services provided by the contractor by virtue of section 16CB(4)(c) of the Act M7 (dental public health);

• “Dentists Act” means the Dentists Act 1984 M8;

• “Dentists Act Order” means the Dentists Act 1984 (Amendment) Order 2005 M9;

• “Dentists Register” means the register maintained by the General Dental Council pursuant to section 14 of the Dentists Act M10 (the dentists register and the registrar);

• “domiciliary services” means a course of treatment, or part of a course of treatment, provided at a location other than—

  1. a

     the practice premises of any provider of primary dental services;

  2. b

     a mobile surgery of any provider of primary dental services; or

  3. c

     a prison;

• “exempt person” means a person who is, by virtue of either Schedule 12ZA to the Act M11 (dental charging: exemptions) or the NHS Charges Regulations, exempt from the need to pay an NHS Charge in respect of the services he has received under the contract;

• “family member” means—

  1. a

     a spouse;

  2. b

     a civil partner;

  3. c

     a person whose relationship with the F1... patient has the characteristics of the relationship between husband and wife or civil partners;

  4. d

     a parent or step-parent;

  5. e

     a son;

  6. f

     a daughter;

  7. g

     a child of whom the person is—

     1. i

        the guardian; or

     2. ii

        the carer duly authorised by the local authority to whose care the child has been committed under the Children Act 1989 M12; or

  8. h

     a grandparent;

• “FHSAA” means the Family Health Services Appeal Authority constituted under section 49S of the Act M13 (the Family Health Services Appeal Authority);

• “financial year” means a period of 12 months ending with 31st March in any year;

• “health care professional” has the same meaning as in section 28M of the Act M14 (persons eligible to enter into GDS contracts) and “health care profession” shall be construed accordingly;

• “health service body” has, unless the context otherwise requires, the meaning given to it in section 4(2) of the 1990 Act M15 (NHS contracts);

• “licensing body” means any body that licenses or regulates any profession;

• “listed”, in relation to drugs, medicines or appliances, means such drugs, medicines or appliances as are included in a list for the time being approved by the Secretary of State for the purposes of section 41(1)(c) of the Act M16 (arrangements for pharmaceutical services);

• “mandatory services” means the services described in regulation 14;

• “mobile surgery”, except where expressly provided otherwise in these Regulations, means any vehicle in which services under the contract are to be provided;

• “national disqualification” means—

  1. a

     a decision made by the F11First-tier Tribunal under section 49N or under regulations corresponding to that section made under section 28X(4) of the Act M17 (national disqualifications);

  2. b

     a decision under provisions in force in Scotland or Northern Ireland corresponding to section 49N of the Act; or

  3. c

     a decision by the NHS Tribunal which is treated as a national disqualification by the FHSAA by virtue of regulation 6(4)(b) of the Abolition of the National Health Service Tribunal (Consequential Provisions) Regulations 2001 M18 or regulation 6(4)(b) of the Abolition of the National Health Service Tribunal (Consequential Provisions) Regulations 2002 M19;

• “NHS Charge” means a charge made to the patient for provision of services pursuant to the NHS Charges Regulations;

• “NHS Charges Regulations” means the National Health Service (Dental Charges) Regulations 2005 M20;

• “NHS contract” has the meaning assigned to it in section 4(1) of the 1990 Act;

• “NHS dispute resolution procedure” means the procedure for disputes specified in paragraphs 55 and 56 of Schedule 3;

• F146“NHS England” means the body corporate established under section 1H of the 2006 Act;

• “NHS Tribunal” means the Tribunal constituted under section 46 of the Act M21 for England and Wales, and which, except for prescribed cases, had effect in relation to England only until 14th December 2001 and in relation to Wales only until 26th August 2002 M22;

• “normal surgery hours” means the times at which the contractor has agreed with F147NHS England (and specified in the contract) that the surgery will be open to patients for the provision of services;

• F44. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• “orthodontic appliance” means a device used in the mouth to move or immobilise the teeth in order to correct or prevent malocclusion;

• “orthodontic course of treatment” means—

  1. a

     a case assessment of a patient; and

  2. b

     the provision of any orthodontic treatment that the contractor determines should be provided to the patient in accordance with Part 2 of Schedule 1 (orthodontic services);

• “orthodontic services” means the provision of orthodontic courses of treatment or the services referred to in paragraph 5(2) of Schedule 1 (repairs);

• “orthodontic treatment” means treatment of, or treatment to prevent, malocclusion of the teeth and jaws, and irregularities of the teeth;

• “parent”, in relation to any child, means a parent or other person who has parental responsibility for that child;

• “patient” means, unless the context otherwise requires, a person to whom the contractor is providing services under the contract;

• “patient record” means a form supplied by F147NHS England for the purpose of maintaining a record of treatment;

• “practice” means the business operated by the contractor for the purpose of delivering services under the contract;

• “practice premises”, except where expressly provided otherwise in these Regulations, means an address specified in the contract as one at which services are to be provided under the contract but does not include a mobile surgery;

• “prescriber” means a dental practitioner who is either engaged or employed by the contractor or is a party to the contract;

• “primary care list” means—

  1. a

     a list of persons performing primary medical or dental services under section 28X of the Act;

  2. b

     a list of persons undertaking to provide general ophthalmic services or, as the case may be, pharmaceutical services prepared in accordance with regulations made under section 39, 42 or 43 of the Act M23;

  3. c

     a list of persons approved for the purposes of assisting in the provision of any services mentioned in paragraph (b) or (d) prepared in accordance with regulations made under section 43D of the Act M24;

  4. d

     a list of persons who undertook to provide general medical services or general dental services prepared in accordance with regulations made under section 29 or 35 of the Act M25;

  5. e

     a services list which fell within the meaning of section 8ZA of the National Health Service (Primary Care) Act 1997 M26;

  6. f

     a list corresponding to a services list prepared by virtue of regulations made under section 41 of the Health and Social Care Act 2001 M27; or

  7. g

     a list corresponding to any of the above lists in Scotland or Northern Ireland;

• F45. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• “prison” includes a young offender institution but not a secure training centre or a naval, military or air force prison, and for the purposes of this definition—

  1. a

     “secure training centre” means a place in which offenders subject to detention and training orders F136within the meaning given by section 233 of the Sentencing Code may be detained and given training and education and prepared for their release; and

  2. b

     “young offender institution” means a place for the detention of offenders sentenced to detention in a young offender institution or to detention in a young offender institution as part of a longer custodial sentence, including custody for life;

• “private”, in the context of services or treatment, means otherwise than under the contract or Part 1 of the Act, and “privately” shall be construed accordingly;

• “professional registration number” means the number against a dental practitioner's name in the Dentists Register;

• F102“prototype agreement” means a contract temporarily varied as part of the Prototype Agreements Scheme which contains—

  1. a

     the terms and conditions required under the Prototype Directions; and

  2. b

     the terms and conditions required under these Regulations;

• F102“the Prototype Directions” means the National Health Service (Dental Services) (Prototype Agreements) Directions 2015;

• F102“the Prototype SFE” means the Prototype Agreements Scheme Statement of Financial Entitlements;

• “referral notice” means the notice referred to in paragraph 9(2)(a) of Schedule 3 (referral to another contractor, a hospital or other relevant service provider for advanced mandatory, domiciliary or sedation services);

• “referral service” means one or more of advanced mandatory services, domiciliary services or sedation services provided by the contractor to a patient who has, during a course of treatment, been referred to the contractor by—

  1. a

     another contractor; or

  2. b

     another provider of primary dental services under Part 1 of the Act,

  for the provision of one or more of those services as part of that course of treatment;

• “referral treatment plan” means a treatment plan provided pursuant to paragraph 2(1) of Schedule 1 or that plan as varied in accordance with paragraph 2(3) of that Schedule;

• “register of dental care professionals” means the register maintained by the General Dental Council under section 36B of the Dentists Act M28 (the dental care professionals register);

• F46. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• “sedation services” means a course of treatment provided to a patient during which the contractor administers one or more drugs to a patient, which produce a state of depression of the central nervous system to enable treatment to be carried out, and during and in respect of that period of sedation—

  1. a

     the drugs and techniques used to provide the sedation are deployed by the contractor in a manner that ensures loss of consciousness is rendered unlikely; and

  2. b

     verbal contact with the patient is maintained in so far as is reasonably possible;

• F20“service provider” has the same meaning as in regulation 2 of the Care Quality Commission (Registration) Regulations 2009 (interpretation);

• “trauma” means damage to teeth, gingival tissues or alveoli caused by a force arising outside the mouth, resulting in mobility, luxation, subluxation or fracture of the hard tissues or injury to the soft tissues;

• “unit of dental activity” means the unit of activity which is in the contract used to—

  1. a

     express the amount of; and

  2. b

     measure in accordance with Part 1 of Schedule 2 the provision of,

  mandatory services and advanced mandatory services provided under the contract;

• “unit of orthodontic activity” means the unit of activity which is in the contract used to—

  1. a

     express the amount of; and

  2. b

     measure in accordance with Part 2 of Schedule 2 the provision of,

  orthodontic services provided under the contract;

• “urgent treatment” means a course of treatment that consists of one or more of the treatments listed in Schedule 4 to the NHS Charges Regulations (urgent treatment under Band 1 charge) that are provided to a person in circumstances where—

  1. a

     a prompt course of treatment is provided because, in the opinion of the contractor, that person's oral health is likely to deteriorate significantly, or the person is in severe pain by reason of his oral condition; and

  2. b

     treatment is provided only to the extent that is necessary to prevent that significant deterioration or address that severe pain; and

• “working day” means any day apart from Saturday, Sunday, Christmas Day, Good Friday or a bank holiday.

F33Conditions: introductory3

General prescribed conditions relating to all contracts4

Additional prescribed conditions relating to contracts with dental corporations5

Reasons6

Appeal7

Pre-contract disputes8

Health service body status9

Parties to the contract10

NHS contracts11

Contracts with individuals practising in partnership12

Duration13

Mandatory services14

Additional services15

Services: general16

Units of dental activity17

Units of orthodontic activity18

F95Units of dental activity for contractors who elect to enter into a prototype agreement18A

F95Capitated patient figures for contractors who elect to enter into a prototype agreement18B

F95Capitated patients18C

Under provision of units of dental activity or units of orthodontic activity19

Domiciliary services and sedation services20

that involve the provision of domiciliary services or sedation services—

Finance21

F104Publication of information about earnings21A

Fees, charges and financial interests of the contractor22

Arrangements on termination23

Other contractual terms24

Variation of contractual terms in respect of election to enter into a Capitation and Quality Scheme AgreementF5524A

Variation of contractual terms in respect of election to enter into a Capitation and Quality Scheme 2 AgreementF11624B

F96Variation of contractual terms in respect of election to enter into a prototype agreement24C

F130Suspension of contract terms or of enforcement of contract terms while a disease is or in anticipation of a disease being imminently pandemic etc.24D

Commencement of contract25