Can the DPA reduce a clawback of £100,000 to £10,000, simply by assisting in negotiation with a Primary Care Trust? Here are some examples taken forward by the DPA.

The DPA supports and assists members—and has done so since 1954. You may not know that this service is available or you may think that you would never need it, but since the introduction of the new NHS contract in April 2006, the number of members seeking assistance has risen. Prior to the new contract most things were decided nationally but more recently we have had to focus less on the national and more on the regional, giving the DPA’s role as an association a new purpose and relevance.

Many of the enquiries are employment-related problems which are mainly disciplinary issues. You can save a lot of time and money by familiarising yourself with the Advisory Conciliation and Arbitration Services’ Web site at ACAS Their leaflet Disciplinary and Grievance Procedures is downloadable and should be the starting point for solving any problem. They also have a Helpline on 08457 47 47 47.

If you do not have a contract with your associate/performers or staff, the DPA will still assist you but you will be starting at a disadvantage as the terms of any contract which is not in writing ends up as an expensive slanging match between the two parties. The chances are you will have to settle against your better judgement simply on the ground of cost. Free contracts are available from the Office on 0207 636 1072 so why not put your employment affairs in order?

They may know little about dentistry, but Primary Care Trusts and Local Health Boards generally have a far greater knowledge and expertise on statutory procedure. By asking for assistance from the DPA you put your practice back on an even footing in negotiations. In many cases the fact that a dentist is backed by his or her professional association is conclusive in the dentist’s favour. We have been instrumental in arguing members’ cases where unreasonable demands or interpretations have been made, particularly in the case of clawback. A good starting point is to read the contract you were given by the PCT. If you need to go further than that (for example to refer to the GDS or PDS Regulations or the Statement of Financial Entitlement) we can assist you.

Here is a selection of cases as examples

  • Assisting retired members.
  • Advised member on current status of Seniority Payments.
  • A new member of staff announced after two weeks’ employment that she was 8-10 weeks pregnant and could not have the vaccinations or commence the training necessary to work in the practice. Referred to a solicitor competent in the relevant regional jurisdiction for free initial advice.
  • Member is an associate dentist but in recent months has had very few patients provided by principal (dental body corporate). He has found alternative and better position but the principal refused to accept two instead of the required three months’ notice. Advised on how to reach compromise with principal using failure to supply patients as counter-claim.
  • Assisted retired dentist with advice on reclaiming alleged underpayment of £100,000 caused by permanent health insurer arbitrarily withdrawing benefit, claiming dentist was fit to return to work.
  • Interview for Sky News on Hungarian ‘tentists’ who are carrying out examinations and treatment planning and recommending patients travel to Budapest, from a tent in Lincoln.
  • Advised member on how to dispose of 14 lb of unwanted mercury.
  • A member was working as an associate having sold his practice to a body corporate. He was unsure what his responsibilities were towards his patient list once he retired. We advised on the notice required for both LHB and corporate body and the division of responsibility for the continuation of treatment and notifying the patients.
  • A member was accused, convicted and cautioned for ‘splitting’ courses of treatment without being given any evidence or being asked to comment on any of the cases reviewed by the PCT. Drafted a letter of reply offering to hold a meeting to review the cases, to explain the unique local factors involved and insisting that the PCT justifies its findings.
  • A PCT was under pressure to hold a performance review meeting as the caseworker was due to take maternity leave—leaving insufficient time for member to work with the DPA to prepare a complete response to the PCT’s concerns. We assisted the member to postpone the meeting and to prepare a written response.
  • A part-time receptionist was authorised to take home the practice takings overnight but did not return a substantial amount of cash after a holiday and gave various reasons for not returning to work. We referred the member to an employment lawyer for free advice.
  • A member had verbal agreement with PCT in year one of the new contract to carry out a small amount of orthodontic activity. This was disregarded by the PCT for the purposes of calculating compliance in year two, leading to an alleged underperformance. Advice was given on how to respond to the Primary Care Trust’s clawback letter.
  • An enquiry regarding payment of superannuation to performers was referred to an experienced Council Member for advice.
  • A member’s technician (a keen advocate of direct reimbursement) applied to the PCT for direct payment of invoices, making a case that the member was a habitual late payer. The PCT used provisions in the PDS contract to suspend the contract, citing likely material damage to the PCT from the provider’s exposure to debts. The DPA attended the meeting with the PCT with the member, explained usual and customary practice with regard to paying technicians and the importance of setting off credit notes against any outstanding balance. The contract was reinstated.
  • A former member was assisted with advice regarding retirement, enforced by his PCT against his wishes at the age of 65.
  • A member had integrated his practice into a larger practice with the promise that his patients would remain his. This promise was subsequently broken when he decided to leave. Advice was sought on terminating his associate agreement. After examination of his contract and additional documents we provided a pro-forma letter setting out his rights.
  • Member was in dispute with the PCT due to them not offering a new contract before March 31st. An appeal letter was drafted and sent on behalf of member. A chaser letter was also sent. Advice was also given on a merger of two practices.

Pre-2006 NHS contract

  • Advice was sought on a nPDS contract and associated material involved in the negotiation. Clarification was needed with regards to his UDA value and funding for VT training among others. Advice and instruction were given on how to proceed with the negotiation.
  • Advice was sought on the negotiation of a child-only GDS/PDS contract. Supporting documents including emails, letters and spreadsheets were analysed, and advice and instruction were given on how to proceed with the negotiation; namely whether to take a PDS or GDS contract, the particular wording of the contract and a timetable of action.
  • Advice was given by email about contract negotiation with the PCT, in particular the wording of letters.
  • Email correspondence. The PCT alleged that the practice’s NHS charge revenue was too low, despite the member explaining that they took on a great number of exempt patients. The member was then offered a contract value 55% less that his current one. Advice was given on how to negotiate with the PCT, how to understand the new system of Units of Dental Activity and their value and a timetable of action set out.
  • The Primary Care Trust did not agree to include orthodontics in the member’s PDS agreement arguing insufficient numbers of cases to demonstrate minimum level of competency and that the patients treated would be likely to fall below the IOTN threshold. Advice given and contract signed in dispute.
  • Advice sought on negotiating a higher value for the practice’s contract due to staffing anomalies in the test period. The DPA attended a negotiation meeting with PCT. The contract was signed in dispute.
  • Advice sought on allocation of UDAs and wages to associate. Advice was given on the nature of attendance (employed vs self-employed). Support was given for ‘top-slicing’ the associate’s contract value. The DPA’s performer employment contracts were implemented and a draft appeal letter over the associate’s contract value sent.
  • Extensive assistance was given with negotiation with the PCT on a practice-based GDS contract. There were discrepancies in the offer due to the absence of an associate and the employment of a new associate. The PCT wanted to make the practice take patients from the NHS Direct waiting list instead of their own waiting list. This was disputed. The DPA attended a negotiation meeting with the PCT and advice was given to the member on how to proceed.

And finally…

  • Negotiation with PCT over new PDS contract. Attendance at two meetings with PCT and drafting of subsequent correspondence. Detailed arguments on the unsuitability of a standard GDS contract for the member. Extensive dispute with PCT over payments made in previous financial years and alleged overpayment of £100,000 by the PCT and DPB. Liaised with member’s solicitor. All correspondence drafted and sent. Advice on negotiating a reduction in overpayment, which was eventually accepted by the PCT to be £10,000.

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