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Patient banding charges leaked
16th Jun 2005
It is well over a year since the patients’ Czar, Harry Cayton, submitted his report on a new patients’ charges regime to ministers. It is possible that, if and when Rosie Winterton speaks to the LDC Conference (this is uncertain at the time of writing), she will make an announcement, but don’t hold your breath. Rumours abound from knowledgeable sources that the Cayton report may well be dumped in the aftermath of the general election. In the meantime details of the proposals have been leaked to Dentistry and we must question why ministers have taken so long to decide on them. We understand that the previous secretary of state, John Reid, was happy with them, but felt that they could be ‘misinterpreted’ by hostile elements in the media in the run up to an election. We now have a new health secretary, Patricia Hewitt, who is, she says, ready to listen. There is, however, some urgency about making a decision. The present charges system relates to output and under PDS this has declined steeply bringing about a shortfall in charge income. Under PDS, however, the emphasis is not on output of item of service but in numbers of patients seen. What is needed to maintain charge income is a system that recognises numbers of courses of treatment and their complexity. That is what Harry Cayton’s group gave them. They rejected the present scheme based on item of service and also two other possibilities. Patients will not be able to pay an annual charge as they can with prescription charges. This could have been useful for those with, say, chronic periodontal disease where frequent visits are indicated. They also appear to have rejected a suggestion where there would be no charge for laboratory items, but the patient would pay a sum equivalent to the laboratory bill, allowing choice of both laboratories and type of appliance. They opted instead for a system of payment by courses of treatment, but banded according to their complexity. In band 1 were treatments described as ‘no dental intervention’, such as examination, radiographs and simple scaling. Around half of all courses of treatment would currently fall into that category. If intervention was needed then the patient would move into either band 2 or 3. Band 2 would contain all interventive treatments, except those requiring laboratory work, which would be put in band 3. They also proposed a band 4 (at the same rate as band 1) for ‘occasional treatments’. As now, dentists would collect patient charges due with the amount that should have been collected being deducted from the dentists’ monthly contract payment. The amount paid depends not on how many treatments are given, but the band in which the most complex treatment lies. Charges are not cumulative; if a patient has treatments in both bands 1 and 2 then they pay only the band 2 charge. Harry Cayton’s group did not recommend a specific level of charge for each band, but given the requirement to raise £500m a year, gave a number of different options that would achieve this level. However charges in band 1 would lie between £10-£18, those in band 2 £30-£35 and band 3 £120-£140. One consequence would be that the maximum charge would come down dramatically to around £130, but the charge for exam, scale and single filling might rise to £35. John Reid said, in January, that it would go out for public consultation this summer. The decision is now his successor’s. There will be winners and losers in any system and opponents of the Government will emphasise the losers and describe the new regime as a stealth tax. But that is the nature of politics. One alternative of course would be to withdraw NHS dentistry from those who pay charges, which would make them redundant. Is that what was meant in the Labour party manifesto as a ‘fundamental review of the scope and resourcing of NHS dentistry’?
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