General Dental Services Regulations (Northern Ireland) 1993

PART IV REMUNERATION OF DENTISTS

Statement of Dental Remuneration

19.—(1) The Department shall after consultation with such organisations as appear to it to be representative of persons providing general dental services make provision for each of the matters set out in column (2) of the Table below in a determination and each determination shall bear the number in column (1) of that Table which corresponds to the subject matter of the determination.

TABLE

(1)	(2)
Determination	Subject Matter of Determination
I	A Scale of Fees which shall prescribe the remuneration to be paid to a dentist, other than a salaried dentist, for care and treatment under a continuing care arrangement or a capitation arrangement, treatment on referral and occasional treatment and the conditions of payment of remuneration;
II	Rates of remuneration for a salaried dentist and for the provision of emergency dental services;
III	Seniority payments;
IV	Vocational training allowances;
VI	Maternity payments;
VII	Long term sickness payments;
VIII	Postgraduate education allowances;
IX	Reimbursement of non-domestic rates.

(2) The Department shall publish the determinations in a statement called the Statement of Dental Remuneration.

(3) The Department—

(a) may amend the determinations, in whole or in part, after consultation with the organisations referred to in paragraph (1); and

(b) shall publish any such amendment in the Statement of Dental Remuneration.

Approval of payments

20.—(1) The Agency shall, where it is satisfied—

(a) that a patient has been accepted by a dentist, other than a salaried dentist, under a continuing care arrangement or a capitation arrangement or for treatment on referral, make the payments which, in accordance with the Scale of Fees, fall to be made by it to the dentist in respect of such an arrangement or referral; or

(b) that a continuing care arrangement or a capitation arrangement has terminated or treatment on referral has terminated or has been completed, cease such payments to the dentist.

(2) The Agency shall, where it approves a claim for remuneration made by a dentist, other than a salaried dentist, in respect of—

(a) care and treatment under a continuing care arrangement or a capitation arrangement; or

(b) treatment on referral; or

(c) occasional treatment;

completed by the dentist, pay, in accordance with the Scale of Fees, the remuneration due to the dentist in respect of such care and treatment, treatment on referral, or occasional treatment.

(3) The Agency shall, where it approves a claim for remuneration made by a dentist, other than a salaried dentist, in any case falling within paragraph 14 or 17(4) of Schedule 2 (inability of dentist to complete treatment), pay, in accordance with the Scale of Fees, and without prejudice to the provisions of the Dental Charges Regulations, the remuneration due to that dentist, in respect of such care and treatment or occasional treatment as he has provided.

(4) The Agency may, before deciding whether to approve a claim for fees payable to a dentist in respect of his provision of general dental services refer the claim to the Dental Committee for advice.

(5) The remuneration which it is the function of the Agency to pay shall be paid in accordance with Determinations I, III, IV, VI, VII, VIII and IX of the Statement of Dental Remuneration.

(6) The Board shall pay to a salaried dentist and a dentist providing emergency dental services remuneration in accordance with Determination II of the Statement of Dental Remuneration.

(7) In the case of orthodontic care and treatment the Agency may make such payments on account as it considers appropriate pending completion of that care and treatment.

Appeals against decisions of the Agency

21.—(1) Where any dentist is aggrieved by a decision of the Agency concerning fees payable to him in respect of his provision of general dental services, that dentist may, in accordance with paragraph (2), appeal against the Agency's decision to the Department.

(2) An appeal under paragraph (1) shall be brought by giving notice of appeal in writing to the Department within 30 days of the date on which the dentist was informed of the decision of the Agency, or within such longer period as the Department may, for reasonable cause, allow.

(3) A notice of appeal under paragraph (2) shall contain a concise statement of the facts and contentions upon which the appellant intends to rely.

(4) The Department shall, within 30 days of receiving a notice of appeal, request from the Agency a written statement of the reasons for its decision, and the Agency shall within 30 days of receiving the request send such a statement to the Department.

(5) The Department shall consider the notice of appeal and the Agency's statement and—

(a) where the Department 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 Agency to approve a claim for remuneration on grounds that the services to which the claim relates cannot be provided as part of general dental services, the Department shall determine it in such manner as it thinks fit and shall give notice of its decision and of the reason for it to the appellant and the Agency;

(c) where—

(i) the appeal is brought under paragraph (1) against a decision of the Agency concerning a dentist's fees, and

(ii) the Agency has certified in its statement under paragraph (4) 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 Department 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 the services provided or intended to be provided;

(d) except where an appeal is dismissed in accordance with the preceding provisions of this paragraph, the Department shall, within 30 days of receiving the Agency's statement under paragraph (4), appoint 2 dentists, who are or have been engaged in the provision of general dental services, as referees to hear the representations of the appellant and the Agency and determine the appeal. One such dentist shall be appointed after consultation with such organisation as represents the dental profession;

(e) for the purposes of any appeal, the dentists so appointed may, if satisfied that the appeal can properly be determined without an oral hearing and with the agreement of the appellant and the Agency, dispense with an oral hearing in which case the appellant and the Agency shall be given an opportunity to amplify their statements.

(6) Where the Department dismisses an appeal under paragraph (5) it shall give notice in writing to the person who brought the appeal and to the Agency that the appeal has been dismissed, and, where the appeal is dismissed under sub-paragraph (c) of that paragraph, they shall include with the notice to the appellant a copy of the Agency's statement under paragraph (4) and a statement of its reasons for dismissing the appeal.

(7) 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 Agency unless 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.

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

Drugs

22.  The fees payable by the Agency to a dentist in respect of listed drugs supplied by him under paragraph 22(1) of Schedule 2 for use before a supply can otherwise be obtained under paragraph 23 of that Schedule shall be calculated in accordance with the provisions of the Drug Tariff.

Recovery of overpayments

23.—(1) Where the Agency or the Board considers it has made a payment to a dentist owing to an error or in circumstances when it was not due, the Agency or the Board shall, except to the extent that the Department on the application of the Agency or the Board directs otherwise, draw that overpayment to the attention of the dentist and—

(a) where he admits the overpayment; or

(b) where he does not admit the overpayment but, the matter having been referred under regulation 4(2) of the Services Committee Regulations for investigation, the Agency, the Board or the Department on appeal, decides that there has been an overpayment,

the amount overpaid shall be recoverable either by deduction from the remuneration of the dentist or in some other manner.

(2) Recovery of an overpayment under this regulation shall be without prejudice to the investigation of an alleged breach of the terms of service.