Avoiding criticism over dental charges and exemptions

Confusion about dental charges and NHS exemption are a common cause of complaint. What measures can you take to avoid the pitfalls?


Complaints about dental charges may arise where:

  • dentists have failed to explain dental charges properly to the patient
  • the difference between NHS and private treatment options has not been made clear
  • there has been confusion about a patient's exemption from NHS charges.

GDC guidance

In its guidance Standards for the dental team, the GDC advises that dental professionals:

  • 'must give patients clear information about costs', including a written and costed treatment plan and explanation of which treatments can be provided under the NHS and which privately
  • must provide patients with clear information about charges in their practice literature and on their website
  • should tell patients if treatment is guaranteed, under what circumstances and for how long
  • should display a list of dental fees in their practices in an area where it can be 'easily seen by patients'.

DDU advice

In the DDU's experience, confusion or disagreement over dental fees can be a factor in the practice losing a valued patient and, in some cases, a GDC investigation.

To avoid problems, we advise you to reflect on how you communicate charges and your practice's fee policy. Our recommendations include the following.

Update your website

  • Set out services and charges in practice notices and on your website.
  • State whether you currently accept NHS patients and provide details of payment arrangements, such as whether patients are expected to pay for their treatment in advance or on completion.

Display NHS options

  • If you offer treatment on the NHS, it's a good idea to download the NHS dental charges leaflet and poster and display these in your practice.

Explain the treatment plan in full

  • Provide a written treatment plan that includes costs and whether the patient has chosen to have some elements of treatment on a private basis and the charge. Retain a copy with the patient's records.
  • Warn the patient in advance if you believe further treatment may be required and advise them of possible additional costs.
  • Obtain the patient's consent if you need to revise your treatment plan. Issue an amended plan in writing and include a revised cost estimate.

Ask for proof of NHS exemption

  • Patients who claim exemption from NHS charges when they are not eligible could face a penalty of £100 in addition to their treatment cost. If a practice has helped the patient apply for free treatment, the patient may blame them and make a complaint.
  • Make sure you understand the rules regarding patients' entitlement to free treatment or help with NHS charges, and ask patients for proof of their exemption status. The NHS Business Services Authority publishes useful guidance on asking for evidence of patients' NHS exemption.
  • It is the patient's responsibility to complete any relevant forms and make the claim for free treatment or assistance. It's important not to advise the patient about their entitlement, as this could raise their expectations and lead to a complaint if they are found not to be exempt.
  • The NHS advises that if patients aren't sure whether they are entitled to exemption, they should pay and ask for a receipt, as they may be able to claim a refund later.

Don't put pressure on the patient

  • Make sure you don't put pressure on patients to accept private treatment. For example, it is not acceptable to tell NHS patients that they can only have a particular treatment privately, when that treatment is available on the NHS.
  • Consider providing a 'cooling off' period before expensive or extensive procedures begin, so patients don't later feel they were rushed into a costly decision.

This page was correct at publication on 20/08/2018. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.