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Access guidance on the removal of NHS charges for people under the age of 26

Published on 26 August 2021

Removal of NHS charges for people under the age of 26

The Memorandum to PCA(D)(2021)4 issued on 20 August 2021, instructed that from 24 August 2021 NHS dental treatment will be free for all patients under the age of 26.  All treatment plans with an acceptance date on or after 24 August 2021 for patients aged under 26 should be marked with this new category. Practice Management System suppliers will update their systems to include this new category. If you are a web form user, we will contact you directly to advise how this change will display on your system.

The following scenarios will help you with submitting claims for patients who fall into this new category:

I have a treatment plan for a patient under the age of 26 that was opened before 24 August 2021 for a patient who was under the age of 18 (or 18 and in full time education) or already exempt from payment.

If you have an open treatment plan with an acceptance date prior to 24 August 2021 for a patient under the age of 26 who already does not pay for their treatment, you should continue to use that category for these courses of treatment.

I have a treatment plan that was opened before 24 August 2021 for a fee paying patient who is over the age of 18 but under the age of 26.

If you have an open treatment plan with an acceptance date prior to 24 August 2021 for a fee paying patient under the age of 26, you should close off and submit these treatment plans by 23 November 2021. A completion date of 23 August 2021 should be recorded on the claim. The patient is liable to pay a patient charge for all treatment carried out where a patient charge applies.

You should then open a new course of treatment with an acceptance date of 24 August 2021, using the new under 26 category, to claim for any outstanding treatment.  This means no patient aged under 26 will pay for any treatment carried out on or after 24 August 2021. These cases should not be treated as continuation cases, but as separate claims. 

What happens with prior approval cases for patients aged under 26 that have been opened prior to 24 August 2021?

Where prior approval has been authorised and the course of treatment has been closed as above, if the remaining treatment total exceeds the prior approval limit or contains an item of treatment that requires individual prior approval (items annotated in the SDR with an asterisk) you should submit a new prior approval request with an acceptance date on or after 24th August 2021. Please include the following in the observations section of your submission: “Previously approved on [enter date of original approval] – closed as per PCA(D)(2021)4”.

Where the remaining treatment total does not exceed the prior approval limit and does not contain any items of treatment that individually require prior approval you may complete the outstanding treatment and submit a payment claim on completion, in the normal way.

I have a treatment plan, with an acceptance date on or after 24 August 2021, for a patient who is under the age of 26 but they fall into another exemption or remission category.

If you have a patient who is under 26 but also falls into another exemption or remission category you should mark the claim with the under 26 category.

Will the GP17PR forms be updated to reflect this change?

There are 2 separate forms, the GP17PR for general dentistry and the GP17(O)PR for orthodontics treatment. Both forms have been updated to version ‘(08/21)’ with the new ‘Under 26’ category added to the forms and the ‘Under 18’ and ‘Aged 18 and in Full Time Education’ categories both removed.

Both new forms have been given a white header strip to help distinguish between the old and new PR forms.

At present practices are not required to capture patient signatures because of infection, prevention and control restrictions when seeing patients. This continues to remain the case until further notice and new guidance is issued.

Additional guidance: Orthodontic claims and prior approvals

I have a treatment plan that was opened before 24 August 2021 for a fee paying patient who is over the age of 18 but under the age of 26.

Following the process below will ensure that patient charges are applied correctly and that patients aged under 26 will not pay for any treatment carried out on or after 24 August 2021:

Step 1

If you have an open treatment plan with an acceptance date prior to 24 August 2021 for a fee paying patient who was aged 18 to 25 (inclusive) at the acceptance date, you should close off this treatment with a completion date of 23 August 2021.

If you have not yet fitted any appliances, you should submit an examination type claim for the diagnostic items.

If you have already fitted appliances, you will need to submit a discontinued fee request. We will return the submission detailing the fees allocated for the discontinued appliances, allowing you to submit a final payment claim for the discontinued treatment and any other completed treatment.

You must calculate the patient charge required for this claim and where patients have already paid more than that amount, a refund should be provided.

Step 2

You should then open a new course of treatment with an acceptance date from 24 August 2021, using the new under 26 category. This must be submitted for prior approval.

If you have not yet fitted appliances, your new prior approval will include all treatment on the original approval, minus the diagnostic items.

If you have already fitted appliances, you should include the code 3999 01 to allow us to allocate the correct balance of fees for the previously discontinued appliances. Also include any approved items of treatment that were not started before you discontinued the original claim.

Your submission should include the retention appliances you plan to use, even if these were not included in the original prior approval request.

Please add the following in the observations section of your submission: “Previously approved on [enter date of original approval] – closed as per PCA(D)(2021)4”.

If you are changing the treatment plan in any way from the originally approved plan, you must detail these changes in observations and submit a complete set of photos and the relevant radiographs when requested.

Step 3

Our system will automatically return your new prior approval submission requesting attachments. You will need to upload one image and re-submit the prior approval. Where your treatment plan has not changed since originally approved you may continue with treatment pending your receipt of the new approval.

To assist us to prioritise approval of these cases, please email our prior approval team at NSS.psd-prior-approval@nhs.scot providing the patient details for the cases you have submitted. Note: You must use an NHS email address when sending patient data.

Prior approval cases that have not yet been approved

Prior approval submissions with an acceptance date prior to 24 August 2021, for a fee paying patient aged 18 to 25 (inclusive) at the acceptance date, that have not yet been returned to you, will shortly be returned with approval ‘declined’.

Please be assured that the purpose of this is solely to allow you to proceed in accordance with Steps 1-3 above and that your subsequent prior approval submissions will be assessed as normal.

For cases we have returned to you requesting further information, our Prior Approval Team will contact your practice directly by telephone or email to advise.

Please note that all the above arrangements apply ONLY to submissions with an acceptance date prior to 24 August 2021 AND where the patient was a fee paying patient aged 18 to 25 (inclusive) at the acceptance date. There is no need to take any action in relation to cases for patients who were exempt from dental charges at the acceptance date on the prior approval submission.