Dental Reform implementation continued

Continuation of the November 2023 Dental reform implementation

Following the introduction of Dental Reform in November 2023, there were a number of changes that were proposed to be delivered but were deferred due to the tight timescales. These changes can be categorised as:

• annotation / material information to support clinical governance
• oral health metrics
• provision of reason for item 1-(c) Unscheduled care assessment and treatment
• eDental validation rules

We have provided more detail below:

Capture of annotation and material to support Item 4 (Extra Coronal Restorations)

Due to the streamlining of the Dental Reform SDR, it was identified that there was a loss of some information relating to Item 4, used previously to support clinical governance. Currently, the PSD dental clinical team request this additional information to clarify proposed treatment plans during the prior approval process. An example of this is for bridges where, prior to Dental Reform, a separate code existed that identified a pontic from a retainer. Under Dental Reform, this is not visible. As such, with the exception of item 4-(h), annotation and/or material will be requested from 01 August 2024. Our understanding is that PMS suppliers will deliver this in the same way it is currently captured for fillings.

Oral Health Metrics:

When a 1-(a) Extensive Clinical Examination is undertaken, key information is being recorded at that time relating to the patient’s oral health. Practitioners do not currently have a snapshot of the oral health of their caseload to help them better focus on their preventative care. The desire is to capture relevant data from what is being recorded, without significant additional effort required by Practitioners.

The plan is to measure three oral health indicators: the number of teeth, the number of teeth requiring restoration or extraction and the highest sextant score for BPE. This will provide data on caries and oral health state and the number of teeth provides a measure of historic oral health. These three measures will provide a measure of the oral health of the practice adult population. More detail is available below on each of the measures. We are also working on developing 2 new eSchedule reports to provide visibility at Practitioner caseload level of their patients’ oral health (currently planned for September paid October 2024). More detail on how these reports will look and appear will be provided as we progress through development.

Future developments will include the data being made available to you alongside Board and national data for comparison.

A discussion was held with PMS software suppliers to determine how we can gather this data as a by-product of how practitioners currently operate, with minimum pain and effort. It appears much of this information is already gathered by PMS suppliers for England for adults and they have confirmed that this is the case, although there may be times when a user is required to confirm what the PMS has derived. The capturing of this data may become mandatory for adults in future in order to help provide a clearer picture of the oral health for adults.

The following information should be recorded at the same time a Dental Reform Item 1-(a) Extensive Clinical Examination is undertaken and prior to undertaking treatment. There are no system rules being imposed at this stage, other than it fits the format of what is expected; for example, number of teeth would assume to be 1 or 2 digits, if provided.

Number of teeth present

This is the total number of teeth present in the mouth when a Dental Reform Item 1-(a) Extensive Clinical Examination is undertaken and can be recorded on any claim with a date of acceptance on or after 01 August 2024.

Number of teeth requiring restoration or extraction

When a dentist undertakes a 1-(a) Extensive Clinical Examination, they will identify the teeth requiring restoration or extraction at the time of examination. This will be recorded as a count of the number of teeth that need to be restored or extracted. This should be recorded on any claim with a date of acceptance on or after 01 August 2024. Note: A tooth will only be counted once.

Highest sextant scores with BPE

Highest BPE sextant score should be recorded at the same time an Item 1-(a) Extensive Clinical Examination is undertaken. This should be recorded on any claim with a date of acceptance on or after 01 August 2024. A basic periodontal exam and periodontal risk/status is part of an extensive clinical examination, where appropriate. In some specific clinical circumstances, it may not be possible to record a basic periodontal examination by probing. If BPE examination has not been recorded by probing due to a specific clinical issue, then code X should be entered as the appropriate periodontal matrix code.

Provision of reason for 1-(c) Unscheduled care assessment and treatment

From 01 August 2024, when an item 1-(c) is claimed, you must provide the reason as listed in the SDR, i.e. recement of crown. This is likely to be available to you as a selectable drop-down list in your PMS software. If the reason is unlisted, select, “Other”. In those specific scenarios continue to follow existing practice and record the reason in your patient record card. There is no requirement to add the reason to observations; in fact, doing so will cause delays to your claim processing.

eDental Validation Rules:

SDRs have always contained provisos as to when an item, and therefore fee, can or cannot be claimed. Historically these provisos were applied in our payment system, MIDAS, along with common sense rules, such as a filling cannot be provided on a tooth that was previously extracted. When eDental and eOrtho were added in recent years, many rules were applied at the point of submission (E000XXX errors) to ensure validity of the claim prior to it reaching the payment system. The way in which we process and validate claims remains unchanged, but in light of the Dental Reform SDR and the new SDR provisos that come along with it, additional rules need to be applied. With the Dental SDR now in a stable state, eDental validation rules that were deferred are now in the development and testing phases.

We are currently working on an updated version of the error message document, to be published on our website in due course.

Practice Management Software suppliers:

All PMS suppliers are aware of the changes mentioned above and are actively working on their own developments to support implementation. PSD meet on a regular basis with suppliers and no concerns have been raised to date around meeting the delivery timescales. As part of our dialogue with them, we have sought to understand both their test timescales with us, which will provide assurance of the changes, and when they expect to implement.

We have published PMS supplier developments to support Dental Reform implementation information on this website and will update this as and when we receive updates.

If your PMS supplier requires you to take an action for implementation, we will also note that.

You do not need to contact your PMS supplier around these changes – they will be in touch with you in due course.

We are currently working towards an implementation date of 01 August 2024 for the above and will provide further updates as things progress.