Regulation 2 Interpretation

“the Act” means the National Health Service Act 1977;

F1“the 2006 Act” means the National Health Service Act 2006;

“the 2012 Act” means the Health and Social Care Act 2012;

“the 1990 Act” means the National Health Service and Community Care Act 1990;

“additional services” means one or more of—

1. (a)

   advanced mandatory services;

2. (b)

   dental public health services;

3. (c)

   domiciliary services;

4. (d)

   orthodontic services; and

5. (e)

   sedation services;

“adjudicator” means the Secretary of State or a person or persons appointed by the Secretary of State under section 4(5) of the 1990 Act (NHS contracts) or paragraph 55(4) of Schedule 3 (NHS dispute resolution procedure);

“advanced mandatory services” means any primary dental service that would fall within the services described in regulation 14 of the GDS Contracts Regulations, but by virtue of the high level of facilities, experience or expertise required in respect of a particular patient, is provided as a referral service;

“agreement” means, except where the context otherwise requires, an agreement for primary dental services made under section 28C of the Act;

“Band 1 course of treatment” means a course of treatment, including a course of treatment consisting of urgent treatment, provided to a patient in respect of which a Band 1 NHS Charge is payable pursuant to the NHS Charges Regulations, or would be payable if the patient was not an exempt person;

“Band 2 course of treatment” means a course of treatment F2, which is not a complex care pathway, provided to a patient in respect of which a Band 2 NHS Charge is payable pursuant to the NHS Charges Regulations, or would be payable if the patient was not an exempt person;

“Band 3 course of treatment” means a course of treatment provided to a patient in respect of which a Band 3 NHS Charge is payable pursuant to the NHS Charges Regulations, or would be payable if the patient was not an exempt person;

“banded course of treatment” meansF3, subject to regulation 14C, a Band 1, Band 2 or Band 3 course of treatment F4, and excludes a complex care pathway;

“bank holiday” means any day that is specified or proclaimed as a bank holiday in England pursuant to section 1 of the Banking and Financial Dealings Act 1971 M1;

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“bridge” means a fixed or removable bridge which takes the place of any teeth;

F6“capitated patient” has the meaning given in regulation 14C;

F7“Capitation and Quality Scheme Agreement” means an agreement containing such terms and conditions relating to the provision of primary dental services as are required by, and which is made in accordance with, directions given by the Secretary of State under section 8 of the National Health Service Act 2006;

F8“Capitation and Quality Scheme 2 Agreement” means an agreement containing such terms and conditions relating to the provision of primary dental services as are required by, and which is made in accordance with, directions given by the Secretary of State under section 114A of the 2006 Act;

F9“caries into dentine” means tooth decay that has progressed beyond the enamel and into the underlying dentine layer of the tooth;

“case assessment”, in respect of an orthodontic course of treatment, means a clinical examination of the patient, including the taking of such radiographs, colour photographs and models as are required in order to determine what orthodontic treatment (if any) is to be provided to the patient;

F10“CDS prototype contractor” means a contractor who has elected to enter into a prototype agreement under which primary dental services are secured for, and provided to, persons who cannot easily access such services;

“charge exempt course of treatment” means a course of treatment that involves the examination and assessment of a patient leading to—

1. (a)

   the issue of a prescription;

2. (b)

   the repair of a dental appliance;

3. (c)

   the arrest of bleeding; or

4. (d)

   the removal of sutures,

which, by virtue of regulation 3(2)(d) or (e) of the NHS Charges Regulations, is provided free of charge to the patient;

“charity trustee” means one of the persons having the general control and management of the administration of a charity;

“child” means a person who has not attained the age of 16 years;

“complete”, in relation to—

1. (a)

   a course of treatment, means that—

   1. (i)

      where no treatment plan has to be provided in respect of a course of treatment pursuant to paragraph 8(5) of Schedule 3 (treatment plans) F11—

      1. (aa)

         where the treatment is a standalone fluoride varnish treatment, that single treatment has been provided;

      2. (bb)

         in every other case, all the treatment recommended to, and agreed with, the patient by the contractor at the initial examination and assessment of that patient has been provided to the patient; or

   2. (ii)

      where a treatment plan has to be provided to the patient pursuant to paragraph 8(1) of Schedule 3, all the treatment specified on that plan by the contractor (or that plan as revised in accordance with paragraph 8(3) of that Schedule) has been provided to the patient; and

2. (b)

   an orthodontic course of treatment, means that—

   1. (i)

      where the contractor determines in accordance with paragraph 4 of Schedule 1 (patients to whom orthodontic treatment may be provided) that no orthodontic treatment should be provided following the case assessment, the completion of the case assessment; or

   2. (ii)

      where the contractor has determined that orthodontic treatment should be provided following the case assessment, all of the orthodontic treatment specified on the orthodontic treatment plan by the contractor pursuant to paragraph 6 of Schedule 1 (orthodontic treatment plans) (or that plan as revised in accordance with paragraph 6(3) of that Schedule) has been provided to the patient,

   and “completed” shall be construed accordingly;

“complex care pathway” means complex care pathway 1, complex care pathway 2 or complex care pathway 3;

“complex care pathway 1” means a course of treatment consisting of all of the required dental services specified in the appropriate entry in Table C in Schedule 2;

“complex care pathway 2” means a course of treatment consisting of all of the required dental services specified in the appropriate entry in Table C in Schedule 2;

“complex care pathway 3” means a course of treatment consisting of all of the required dental services specified in the appropriate entry in Table C in Schedule 2;

F12“contractor” means a person other than F13NHS England, who is a party to the agreement;

F14“course of treatment” means—

1. (a)

   an examination of a patient, an assessment of that patient’s oral health, and the planning of any treatment to be provided to that patient as a result of that examination and assessment; and

2. (b)

   the provision of any planned treatment (including any treatment planned at a time other than at the time of the initial examination) to that patient up to the date on which—

   1. (i)

      each and every component of the planned treatment has been provided to the patient, F15...

   2. (ii)

      the patient either voluntarily withdraws from, or is withdrawn by the provider from, treatment, F16or

   3. (iii)

      F17the treatment provided as part of a complex care pathway is terminated following a suspension,

by, unless the context otherwise requires, one or more providers of primary dental services, except that it does not include the provision of any orthodontic services or dental public health services and, F18in the case of a standalone fluoride varnish treatment, it does not include the steps mentioned in sub-paragraph (a)

“dental appliance” means a denture or bridge and for the purposes of this definition, a denture includes an obturator;

“dental care professional” means a person whose name is included in the register of dental care professionals or on the appropriate roll for dental auxiliaries established in accordance with Part II of the Dental Auxiliaries Regulations 1986 M2;

F19“dental performers list”, means the list of dental practitioners maintained by NHS England in accordance with regulations made under section 106 of the 2006 Act;

“dental public health services” means services provided by the contractor by virtue of section 16CB(4)(c) of the Act M3 (dental public health);

“Dentists Act” means the Dentists Act 1984 M4;

“Dentists Act Order” means the Dentists Act 1984 (Amendment) Order 2005 M5;

“Dentists Register” means the register maintained by the General Dental Council pursuant to section 14 of the Dentists Act M6 (the dentists register and the registrar);

“domiciliary services” means a course of treatment, or part of a course of treatment, provided at a location other than—

1. (a)

   the practice premises of any provider of primary dental services;

2. (b)

   a mobile surgery of any provider of primary dental services; or

3. (c)

   a F20secure and detained estate;

“electronic submission” means the submission of information electronically via a computer system approved by NHS England;

“exempt person” means a person who is, by virtue of either Schedule 12ZA to the Act M7 (dental charging: exemptions) or the NHS Charges Regulations, exempt from the need to pay an NHS Charge in respect of the services he has received under the agreement;

“family member” means—

1. (a)

   a spouse;

2. (b)

   a civil partner;

3. (c)

   a person whose relationship with the F21... patient has the characteristics of the relationship between husband and wife, or civil partners;

4. (d)

   a parent or step-parent;

5. (e)

   a son;

6. (f)

   a daughter;

7. (g)

   a child of whom the person is—

   1. (i)

      the guardian; or

   2. (ii)

      the carer duly authorised by the local authority to whose care the child has been committed under the Children Act 1989 M8; or

8. (h)

   a grandparent;

“FHSAA” means the Family Health Services Appeal Authority constituted under section 49S of the Act M9 (the Family Health Services Appeal Authority);

“financial year” means the period of 12 months ending with 31st March in any year;

F22“fluoride varnish treatment” means the surface application of topical fluoride varnish;

“GDS Contracts Regulations” means the National Health Service (General Dental Services Contracts) Regulations 2005 M10;

“health care professional” has the same meaning as in section 28M of the Act M11 (persons eligible to enter into GDS contracts) and “health care profession” shall be construed accordingly;

“health service body” has, unless the context otherwise requires, the meaning given to it in section 4(2) of the 1990 Act M12 (NHS contracts);

“intra-oral injury” means an injury not related to underlying unmanaged active disease, requiring reparative care;

“licensing body” means any body that licenses or regulates any profession;

“listed”, in relation to drugs, medicines or appliances, means such drugs, medicines or appliances as are included in a list for the time being approved by the Secretary of State for the purposes of section 41(1)(c) of the Act M13 (arrangements for pharmaceutical services);

“mandatory services” means the services described in regulation 14 of the GDS Contracts Regulations;

“mobile surgery”, except where expressly provided otherwise in these Regulations, means any vehicle in which services under the agreement are to be provided;

“modifiable risk factors” means behaviours or conditions that can be changed or managed to reduce a patient’s risk of developing tooth decay or gum disease;

“monetary value of a unit of dental activity” means the relevant contract value divided by the total number of units of dental activity to be provided by the contractor in a financial year, but excluding those units of dental activity that relate to sedation services and domiciliary services;

“national disqualification” means—

1. (a)

   a decision made by the F23First-tier Tribunal under section 49N or under regulations corresponding to that section made under section 28X(4) of the Act M14 (national disqualifications);

2. (b)

   a decision under provisions in force in Scotland or Northern Ireland corresponding to section 49N of the Act; or

3. (c)

   a decision by the NHS Tribunal which is treated as a national disqualification by the FHSAA by virtue of regulation 6(4)(b) of the Abolition of the National Health Service Tribunal (Consequential Provisions) Regulations 2001 M15 or regulation 6(4)(b) of the Abolition of the National Health Service Tribunal (Consequential Provisions) Regulations 2002 M16;

“NHS Charge” means a charge made to the patient for provision of services pursuant to the NHS Charges Regulations;

“NHS Charges Regulations” means the National Health Service (Dental Charges) Regulations 2005 M17;

“NHS contract” has the meaning assigned to it in section 4 of the 1990 Act;

“NHS dispute resolution procedure” means the procedure for disputes specified in paragraphs 55 and 56 of Schedule 3;

F24“NHS England” means the body corporate established under section 1H of the 2006 Act;

“NHS Tribunal” means the Tribunal constituted under section 46 of the Act M18 for England and Wales, and which, except for prescribed cases, had effect in relation to England only until 14th December 2001 and in relation to Wales only until 26th August 2002 M19;

“normal surgery hours” means the times at which the contractor has agreed with NHS England (and specified in the agreement) that the surgery will be open to patients for the provision of services;

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“orthodontic appliance” means a device used in the mouth to move or immobilise the teeth in order to correct or prevent malocclusion;

“orthodontic course of treatment” means—

1. (a)

   a case assessment of a patient; and

2. (b)

   the provision of any orthodontic treatment that the contractor determines should be provided to the patient in accordance with Part 2 of Schedule 1 (orthodontic services);

“orthodontic services” means the provision of orthodontic courses of treatment or the services referred to in paragraph 5(2) of Schedule 1 (repairs);

“orthodontic treatment” means treatment of, or treatment to prevent, malocclusion of the teeth and jaws, and irregularities of the teeth;

“parent”, in relation to any child, means a parent or other person who has parental responsibility for that child;

“patient” means, unless the context otherwise requires, a person to whom the contractor is providing services under the agreement;

“patient record” means a form supplied by NHS England for the purpose of maintaining a record of treatment, and may include an electronic form;

“practice premises”, except where expressly provided otherwise in these Regulations, means an address specified in the agreement as one at which services are to be provided under the agreement but does not include a mobile surgery;

“prescriber” means a dental practitioner who is either engaged or employed by the contractor or is a party to the agreement;

“primary care list” means—

1. (a)

   a list of persons performing primary medical F26services, primary ophthalmic services or dental services under section 28X of the Act M20;

2. (b)

   a list of persons undertaking to provide general ophthalmic services or, as the case may be, pharmaceutical services prepared in accordance with regulations made under section 39, 42 or 43 of the Act M21;

3. (c)

   a list of persons approved for the purposes of assisting in the provision of any services mentioned in paragraph (b) or (d) prepared in accordance with regulations made under section 43D of the Act M22;

4. (d)

   a list of persons who undertook to provide general medical services or general dental services prepared in accordance with regulations made under sections 29 or 35 of the Act M23;

5. (e)

   a services list which fell within the meaning of section 8ZA of the National Health Service (Primary Care) Act 1997 M24;

6. (f)

   a list corresponding to a services list prepared by virtue of regulations made under section 41 of the Health and Social Care Act 2001 M25; or

7. (g)

   a list corresponding to any of the above lists in Scotland or Northern Ireland;

“Primary Care Trust” means, except where the context otherwise requires, the Primary Care Trust which is a party, or prospective party, to an agreement;

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“private”, in the context of services or treatment, means otherwise than under the agreement or Part 1 of the Act, and “privately” shall be construed accordingly;

“professional registration number” means the number against a dental practitioner's name in the Dentists Register;

F28“prototype agreement” means an agreement temporarily varied as part of the Prototype Agreements Scheme which contains—

1. (a)

   the terms and conditions required under the Prototype Directions; and

2. (b)

   the terms and conditions required under these Regulations;

“the Prototype Directions” means the National Health Service (Dental Services) (Prototype Agreements) Directions 2015;

“the Prototype SFE” means the Prototype Agreements Scheme Statement of Financial Entitlements;

“referral notice” means the notice referred to in paragraph 10(2)(a) of Schedule 3 (referral to another contractor, a hospital or other relevant service provider for advanced mandatory, domiciliary or sedation services);

“referral service” means one or more of advanced mandatory services, domiciliary services or sedation services provided by the contractor to a patient who has, during a course of treatment, been referred to the contractor by—

1. (a)

   another contractor; or

2. (b)

   another provider of primary dental services under Part 1 of the Act,

for the provision of one or more of those services as part of that course of treatment;

“referral treatment plan” means a treatment plan provided pursuant to paragraph 2(1) of Schedule 1 or that plan as varied in accordance with paragraph 2(2) of that Schedule;

“register of dental care professionals” means the register maintained by the General Dental Council under section 36B of the Dentists Act M26 (the dental care professionals register);

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“relevant contract value” means the amount agreed under the contract to be paid by NHS England to the contractor for services that are required to be provided in a financial year, excluding dental public health services, orthodontic services, sedation services and domiciliary services;

“relevant contractor” has the meaning given by regulation 13A(7);

“required number of urgent treatments” has the meaning given in regulation 13A(1) and (2);

“secure and detained estate” means a prison or other accommodation as described in regulation 10(2)(b) to (e) of the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012;

“sedation services” means a course of treatment provided to a patient during which the contractor administers one or more drugs to a patient, which produce a state of depression of the central nervous system to enable treatment to be carried out, and during and in respect of that period of sedation—

1. (a)

   the drugs and techniques used to provide the sedation are deployed by the contractor in a manner that ensures loss of consciousness is rendered unlikely; and

2. (b)

   verbal contact with the patient is maintained in so far as is reasonably possible;

“standalone fluoride varnish treatment” means a course of treatment comprising a single fluoride varnish treatment in circumstances where—

1. (a)

   the treatment is delivered to a patient, who is a child, by a dental nurse in accordance with a prescription issued by a dental practitioner;

2. (b)

   a dental practitioner, dental therapist or dental hygienist, having conducted an initial assessment and examination as part of another banded course of treatment, has produced a schedule for the provision of—

   1. (i)

      a single fluoride varnish treatment; or

   2. (ii)

      a number of fluoride varnish treatments to be applied at regular intervals;

3. (c)

   each scheduled treatment is a single course of treatment to be delivered as part of that schedule and does not include examination and assessment; and

4. (d)

   where a number of treatments is scheduled, each interval in the schedule is not less than three months;

“trauma” means damage to teeth, gingival tissues or alveoli caused by a force arising outside the mouth, resulting in mobility, luxation, subluxation or fracture of the hard tissues or injury to the soft tissues;

“unit of dental activity” means the unit of activity which is in the agreement used to—

1. (a)

   express the amount of; and

2. (b)

   measure in accordance with Part 1 of Schedule 2 the provision of,

mandatory services and advanced mandatory services provided under the agreement;

“unit of orthodontic activity” means the unit of activity which is in the agreement used to—

1. (a)

   express the amount of; and

2. (b)

   measure in accordance with Part 2 of Schedule 2 the provision of,

orthodontic services provided under the agreement;

“urgent treatment” means a course of treatment that consists of one or more of the treatments listed in Schedule 4 to the NHS Charges Regulations (urgent treatment under Band 1 charge) that are provided to a person in circumstances where—

1. (a)

   a prompt course of treatment is F31clinically necessary because, in the opinion of the contractor, that person's oral health is likely to deteriorate significantly F32, or the person’s presentation indicates a need for treatment within seven days; and

2. (b)

   treatment is provided only to the extent that is necessary to prevent that significant deterioration or F33treat that need

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