The mixed list dilemma
 

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The mixed list dilemma

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The mixed list dilemma

 

The mixed list dilemma

One of the biggest areas of concern regarding the new contract is the issue of mixed lists. Lets face it, the vast majority of UK practices have a mixed list, i.e. there are some patients treated on the NHS and some treated privately.

For some this may be just children and for others this may be all exempt categories of patients. It is the ability for a practice to continue this arrangement under the new contract that is certainly one of the areas open to different interpretation. The problem has arisen due to the way the discrimination clause that is in the draft contract has been interpreted. If you look at the clause, it states that a dentist, ‘will not be able to refuse to treat a patient on the NHS on the grounds of race, gender social class, age, religion, sexual orientation, appearance, disability or medical condition.’ There are those who argue that this clause, if interpreted to the letter, would mean that children only or exempt only lists are now not possible as you would be seen to be discriminating against elder fee paying patients. This argument has been readily accepted and publicised by the some companies who see this as a major growth opportunity for their business. After all the administration fee for a child is exactly the same as that for an adult. I am not so sure that advice from a source that benefits so significantly from this clause can be offered in an entirely independent way.

On the 7 October I received an open letter addressed to all NHS dentist from Barry Cockroft (the new acting chief dental officer). This letter categorically states on page four in response to the direct issue of children only lists, ‘the new arrangements extend to dentists the situation that already exists for general medical practitioners, reflecting the principles of an accessible NHS service. We do not intend to stop you continuing to provide ongoing care to your existing patients.’ I think this means dentists will be able to carry on with the same list as before.

After receiving this, I contacted my PCT and asked them to confirm this in writing was indeed the case; however they said that they would have to get back to me. My belief is that this discrimination clause is an all-encompassing clause that has to be put into the contract. It is an own goal for the overtly PC world we are forced to live in. Just this morning I nearly drove off the road when I heard that, ‘for political correctness sake’ Lambeth council is stopping any reference to Christmas so as not to offend non-Christians living in the borough. So now they are having ‘winter festival’ lights!

So where does this leave us?

My advice to any practitioner who wishes to continue with their existing list or practice profile is to write to their PCT and say that they are willing to do so. This puts any withdrawal politically on the PCT/ Government’s plate. It would be an entirely different matter if the press were to see letters from practitioners saying they were willing to see groups of patients and the PCT not allowing it. Voluntary or early withdrawal leaves us, the profession, seen as the villains, doing the Government’s dirty work for them.

 Posted on : Thu 10th - Nov - 2005

 

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