Sir, since the introduction of the nGDS contract, dentists have been prohibited from charging patients for failed NHS dental appointments. In an effort to gauge the current opinions of colleagues on this matter, a poll was conducted on a UK dental discussion group.

The first question sought to determine the level of support for reintroducing patient charges: 2% (n = 1) of voting members were against failed appointment charges; 77% (n = 50) for all such appointments being chargeable and 22% (n = 14) that charging should be limited to a specified range of unacceptable reasons/excuses. Question 2 asked who should set failed appointment charges if permitted by the NHS: 37% (n = 23) believed NHS, 55% (n = 34) the provider and 8% (n = 5) the performer. Question 3 addressed the division of any fees collected: 20% (n = 12) provider should retain all fees collected, 10% (n = 6) performer should receive all fees and 70% (n = 43) splitting of fees between provider and performer. The fourth question asked if the voter or their practice stopped offering appointments following a maximum of two failed appointments and approximately two thirds were adopting such policies.

In 2011, the BDA reported research which it had conducted into failed dental appointments.1 It found that failure to attend rates were high, particularly in predominantly NHS practices. In those practices which derived 50% or more of their income from the NHS, failed attendances accounted for an average of 81 hours of lost time per full-time-equivalent dentist per annum, and 69 hours per dentist in practices with lower NHS commitments. Furthermore, many dentists reported an increase in the number of patients failing to attend appointments since the prohibition on such charges.

However, a note of caution needs to be sounded as the re-introduction of charges may have associated costs and adverse outcomes, including reductions in patient goodwill, related complaints, counter claims for compensation by patients kept waiting and precipitating legal claims for perceived failures of care. Also any policy which is insensitive to the personal circumstances which precipitated the failure to attend (eg illness, personal stressors, factors beyond the control of the patient, dental phobias, etc) is likely to be viewed negatively by both patients and regulators.

One further factor the profession must consider is the political pressure on politicians as they are probably more likely to lose votes by supporting such charges than gain them. The profession, therefore, appears to be in a Catch 22 situation on this issue. It seems likely that only a clear, judicious and fair charging policy is likely to receive qualified support from all the stakeholders.