Orthodontist Contractor - DOC

							                                                                               Appendix 1

                        West Midlands Regional Orthodontic Appeal
                                    Patient Proforma


Dear Patient

I understand from your recent contact with the Primary Care Trust that the dentist
or orthodontist who has examined your mouth does not consider that you are
eligible for NHS orthodontic treatment based on the assessment s/he made of
your mouth and teeth.

You have told us that you wish to appeal against his/her decision.

New rules introduced since April 2006 mean that only those people with greater
needs will be eligible for orthodontic treatment by the NHS.

General dental practitioners and orthodontists use nationally agreed
measurements to assess how great a need each person has for orthodontic
treatment.

NHS orthodontic treatment may be provided to people who have been assessed
as having a need for treatment due to the position of their teeth or the
appearance of their teeth by a general dental practitioner or orthodontist. In
exceptional circumstances some people may still be eligible for treatment due to
the condition of their teeth and mouth who would not routinely be offered NHS
treatment.

The West Midlands Appeal Panel will now be convened to hear your appeal.

The panel is made up of the following people:
                          A orthodontic specialist
                          A dental technician experienced in assessing models
                          of teeth
                          A Primary Care Trust Officer from the Primary Care
                          Trust the dentist/orthodontist works in.

The outcome of the appeal will be either:

    1. Appeal upheld – Orthodontic Treatment is indicated (A written explanation
       will be provided by the Appeal Panel to you and the dentist/orthodontist)
    2. Appeal overturned – Orthodontic Treatment is not indicated.

The outcome of the appeal will be communicated in writing to both you and the
dentist/orthodontist within 5 working weeks from receipt of all relevant
documentation from the dentist/orthodontist. The whole process should take no
longer than 9 weeks from your appeal being received to a decision being made.



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                                                                               Appendix 1


Enclosed is a form for you to complete and return to us, giving details of why you
wish to appeal the dentist/orthodontist’s decision.

Please don’t hesitate to contact me if you require any further information or
assistance in completing the form.

Yours sincerely




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                                                                               Appendix 1

                                            Orthodontic Appeal

  Please complete this form and send it to the address at the bottom of the form

Name of Responsible Adult

Name of Patient

Date of Birth

Address (including postcode)




Telephone Number

Address for Correspondence if different from above




Name of Dentist/Orthodontist

Address



Telephone Number


Please explain in the section below the reason(s) why you feel that you should
be eligible for NHS Orthodontic treatment. (Please continue over the page if
necessary)




                                            Please return this form to
                                                      Ms X
                                                     Y PCT
                                                 West midlands



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                                                                               Appendix 2


Dear Dentist/Orthodontist

                                       Re Orthodontic Appeal
                                       Name:
                                       Address:
                                       D.O.B.


I understand that you recently undertook an orthodontic assessment on the
above named individual. S/he is appealing your decision to refuse access to
NHS orthodontic treatment based on the new NHS eligibility criteria detailed
below:

                                  PART 2 ORTHODONTIC SERVICES

Patients to whom orthodontic services may be provided

(3) The contractor shall only provide orthodontic treatment to a person who is assessed
by the contractor following a case assessment as having a treatment need in –
    a) Grade 4 or 5 of the Dental Health Component of the Index of Orthodontic
        Treatment Need (b); or
    b) Grade 3 of the Dental Health Component of that Index with an Aesthetic
        Component of 6 or above,
Unless the contractor is of the opinion, and has reasonable grounds for its opinion, that
orthodontic treatment should be provided to a person who does not have such a
treatment need by virtue of the exceptional circumstances of the dental and oral
condition of the person concerned.
Reference: NHS (GDS Contracts) Regulations 2005 (SI2005/3361) and The NHS (PDS
Agreements) Regulations 2005 (SI 2005/3373)

The West Midlands Appeal Panel will now be convened to hear this appeal.

The panel comprises:
                                       A specialist orthodontist
                                       A dental technician experienced in IOTN scoring of
                                       study models.
                                       A Primary Care Trust Officer from the PCT you work
                                       in.

The following information is required from you by the PCT by (insert appropriate
date – 4 working weeks from receipt):

A statement completed on the enclosed proforma (Dentist/Orthodontist Statement),
Appropriate radiographs (if available),
Study Models,
Photographs (if available).



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                                                                               Appendix 2

You are responsible for ensuring their delivery to me at the PCT address above.

The outcome of the appeal will be either:

    1. Appeal upheld – Orthodontic Treatment indicated (An written explanation
       will be provided by the Appeal Panel)
    2. Appeal overturned – Orthodontic Treatment not indicated.

The outcome of the appeal will be communicated in writing to both you and the
patient within 5 working weeks from receipt of all relevant documentation from
yourself.


Please don’t hesitate to contact me if you need any further advice or assistance.

PCT officer




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                                                                               Appendix 2

                                   Dentist/Orthodontist Statement


Name:

Address:




Phone Number:


Patient Name:

Address:




Date of Birth

Phone Number:


Please state below your reason(s) for declining orthodontic treatment for the
patient named above with reference to Part 2 Orthodontic Services: Patients
to whom orthodontic services may be provided. [The NHS (GDS Contracts)
Regulations 2005 (SI2005/3361) and the NHS (PDS Agreements) Regulations
2005 (SI 2005/3373). This section can be found in your letter from us].

Please indicate the information included in your submission
Radiographs          Y/N
Study Models         Y/N
Photographs          Y/N




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