On 5 May 2023, the Court of Appeal handed down judgment in General Dental Council v. Williams.
The Court of Appeal held that the NHS Contracts Regulations did not prevent dentists from charging a private “top up” fee in order to provide more aesthetically pleasing crowns on the NHS. That was contrary to a longstanding assumption by the dental profession and by the General Dental Council itself.
In respect of 3 patients the registrant offered her patients a porcelain bonded crown on the NHS. However, she advised them that she could provide a better looking ceramic crown for an additional fee to be paid privately: between £30 and £65. This was to cover the additional laboratory cost of a ceramic crown.
The Professional Conduct Committee held that it was contrary to a fundamental principles contained within the Regulations to mix the payment structure of NHS and private payments in this way. It further held that the registrant’s offer to charge such a fee was dishonest.
The Court of Appeal held that, properly construed, the Contracts Regulations did not prevent a dentist from mixing NHS and private treatment on the same tooth. This did not contravene the overarching principle that NHS dental treatment should be free of charge. Indeed, the ability of patients to “top up” their NHS care privately – without having to pay for the whole of their treatment themselves – was much closer to the spirit of free dental services than the interpretation advanced by the GDC.
The Court held that, regardless of the way in which the Regulations were interpreted, the PCC’s determination on dishonesty was flawed. The PCC did not have before it copies of the Regulations and the registrant was not cross examined on them. Reliance on expert evidence as to what the Regulations meant without sight of the Regulations was a manifest error. The registrant was not challenged on her evidence that she had not covered this aspect of the Regulations in her foundation year training. As to her state of mind, it was also relevant that – at the material time – she had worked in an unpleasant, pressurized and poorly supported situation at the Practice.