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REGULATION 9 APPLICATIONS FOR REPLACEMENT OF DENTAL APPLIANCES TERMS OF REFERENCE Regulation 9 applications are submitted on the patient’s behalf by their dentist. The purpose is to seek a decision from the Health Board’s Primary Care Division (PCD) on whether the patient is eligible for free replacement of appliances which are required as a result of an act or omission on the part of the patient. The reasons for the replacement should be because the appliance has broken beyond repair, lost or illfitting due to neglect on behalf of the patient, eg not worn or lost and found but no longer fits. The appliances covered by Regulation 9 are Dentures, Bridges, Splints and Orthodontic. REGULATION 9 APPLICATION FORM Regulation 9 application forms are available from the Stationery Department, Primary Care, Law House, Airdrie Road, Carluke, ML8 5ER (copy attached). Please note that, when completing the forms in respect of orthodontic appliances, the Practitioner should only claim the replacement fee under item 32(e) in the Statement of Dental Remuneration, and not the full appliance fee. Failure to furnish the correct fee could result in payment of the GP17/GP17(O) being rejected by Practitioner Services – Dental, Edinburgh. Duly completed forms should be returned to Primary Care Services, Kirklands Hospital, for the attention of the Administration Team Leader. The practice should retain the form GP17/GP17(O) pending receipt of the PCD’s decision and should not submit it along with the Regulation 9 application. Attached is a copy of an information sheet compiled by Practitioner Services – Dental, Edinburgh, which provides further guidance on their requirements for prior approval and contains a check list for completing a GP17/GP17(O) under Regulation 9. ACTION BY HEALTH BOARD On receipt of the Regulation 9 application, the first procedure for the Administration Team Leader is to check that the form has been correctly completed and signed by both the dentist and patient (parent/guardian in respect of children aged 16 and under). REGULATION 9 APPLICATIONS FOR REPLACEMENT OF DENTAL APPLIANCES The next step is to ensure the reason why a replacement is necessary has been completed, otherwise the form will be returned to the patient or parent/guardian. For appliances lost whilst in care, eg hospital, it would greatly facilitate the decision of the dates of admission and the ward, if known, could be supplied, as the PCD will write to the relevant Hospital to obtain their views and ask if they will assume responsibility. The Administration Team Leader then reviews all the information available concerning each application and a decision is made on how much the patient is required to pay, taking factors into account such as receipt of benefit(s), following a protocol developed in consultation with the Area Dental Committee GP SubCommittee. The application is then authorised and a letter sent to both the patient and the dentist to inform them of the Board’s decision. The patient’s letter informs them that if they feel that the amount they should pay would result in financial hardship, they may appeal against the Board’s decision and in doing so submit a note of their weekly income and major items of expenditure. All Regulation 9 applications and any appeals received are reported to the Area Dental Committee GP Sub-Committee as an Appendix to the Dental GPA Report issued at the end of every quarterly period. REGULATION 9 APPLICATIONS FOR REPLACEMENT OF DENTAL APPLIANCES REGULATIONS The Regulations covering applications for replacement of dental appliances are contained within the National Health Services (Dental Charges) (Scotland) Regulations 2003, as amended, which state inter alia: 9.—(1) Where a dental practitioner providing general dental services or providing services under a pilot scheme replaces a dental appliance supplied as part of those services and it is determined in accordance with Schedule 3 that the replacement is necessitated by – (a) an act or omission on the part of the person supplied; or (b) if the act or omission occurred when the person supplied was under 16 years of age, an act or omission of the person supplied or of the person having charge of the person supplied when the act or omission occurred, the dental practitioner may make and recover a charge from the relevant person. (2) The amount of the charge to be made and recovered under paragraph (1) is, subject to paragraph (3), the Statement remuneration for the supply of the dental appliance. (3) If the Health Board considers– (a) that payment of the full amount of the charge under paragraph (1) would involve undue hardship to the relevant person; or (b) that the replacement, though necessitated by the relevant person’s act or omission, was not wholly necessitated by lack of reasonable care on the part of the relevant person, it may determine that the charge shall not be payable, or that its amount shall be reduced. (4) In this regulation, “relevant person” means– (a) where paragraph (1)(b) applies, the person having charge of the person supplied when the act or omission occurred; (b) in any other case, the person supplied.