CQC v PCT or NCB

Are you a dentist with a GDS contract or a dentist who would like to buy an NHS practice? Then read on! 

It would be fair to say that there has on occasion been some disagreement between some dentists and their PCTs with more than a few wishing they never existed. Whilst I can see why dentists may have felt a degree of frustration, it may well be that the grass is not always greener now that we are on the other side so to speak.

With the dissolution of the PCTs, there is a lot of uncertainty as to who or what is dealing with the dental contracts – have you tried speaking to your contract manager recently? It’s highly likely that they have been swallowed up by NHS England and are now floating around in a bureaucratic parallel universe. 

With a great deal of investigatory work involving dialling various post-PCT bodies I have finally managed to speak to a number of the new “Commissioning Officers”. The reason for my need to speak to them precisely at this moment is because of an NHS policy which has recently been published. 

Since the 2006 NHS dental contracts were put in place, there is no right for a dentist to “give, sell, assign or otherwise dispose of the benefit” of their NHS contract. However there is nothing to prevent Dentist A taking Dentist B in as a partner before subsequently retiring and thus leaving the contract in the sole name of Dentist B –, this has become known as the “Partnership Route”. Since 2006 therefore, we have been using the partnership route in order to facilitate the sale and purchase of NHS dental practices.

 Matters became even more complex when CQC came along as, under the CQC regulations, a partnership – which created when using the Partnership Route must be registered with the CQC. This meant an awful lot of work for the already under resourced CQC who would have to register a partnership which would only be in existence for a short period. 

When this was brought to the CQC’s attention we had the PCTs and CQC in conflict as to what should happen. Let’s call this Round 1.

Round 1

In order to comply with the CQC registration requirements, a dentist wishing to go down the partnership route with another dentist would have to go through the following steps:

  1. Both dentists applied for an enhanced CRB check (now called a Disclosure and Barring Service check)
  2. Once in receipt, the selling dentist would apply to de-register as an individual
  3. Both the selling and buying dentist would apply to register as partners
  4. The buyer would also apply to be the Registered Manager for the partnership
  5. Following the retirement from the NHS contract of the seller, the partners would send an application to de-register the partnership together with an application to de-register the Registered Manager
  6. Simultaneously an application would be made to register the buyer as an individual with CQC.

The PCTs insisted that this process be followed to reflect the fact that a partnership had been set up.

However, the CQC had other ideas. Some of you may remember the mad rush to have all dentists registered by 1st April 2011. The CQC was (and is) under resourced, under pressure and heavily criticised in their handling of the dentists’ registration exercise. The last thing they wanted was the extra administration of having to go through the 6 steps above to register a partnership with no longevity simply in order to keep PCTs happy.

CQC determined this was a nonsense and what was finally agreed was a straight forward 3 step process:

  1. Buyer applies to register
  2. Seller applies to de-register
  3. CQC sends the buyer a letter of comfort confirming there was no intention to reject the buyer’s application – the “Comfort Letter”

Since April 2011 the CQC, the PCTs, dentists, banks and legal teams have all been working harmoniously together using this 3 step process and there has been no problem with this.

That is until recent developments – Round 2.

Round 2

31st March 2013 PCT Armageddon. PCTs were scrapped and the dental contracts are now under the control of the NHS Commissioning Board (NCB). We all expected there to be some disruption whilst the NCB found their feet but what has landed on our desks is something quite alarming. 

A document entitled “Policy for Variations of Primary Dental Care Contracts” was published on 2nd April 2013. This policy states what is required from dentists wishing to use the partnership route. The majority of it is useful in a way as it lays out the same procedure for all NCBs to follow so (in theory at least) we won’t find area teams doing things differently. 
 

However, the big issue causing considerable concern is the NCB’s requirement within the policy document which states, “The contract holder (ie the seller) should also show that they have received CQC registration under the new partnership agreement”. 

If the NCB get their way, this new requirement would mean a return to the 6 step CQC registration process described in Round 1!. 

The twenty or so phone calls I have made trying to determine how each NCB area team have been nothing if not entertaining and have demonstrated that the hope of a uniform approach by local teams may well be forlorn.

Some area teams are not aware that this policy exists and they have no intention to part from the procedure described in Round 2.

Others have told me that this is the way it must be otherwise contracts must be returned and put out to tender

Others still have referred me to the CQC. 

The CQC’s advice is that these are the NCB’s policies and not theirs but offered no guidance on whether to follow the 3 step rule or the 6 step rule.

The advice I would give dentists facing this predicament at this moment in time is to let your legal representative approach the relevant NCB. They will ask the right questions in order to gauge the approach of the local team to this policy. The objective here is to ensure the GDS contract transfers safely from seller to buyer. Each transaction should be taken on a case by case basis – if a particular NCB area team isnot interested in seeing a CQC partnership registration then why go through the trouble and expense of doing it?

The policy does state that it, “will be refined in light of feedback from users” so there is at least hope that this part of the policy may be scrapped.

In the meantime we appear to be back in the land of uncertainty – but we have been here before and no doubt, whatever the outcome of this particular issue, we will be here again !

Next issue – Amardeep Dhillon specialist dental regulatory barrister gives his opinion. Amardeep was a dentist before becoming a barrister specialising in regulatory law etc etc.

 

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