A dental practice in the City of Derby area

5. Mrs R complains the Practice removed her from the NHS patient list without warning or notification, and she only became aware of this when she later tried to book an appointment. She says the Practice did not send reminders to prompt her to book an appointment.

6. She also complains the Practice made inaccurate claims that she had not attended an appointment since August 2022 and said she had cancelled nine appointments and missed one.

7. Mrs R also complains about the Practice’s complaint handling.

8. Mrs R says as a result of being removed from the NHS patient list, she has been left without NHS dental treatment and felt pressured into attending a private dental appointment. She also says the inaccurate claims of attendances and poor complaint handling have caused her to lose trust in NHS services.

9. Mrs R is seeking a further investigation and for the Practice to reconsider reinstating her as an NHS patient. She also wants a written apology and improvements to their communication practices. She also seeks a financial remedy.

10. What follows is a short summary of events. We do not include full details as both the organisation and Mrs R are aware of these.

11. Mrs R first attended an NHS appointment at the Practice in 2018.

12. In April 2025, Mrs R contacted the Practice to arrange an appointment due to painful toothache. The Practice told her she had been removed from the NHS patient list as she had not had an appointment since August 2022.

13. The Practice said Mrs R could be treated at the Practice as a private patient, and she attended a private appointment.

17. When we look at a complaint, we first consider what are the relevant standards or guidelines to inform what should happen. Next, we go onto consider the version of events from all parties. We do so to identify if care fell so far below a standard to be considered a failing (often referred to as ‘maladministration’). We recognise not all failings will be maladministration. On occasions this could be a shortcoming. Where we identify so we will make this distinction in our decision making.

18. If we identify a failing, we consider the impact and injustice on the aggrieved and if we can link this to the failing. We refer to this as ‘flowing’ from the claimed injustice.

19. Following this we then look to establish what the organisation has done to put matters right for the failing (the ‘remedy’).

20. If we consider more could be done, we may make a range of recommendations. Though we consider the individual circumstances of each complaint, it is for the Ombudsman to determine remedy that is fair, proportionate and reasonable.

21. We reach a view based on what we must consider to be independent reliable evidence. Often this involves investigation of the contemporaneous records taken at the time of events, as these are both a clinical and legal account for us to reach a view.

Removal from NHS patient list

22. Mrs R says she only became aware she was no longer a patient at the Practice when she tried to book an appointment in April 2025. Mrs R says the Practice had not sent any reminders to prompt her to book an appointment and had removed her in 2022 without any warning or notification by telephone, text, email or post.

23. We appreciate Mrs R will have been anxious to attend a dental appointment for her painful toothache and expected to be able to make an appointment.

24. In its complaint response, the Practice explained a patient is only classed as a ‘registered’ NHS patient if they are in an open course of treatment or need further treatment within eight weeks of completing an NHS course of treatment. The Practice said the last time Mrs R attended for an NHS appointment was in August 2022 and so she was not covered by these rules.

25. We have considered the Practice’s decision to remove Mrs R from its NHS patient list in 2022, in line with the relevant guidance.

26. The NHS GDS/ PDS contracts are the terms and conditions set out by the NHS when commissioning dental services. This framework, overseen by NHS England, says a dental practice can stop offering NHS appointments if a patient fails to attend an appointment or frequently cancels at short notice.

27. The Practice ‘Refusing access to patients policy’ says when a patient fails to attend an appointment or late cancels, the patient will be sent a letter or email informing them about the date of the missed appointment and the consequences of this. The Practice policy says the consequences include if a patient fails to attend an appointment or late cancels without 24 hours notice twice, then the patient may be informed they will no longer have access to treatment at the Practice.

28. Our adviser notes the Practice also has an appointment management and cancellation policy which has clear time frames and consistent enforcement for all NHS patients.

29. We consider the Practice’s ‘Refusing access to patients policy’ and ‘Appointment management and cancellation policy’ are within the NHS GDS/ PDS contract frameworks.

30. We can see Mrs R failed to attend one appointment in November 2021 and cancelled nine appointments during 2019, 2020 and 2021. The Practice systems do not record when appointments are cancelled, which means we cannot know for sure how much notice Mrs R gave to the Practice. However, the Practice says the appointment diary shows spaces on these dates and times, and this indicates a short notice cancellation.

31. We can also see two conversations noted between the attending dental practitioner and Mrs R during appointments in January 2019 and February 2019. In these conversations, it was explained to Mrs R about the Practice’s strict appointment management and cancellation policy and the consequences of both failing to attend appointments and late cancellations.

32. The GDC ‘Standards for the Dental Team’ says dental practitioners must always act honestly and fairly in dealings with patients.

33. We consider these conversations between the dental practitioner and Mrs R were in line with this guidance. The practitioner honestly explained the Practice’s policies about missed appointments and late cancellations, so Mrs R could understand the potential consequences of these for patients.

34. We can also see the Practice emailed Mrs R in July 2022 to remind her she had not attended an appointment for over a year. The Practice told Mrs R she would be classed as an irregular attender if she did not contact the Practice within 14 days. The Practice explained irregular attenders may only be seen for emergency treatment, subject to availability. The email included Practice contact details including a telephone number, email address and portal link.

35. We can see the Practice emailed Mrs R again 14 days later in August 2022 and said as she had not attended an appointment for over a year, she was now classed as an irregular attender. Again, the Practice explained irregular attenders may only be seen for emergency treatment, subject to availability. The Practice noted Mrs R could contact it if she wished to rejoin the Practice, and Mrs R would be added to the wait list.

36. The GDC ‘Standards for the Dental Team’ says dental practitioners must give patients the information they need, in a way they can understand, so they can make informed decisions.

37. We consider these Practice emails were in line with this guidance. The emails reminded Mrs R she had not attended the Practice for over a year and asked her to contact the Practice within 14 days so she would not be classed as an irregular attender. The emails also explained how being classed as an irregular attender would impact on the NHS dental care that would be available, so Mrs R could make an informed decision about this.

38. Overall, we can see evidence to suggest Mrs R breached the Practice’s appointment management and cancellation policy, which asks patients to give at least 48 hours notice to cancel a dental appointment. We also consider that under the terms of the Practice’s ‘Refusing access to patients’ policy, this meant the Practice might inform Mrs R she no longer had access to treatment at the Practice.

39. Our adviser explains it is best practice before the removal of a patient to provide a written warning and provide a clear explanation that further failures may result in removal.

40. We can see the Practice sent Mrs R three emails about this. One to let her know she failed to attend an appointment including a clear explanation that any further failures may result in removal, one reminder to book a dental examination, and one to make her aware of the rules of being an irregular attender.

41. Whilst these emails did not explicitly say Mrs R would be removed from the NHS patient list, we consider the information in these was sufficient to make Mrs R aware that she would not be able to access the same NHS service.

42. Overall, we consider the Practice acted within its contract framework and the relevant Practice policies when it removed Mrs R from its NHS patient list in 2022.

Examination appointment in August 2022

43. Mrs R explains she attended an examination appointment later in August 2022, after the Practice email saying she was now classed as an irregular attender. We appreciate this may have been confusing for Mrs R and may have suggested to her that she continued to be a regular patient at the Practice.

44. The NHS Constitution for England says a person has responsibility to show proactive involvement for the care of themselves and their family.

45. Under the NHS Constitution, we would expect to see Mrs R be active in clarifying any matters that were unclear to her. We also note this appointment was close to the decision to remove Mrs R from the NHS patient list, and there may have been overlap with this decision being applied and Mrs R booking this appointment. We do not consider the further appointment in August 2022 overrode the information Mrs R had been given in writing three time prior to this. We therefore do not see indications of failings in relation to this aspect of the complaint.

Next patient contact

46. Mrs R disagrees with the Practice’s view that it had been 33 months before she contacted the Practice again in April 2025. She says she attended a more recent appointment at the Practice in January 2023.

47. The Practice said the January 2023 appointment was an emergency appointment, and a hospital referral was subsequently made for further investigation. The Practice says this was not a regular appointment, and emergency appointments are generally offered when capacity allows, as in this case.

48. We consider this advice was correct and in line with the information about emergency appointments provided in the July and August 2022 emails. We therefore do not see indications of failings in the Practice’s view that it had been 33 months since Mrs R was last seen as a patient on the NHS list at the Practice.

49. In addition, even taking into account the emergency appointment in January 2023, we can see there was a gap of over two years from this time until Mrs R requested an appointment in April 2025. We consider this adds to our view that there was no indication of failings at this time.

Practice decision not to offer NHS care in April 2025

50. Mrs R says she was deeply upset in April 2025 when the Practice told her she was no longer eligible for NHS treatment because she had not attended an appointment since August 2022.

51. The Practice explained a patient is only classed as a ‘registered’ NHS patient if they are in an open course of treatment or need further treatment within eight weeks of completing an NHS course of treatment. The Practice said Mrs R was not covered by these rules as she was not in an open course of treatment and had not had treatment in the previous eight weeks.

52. Section 1.1 of the HOCRB states ‘Since the current dental contract was introduced in 2006, there has been no system of registration for dentistry in England. This means that, unlike with GPs, patients can attend any dentist that provides NHS services for a course of treatment. A patient’s details may be added to a list held by a practice. However, this does not guarantee an NHS appointment with the same practice in future once their current course of treatment is finished.’

53. We consider as Mrs R was not in an open course of treatment and had not had treatment in the previous eight weeks, then under the current dental contract, the Practice was able to decide whether to offer further NHS appointments. As the Practice said they had limited NHS capacity due to a dentist leaving, we consider the decision to not offer Mrs R an NHS appointment in April 2025 was one the Practice could make.

54. We therefore cannot see any indications the Practice did not act in line with its contract or national standards. We therefore do not see any indications of maladministration in relation to this concern.

Failure to take Mrs R’s disability into account

55. Mrs R says the Practice did not take her disability of partial blindness with poor eyesight into account. She says the Practice should have taken extra measures to contact her before removing her from the Practice’s NHS patient list. Mrs R also says the Practice failed in its duties under the Equality Act 2010. Mrs R says the Practice should have taken extra measures to contact her before removing her as a patient because of her disability.

56. We would not reach a view as to whether the Practice had failed in its duties under the Equality Act, as this is a legal determination. We can however consider if the Practice acted fairly and whether Mrs R was able to access and benefit from its services on an equal basis with others.

57. We can also consider whether the Practice acted within NHS England contractual requirements and GDC standards about these issues. The GDC is legally bound to uphold the Equality Act 2010 and ensure its regulatory framework (the GDC ‘Standards for the Dental Team’) incorporates the Act’s legal requirements.

58. As noted above, over time, the Practice sent a number of emails to Mrs R including warning her about the consequences of non-attendance, asking her to make an appointment to avoid being classed as an irregular attender and notifying her she was classed as an irregular attender.

59. We can also see there were two in person discussions with Mrs R about the Practice’s strict appointment management and cancellation policy and the consequences of both failing to attend appointments and late cancellations. We therefore consider different communication methods were used to explain the policies.

60. We can see Mrs R has used email successfully in her complaint correspondence with the Practice. We cannot see any reference in Mrs R’s records that she told the Practice she was unable to access or read emails and she has not said this is the case here. We therefore consider the Practice acted appropriately in communicating with Mrs R by email.

61. We consider it was reasonable for the Practice to think emails were suitable and accessible by Mrs R and the Practice acted in line with the above guidance about this. We also consider the Practice acted fairly in applying its policy rules and NHS capacity considerations to Mrs R.

62. Part 6 of the NHS GDS contract says dental services can only be refused if there are reasonable grounds for doing so which do not relate to disability (amongst other groups). We consider the Practice had reasonable grounds (which are noted above) which do not relate to disability to refuse to offer Mrs R NHS dental care. We consider therefore the Practice acted within its contract.

63. We therefore cannot see any indications the Practice did not act in line with its contract or national standards in relation to this concern.

Complaint handling

64. Mrs R says the Practice did not respond to her complaint within ten working days, and she had to contact the Practice again about this. She says that only then did the Practice respond to her complaint.

65. The GDC standards say patients expect their concerns or complaints to be acknowledged, listened to and dealt with promptly. The standards also say:

‘5.3.4 You must respond to complaints within the time limits set out in your complaints procedure.

5.3.5 If you need more time to investigate a complaint, you should tell the patient when you will respond.’

66. We can see the Practice acknowledged Mrs R’s complaint on the day she made the complaint and said the results of the investigation would be sent to her within ten working days in line with the Practice’s complaints procedure. This acknowledgement also included a copy of the complaints procedure, and it is in line with GDC standards to provide this.

67. We can also see the Practice’s response to Mrs R’s complaint was sent about six weeks later and after she had contacted the Practice again about this. The Practice had not sent any updates to Mrs R in the meantime.

68. We consider the Practice response to Mrs R in this timeframe did not follow Practice policy. The response after six weeks also did not follow GDC standards which say complaints must be responded to within the time limits set out in the Practice complaints procedure.

69. Our NHS Complaint Standards says that organisations should respond to complaints within expected timescales. These are set out in the NHS Complaint Regulations which say that an organisation should respond to the complainant within six months of the complaint being received.

70. We sympathise with Mrs R about this and accept the Practice did not act in line with its internal complaint handling policy. However, as the Practice responded within six weeks, we consider it acted in line with our NHS Complaint Standards and the NHS Complaints Regulations. Therefore, we consider this a shortcoming by the Practice rather than a failing. We therefore do not take further action in relation to this aspect.

Conclusion

71. We appreciate this has been a distressing time for Mrs R, and our decision is not intended to lessen the impact this has had on her.

72. We hope we have clearly explained the reasons for our decision and would like to thank Mrs R for giving us the opportunity to consider her complaint.

1. We have carefully considered Mrs R’s complaint about a dental practice in the Derby area (the Practice). Mrs R raises concerns that she was removed from the NHS patient list by the Practice without warning. She also complains about the Practice’s handling of her complaint.

2. We are sorry to hear about her experience and recognise the removal from the NHS patient list has caused her upset and frustration. We understand Mrs R continues to experience dental issues, and the removal from the list meant she has not been able to access care as an NHS patient.

3. We are satisfied that we have not seen any indication of failings in the Practice’s actions or communication. We can see it acted in line with the relevant guidelines and dental contract when it declined to offer Mrs R an NHS dental appointment. We would also like to reassure Mrs R we have not seen indications of failings in its handling of her complaint. We therefore will take no further action on Mrs R’s complaint.

4. We explain our decision further below and hope this reassures Mrs R about her experiences and provides a further explanation of how we conduct investigations.