Practice Policy: Refusal to Treat Patients

Policy title: Refusal to Treat, Failed to Attend (FTA/DNA), and Breakdown in Relationship
Practice: Restore Dental Group
Health Board: Cardiff & Vale University Health Board & Aneurin Bevan University Health board.
Applies to: All dentists, dental care professionals, and practice staff
Review date: 2027
Based on: GDS Contract & PDS Regulations 2006, NHS Wales Guidance (Revised November 2025)

1. Policy Statement

Restore Dental Group is committed to providing safe, respectful, and equitable dental care to all patients. We recognise that accessing healthcare can be stressful and aim to manage concerns, complaints, and missed appointments in a fair, transparent, and compassionate manner.

However, under the General Dental Services (GDS) Contract Regulations, Restore Dental Group reserves the right to refuse or terminate treatment in defined circumstances where continuing care is no longer appropriate, safe, or feasible.

This policy ensures that any refusal to treat is lawful, proportionate, documented, and communicated clearly, in line with Cardiff & Vale University Health Board requirements.

2. Patient Preference of Clinician

Patients may express a preference to be seen by a particular clinician. Restore Dental Group will endeavour to meet reasonable requests; however, this cannot be guaranteed.

A request may be declined where:

• The preferred clinician does not work on the requested day or time

• The clinician is at full capacity and patients cannot reasonably be transferred

• The clinician has planned or imminent leave (e.g. maternity or long-term leave)

• The clinician does not routinely provide the treatment required

A clinician may also refuse to treat a patient where there are reasonable professional or safety grounds.

3. Violent, Abusive, or Aggressive Behaviour

Restore Dental Group operates a zero-tolerance policy towards violence, abuse, discrimination, or threatening behaviour.

Treatment may be refused or terminated where:

• A patient commits or threatens violence towards staff, patients, or visitors

• Behaviour causes a member of staff to fear for their safety

• Abusive, racist, discriminatory, or threatening language is used (verbal, written, non-verbal, or via social media)

• The incident has been reported to the police

Where appropriate:

• The patient will be informed of the decision

• Cardiff & Vale University Health Board will be notified in writing within 7 days

• The practice will liaise with the Health Board prior to termination wherever possible

4. Non-Payment of NHS Charges

Restore Dental Group may:

• Refuse to commence a course of NHS treatment, or

• Terminate a course of treatment prior to completion

Where a patient fails to pay NHS charges that have been properly requested in accordance with NHS Charges Regulations.

The practice does not:

• Charge for missed NHS appointments

• Request non-refundable deposits for NHS treatment

5. Failed to Attend (FTA / DNA) Appointments

Restore Dental Group recognises that missed appointments reduce access to care for other patients.

An irrevocable breakdown in relationship may be considered where:

• Two consecutive appointments are missed without prior notification, or

• Two short-notice cancellations (less than 24 hours) occur within the last six appointments or within a three-year period

Management of FTAs:

• All FTAs and late cancellations are recorded in the patient record

• Patients receive a written warning after the first missed appointment

• The policy is applied fairly and consistently

• Removal from the practice will not occur without prior warning

6. Was Not Brought (WNB)

Where a child or adult at risk does not attend due to reliance on another person, this will be recorded as “Was Not Brought” (WNB) rather than DNA.

Restore Dental Group will:

• Consider safeguarding implications

• Follow NHS Wales “Was Not Brought” guidance

• Take appropriate follow-up action to support patient safety

7. Irrevocable Breakdown in Relationship

Treatment may be refused where, in the reasonable opinion of the Contractor:

• There has been an irrevocable breakdown in trust or cooperation, and

• Reasonable steps have been taken to resolve or de-escalate the situation

Examples may include:

• Loss of mutual trust

• Persistent refusal to follow essential clinical advice

• Continued requests for inappropriate or unavailable treatment despite advice

• Micro-aggressions or behaviour that makes staff feel uncomfortable

A single incident would not normally constitute an irrevocable breakdown.

Where possible:

• An alternative clinician within Restore Dental Group will be offered

• Cardiff & Vale University Health Board will be notified in writing

• Patients will be informed how to access urgent dental care via NHS 111 or the Health Board helpline

8. Removal from the Practice and Ongoing Access to Care

Where a patient is removed from Restore Dental Group:

• The patient will be informed in writing

• Cardiff & Vale University Health Board will be notified

• The patient will be directed to the Dental Access Portal (DAP) for reallocation of care

• Information on accessing urgent dental care will be provided

9. Communication and Record Keeping

Restore Dental Group will:

• Maintain accurate clinical and administrative records

• Record all FTAs, cancellations, warnings, and communications

• Make this policy accessible via the practice website and practice information leaflet

• Regularly audit DNA/FTA rates and outcomes

10. Equality and Fairness

This policy is applied:

• Lawfully

• Without discrimination

• In accordance with NHS Wales equality and anti-racism guidance

Patients who raise concerns or complaints politely and appropriately will not be considered aggressive.

Approved by: Restore Dental Group
Date implemented: 05/02/2026
Next review: 2027