For a patient who meets the clinical entry criteria, the CCP is, almost by definition, a reasonable option. It is the option the NHS has built for precisely this disease profile, it funds the longitudinal care they need, and it fixes the patient charge at a known band. A clinician who simply does not mention it, or who silently routes every eligible patient onto a banded CoT without discussion, is not exercising a permitted option; they are withholding a material one. The “choice” the guidance describes is, properly understood, the patient’s choice to make on an informed basis, not the practice’s choice to make on the patient’s behalf.

There is a best-interests dimension in operation as well. The first principle of the GDC’s standards is to put patients’ interests first. Where the pathway is the better-resourced and better-structured route for an eligible patient a decision not to offer it needs a clinical justification recorded in the notes. “We don’t do pathways” is not, on its own, an answer that sits comfortably alongside that principle.

None of this makes the pathways mandatory. A banded CoT remains a legitimate route where it genuinely meets the patient’s needs, and there will be patients for which it does: those unwilling or unable to commit to a longer period of care, a factor the guidance itself flags.

The point is narrower, and more important, the contractor’s discretion is a discretion about clinical management, exercised patient by patient and documented, not a blanket licence to keep eligible patients off the pathways altogether.

Documentation: Your best defence

The trouble with quietly not mentioning a complex care pathway is that the omission may not remain silent. A patient who later discovers from a friend, a forum, or the next dentist that a CCP exists and was simply never put in front of them will not experience that as a clinical judgement call. They will experience it as having been shut out of something they were entitled to, and few things sour a patient relationship faster than the suspicion that a door was closed without their knowledge.

Complex Care Pathways: To choose or not to choose - that is the dento-legal question

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