How to Work with Complex Care Pathways (NHS England) – Carestream Dental

Sensei Cloud now incorporates Complex Care Pathway (CCP) functionality for NHS England, including sign-up and interim claims and a new Complex Care Pathways worklist, to comply with the 1 April 2026 Contract Reform Package.

Complex Care Pathways are designed to prioritize care for patients with extreme dental needs for a longer-term treatment time period and are charged as a fixed fee converted to UDAs, rather than a value based on the treatment provided. This feature allows practices to undertake treatment plans spanning over the course of 6 or 12 months, with monthly declarations to the NHS.

Three Care Pathways are available for adults (i.e., patients 16 years old and above):

Pathway 1: For patients with five or more carious teeth into dentine (and no periodontal disease)
Pathway 2: For patients with five or more carious teeth into dentine and unstable periodontal disease (i.e., Stage II Grade B or above)
Pathway 3: For patients with first new diagnosis of severe Stage 3 / unstable Grade C periodontal disease (or higher)

Complex Care Pathway Sign Up Claims

You can identify a claim as the start of a Complex Care Pathway by selecting the correct Pathway type within the claim.

To sign up a patient for a Complex Care Pathway:

Create and accept a treatment plan as normal. See NHS Treatment Planning for more information.
Note: The plan cannot contain a Band 3 item. The option to start a CCP is disabled when treatment plans contain one or more Band 3 treatment items.
View the NHS claim that is generated for the treatment plan.
From the Complex Care Pathway drop-down list near the top of the claim, select the Pathway type: Pathway 1, Pathway 2, or Pathway 3.
Select the Complex Care Pathway Declarations menu to expand it, and then select the clinician declarations for the Sign Up claim.
Note: If the claim overlaps a concurrent treatment, the relevant additional declarations are shown and marked as mandatory.
Click Mark as Ready to Send.
From the Claims Management screen, submit the claim.
Important: When the claim has been submitted, the Pathway selection cannot be changed.

Note: Treatment plans that are for CCPS have (CP) prepended to the Treatment Plan Name.

Concurrent Treatment

There is support for certain concurrent treatment alongside Pathways. Most treatments cannot run alongside an active pathway, with the exception of the following:

Band 3 courses of treatment (excluding orthodontic treatment and appliances)
Denture repairs (charge-exempt)
Denture modifications, relines or rebasing
Unscheduled care

For the preceding treatment items, Sensei Cloud calculates the correct charge adjustment and surfaces the mandatory clinician declarations automatically, so the claim is not rejected for a missing code or incorrect charge.

Note: A patient cannot be on more than one Complex Care Pathway at the same time.

Complex Care Pathway Worklist

A Complex Care Pathway worklist is available from the Location tab (Location > NHS Claims > Complex Care Pathways) to help you track and manage CCPs. This dedicated worklist brings together every Pathway and the associated claims, with the ability to quickly and easily filter to the claims that require action.

The worklist includes columns for Pathway Type, Patient, Acceptance Date, Pathway Status, Settled Claims, Next Claim Assigned Month, Next Claim Status, Provider, and Location (if accessing from the All Locations tab).

Visual indicators alert you of claims that are overdue or nearing the reactivation deadline. You can also mark pathways as Incomplete or Suspended, or reactivate any Suspended claims (within the three-month NHS window), ensuring concurrent and Sign up/Interim activity is charged, declared, and tracked accurately.

The indicators update automatically as claim statuses change (e.g. a claim moving from Due to Overdue).

From the worklist, you can perform the following actions:

Expand rows to view details for a Pathway, including:
- Patient snapshot, pathway type, claim of acceptance and status
- Expected month for the last claim
- A table of existing claims associated with the Pathway, identified by sequence number (e.g., 3/12), with a link to open the next claim in sequence or any existing claim
Use the Filter List items to locate specific Pathways (e.g., Pathways that have claims that are currently due or overdue or Pathways that are due in the Next Month, etc.)
Note:
-- You must click Apply Filter after making filter selections to apply them to the list.
-- Select Show Only Actionable Pathways to display only the CCPs that you can currently take action on.
Under Actions, click View Legend to identify the different symbols used in the list and what status they indicate for the CCP:

Interim Claims

Interim claims are created automatically in sequence as the Pathway progresses. A new claim is generated after the previous claim has been settled (i.e., accepted, adjusted, or manually settled).

Interim and final claims are created only when previous claim has been settled, and not before the first day of the assigned month. Each new claim is assigned to the month following the previous claim and appears under the Pathway in the Complex Care Pathway worklist.

If the previous claim is settled but the next claim is not currently due, the status is indicated as Pending in the worklist.

Note: Deletion of claims is prevented for Failed to Return (FTR) patients once the initial claim has been submitted.

To submit an interim CCP claim when it is due:

From the Complex Care Pathway Worklist (Location > NHS Claims > Complex Care Pathways) or from the Patient's Claims Management screen, select the claim to open it.
Proceed with any adjustment of the clinical dataset or other parameters as needed.
Select the clinician declarations for the claim.
Click Mark as Ready to Send.
Submit the claim.
Note: Two claims for the same Pathway cannot be sent on the same day.

Note: If you are unable to see the next claim in sequence for a Complex Care Pathway, the most likely reason is that the next claim has not reached its assigned month yet. A new claim is generated automatically once the previous one is settled, but it only becomes available to open from the first day of its assigned month. Until then, it shows as Pending in the Complex Care Pathway worklist.

Additional Pathway Information

See the following additional sections for more information in regard to Complex Care Pathway functionality within Sensei Cloud.

UDA Display

The UDA is not available in certain locations for Complex Care Pathway claims. This is because, unlike standard NHS courses of treatment, the number of UDAs is not fixed and known in advance.

Each claim corresponds to a fixed monetary amount, and the number of UDAs it represents depends on the notional UDA value set for each individual contract. Since Sensei Cloud cannot reliably calculate the UDA figure for these claims, the UDA display is removed from the relevant places, rather than displaying a potentially inaccurate number.

Suspended or Incomplete CCPs

Note: Sensei Cloud supports marking a Complex Care Pathway as Suspended or Incomplete. However, NHS England recently announced a delay in their support for these declarations, and a resolution is expected shortly. It is recommended that practices hold off submitting these declarations in the meantime, until NHS England confirms next steps.

Both Suspended and Incomplete statuses are used when a patient does not complete a Pathway as originally planned, but the consequences differ:

Suspended — Pathways that are Suspended are paused temporarily. The Pathway can be reopened within 3 months by submitting the next declaration in sequence, continuing from where it left off.
A pathway can only be suspended once, and not on the first, penultimate, or final declaration. If it is not reopened within 3 months, the pathway is automatically closed as Incomplete.
Incomplete — Pathways that are Incomplete have ended permanently. No further declarations are accepted, and it cannot be reopened. The patient has to start a new Pathway if they meet the entry criteria.

Note: NHS guidance is to use Suspended where a patient has not attended or has cancelled an appointment but may still resume; Incomplete is for cases where the pathway definitely will not continue (e.g. the patient has declined further treatment).

Late Pathway Submission

When a Pathway claim is not submitted within its expected window, for regular declarations, NHS will still accept it late. However, the UDA credit for the Pathway is paused until the claim is received (and resumes from that point).

Failed to Returns

A Complex Care Pathway is not intended to be marked as Failed to Return. If a patient does not return, the correct route is to declare a Suspended or Incomplete complex care pathway, once these declarations are supported by the NHS.