As England moves towards further easing of the lockdown imposed in March 2020, MDDUS has been approached by members seeking advice and guidance about how this change might impact upon their dental practices. We note that the lifting of the lockdown has happened at different times in different jurisdictions, and that now England is moving to re-establish dental practice at pace. In these circumstances, MDDUS’s role is to ensure that members have been signposted towards the relevant guidance, to assist them in making an informed decision about their return to work. It is not MDDUS’s role to approve or disapprove of any particular course of action or business decision.
MDDUS has sought legal advice from Leading Counsel experienced in healthcare law.
MDDUS’s advice remains that members who work in practices providing care for NHS patients, must follow the guidance issued by the Chief Dental Officer (CDO) in England. This guidance has been issued in the context of the public health emergency caused by the coronavirus. Members will appreciate that this is a rapidly changing situation and are therefore advised to pay close attention to all new guidance published, notably that sent out by the CDO.
Practitioners working in an entirely private practice are not bound by the CDO’s directions as to the treatment they may or may not provide, although they will no doubt wish to take the CDO’s position into account when deciding how to proceed. They should only offer face-to-face treatment to the extent that they can do so safely and in accordance with adequate infection control measures after carrying out a proper risk assessment, which needs to be recorded. The consequences of reopening and treating patients without adequate infection control measures are potentially very severe. Members will necessarily be subject to obligations towards their staff - in particular under health and safety legislation.
It is essential that members obtain valid consent from patients for face-to-face care and would be advised to explain the additional risks of coronavirus transmission, including the steps that the practice has taken to reduce those risks.
Mixed NHS and private practice
Mixed practices must treat NHS patients in accordance with the guidance from the CDO and ensure that they have the necessary equipment and an appropriate SOP in place to maintain staff and patient safety at all times. Private patients may be seen for face-to-face care as described above. In communicating with patients about the choices available to them, there must be clarity about the financial arrangements made for care, mindful of the GDC Standards for the Dental Team guidance Sections 1,2 and 9. MDDUS recognises that some NHS patients may choose to have certain items of care provided under private contract. In these circumstances, the choices offered to the patient must be clearly captured in the notes and provided to the patient in a written estimate. This is particularly important at this time given that NHS care is currently provided without charge to the patient.
MDDUS members are advised to review the professional guidance which is available from organisations such as the British Dental Association, the Faculty of General Dental Practice and the Scottish Dental Clinical Effectiveness Programme. These authoritative bodies provide appropriate guidance concerning returning to work, risk assessments, definitions of emergency care and analgesic and antibiotic prescribing.
Further, all practices that are open will need to comply with any requests for information or directions (including any enforcement action) made by CQC and NHSE/I, which are designed to protect patients and staff.
Indemnity for clinical practice is provided as a member benefit. It is not conditional on members following one particular set of guidelines or another. So if a claim, complaint or investigation arises from the care of a patient during this time, members can look to MDDUS for support and assistance in the usual way.
Members must appreciate, however, that if departing from the authoritative guidance the ability to provide a meaningful defence when challenged by a third party, may be limited.
If a member’s revised practising arrangements will exceed five hours clinical activity per week, it is imperative that they notify MDDUS, to ensure that adequate and appropriate indemnity is in place.
We hope that the above clarifies the current understanding of the Dental Advisory Team. Should you be an MDDUS member and have any queries, then please contact us on firstname.lastname@example.org or call the Dental Advisory line.
Dental Advisory Team
Updated – 7 July 2020
*Please note, this update supersedes the MDDUS guidance published on 5 June 2020 here.
**For those dental members returning to practice, please read the latest MDDUS guidance on your proposed working pattern here.