As the UK 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 the re-opening of their dental practices. We note that the lifting of the lockdown is happening at different times in different jurisdictions. In these circumstances MDDUS’ role is to ensure that members have been signposted towards the relevant guidance, to assist them in making an informed decision. It is not MDDUS’ 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’ advice remains that members who are NHS Providers and/or Performers or independent contractors working in NHS practices providing care for NHS patients, must follow the guidance issued by the Chief Dental Officer (CDO) in the relevant jurisdiction. This guidance has been issued in the context of the public health emergency caused by the Coronavirus. It is designed to markedly reduce the movement of the population and the number of physical contacts in an effort to reduce the spread of the virus in accordance with The Health Protection (Coronavirus, Restrictions) Regulations 2020.
In England the Chief Dental Officer has advised that practices may re-open on 8 June 2020 and has issued a SOP to guide practices on delivering care safely. In Scotland (20 May 2020) and Wales (22 May 2020) the CDOs have recently updated their advice setting out a pathway for fully reopening practices. In Northern Ireland the HSCB published guidance on 1 May 2020 which includes frequently updated live hyperlinks. 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 CDOs, Health Boards and local NHS Commissioners.
Private practitioners are not bound by the CDOs’ directions as to the treatment they may or may not provide although they will no doubt wish to take the CDOs’ 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 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
MDDUS’ advice is that NHS patients must be managed according to the pathways set out by the CDOs. Where either the CDO or the Health Board has determined that practices cannot re-open, this restriction only applies to the delivery of care to NHS patients. 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 members are also advised to review professional guidance which is available from the British Dental Association, the Faculty of General Dental Practice, and the Scottish Dental Clinical Effectiveness Programme. These authoritative bodies provide appropriate guidance in terms of risk assessment, definition 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 the CQC, HIS, HIW and RQIA, which are designed to protect patients and staff.
Communication with patients
As many members will have already experienced, patients are keen to return to their practices for care. It is important that patients’ expectations about what care is available and when it can be delivered are managed carefully. Clear statements and explanations on practice websites and email messages can assist, as well as effective staff training for telephone discussions, all help to avoid disappointment and potential complaints.
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, having decided upon an increase in clinical activity, a member’s practising arrangements exceed five hours clinical activity per week (including triaging) 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
5 June 2020