Call log

These cases are based on actual calls made to MDDUS advisers and are published here to highlight common challenges within dental practice. Details have been changed to maintain confidentiality.

Hospital vaccinations

Q I am a specialist dentist working in a hospital. I plan to assist with the Covid vaccination programme – will MDDUS indemnify me for this?

As this is a national programme being rolled out by the NHS, you should be indemnified for any claims by the NHS – but this is something you should confirm with the programme organisers. MDDUS will continue to provide professional advice and support to General Dental Council-registered dentists participating in the national Covid vaccination programme regardless of setting, e.g. at GP practices, vaccination hubs, hospitals. Members must be practising in accordance with regulatory requirements and contractual obligations.

Colleague mask refusal

Q I am a self-employed dental hygienist and have been working during the pandemic at two practices. At one of the practices, the receptionist refuses to wear a mask as she says she doesn’t believe in Covid-19. I have raised it with her employer but he said he cannot force her to wear a mask. A couple of patients have already raised concerns about it to me. What should I do?

The best approach would be to discuss this with the practice principal and hopefully reach an amicable solution. Familiarise yourself with the practice’s standard operating procedure and refer to any relevant sections. Mention to the principal that patients have expressed concern about the receptionist and make it clear you only want what is best for patients, staff and the practice. If any issues were to arise in relation to the receptionist’s mask refusal, ultimately it would be the principal who is held accountable. He may wish to seek his own independent advice. Document the steps you have taken to address the matter. And remember, it is your decision as to whether you continue working at the practice under these circumstances.

Referred patient

Q I recently treated a patient who was referred to me by a fellow GDP at another practice, Ms C. The patient has since asked to transfer to my practice permanently because there are some treatments available here that Ms C does not offer. Is it ethical for me to accept this patient under such circumstances?

This type of scenario is not uncommon and is to be expected when services differ between practices. You describe how the patient made the decision to leave Ms C’s practice independently, and that you did not influence this move. You also confirmed there has been no criticism of Ms C. The patient is perfectly entitled to transfer to your practice. It may be helpful to write a brief courtesy note to Ms C explaining these points, emphasising that it was an independent decision that implies no criticism of her skills.

Restrictive covenant

Q I sold my practice 10 months ago and would like to take up a new position two days a week in a new practice across town. When I sold up, I signed a restrictive covenant stating that I would not work anywhere within a two mile radius for the first year. This new practice is only slightly within the two-mile limit. It seems unfair to miss out on an opportunity for such a technicality – can I go ahead and take the job?

It may seem unfair, but the fact is that the new role would breach the limits on both time and distance that you agreed to when selling your practice. If you took up this post then your purchaser would be within his rights to pursue legal action against you. As MDDUS would not be in a position to help with such an issue, this could be a costly endeavour for you. You may wish to consider seeking independent employment law advice, but this would also likely incur a cost. It may be best to wait until the restrictive covenant has expired, or consider other roles on offer beyond the two-mile “exclusion zone”. Be sure to read all the terms of the contract so that you do not fall foul of any other legally binding agreements. From a pragmatic perspective, it may be worthwhile approaching the practice owner to whom you sold. Explain the situation and acknowledge that, strictly speaking, the new role falls within the restrictive covenant, but ask if he would be prepared to consider waiving this provision in the circumstances. If he is agreeable to doing so, it would be sensible to have this confirmed in writing before accepting the new role.

CPD required

Q Our practice is under enormous pressure at the moment. Do I need to keep up with my CPD at this time?

All General Dental Council (GDC) registrants must maintain their continuing professional development in line with their ethical and legal obligations. This means following the regulator’s enhanced CPD model. It is important to keep up to date in terms of skill set and competence. In the current climate with very limited face-to-face teaching available, it is important that you maintain learning with reference to the recommended/core topics but also other topics that reflect your sphere of practice. Of particular relevance here is basic life support. In the absence of face-to-face teaching, you should be able to access appropriate alternatives online. While not always ideal, making use of virtual training would demonstrate appropriate insightful reflection that you have sourced the most suitable alternative in the current circumstances. The GDC has acknowledged that access to CPD has been hindered by Covid-19 control measures and reassured dentists who have been affected that "you will not be penalised". The regulator has asked dentists to “do your utmost to meet CPD requirements”.

Coroner ID

Q I have received an email from the coroner asking me to disclose clinical records to assist in the identification of one of my practice’s patients. I know that patient confidentiality extends beyond death and am not sure how to respond.

The first step would be to satisfy yourself that this is a legitimate request. If so, as a dental professional, you are obliged to disclose the records requested by a coroner. The identification of a dead body can usually be justified as being in the public interest and so would meet the threshold for disclosure without consent. Before disclosing, double check you have the correct patient details and only disclose what is necessary to satisfy the request.

Patient gift

Q A 52-year-old patient has been a frequent attender at the practice for the past few months. At her last appointment, she insisted on giving bottles of whisky to the two dentists who have been treating her. Each bottle is worth around £50. The patient said she simply wanted to show her appreciation after such a tough time. Can the dentists accept these gifts?

The General Dental Council states in Standards for the dental team that: “You must refuse any gifts, payment or hospitality if accepting them could affect, or could appear to affect, your professional judgment” (par 1.7.5). While this does not constitute a total ban on unsolicited gifts of any kind, you should consider whether accepting a gift might alter the dentists’ relationship with the patient, and also how this may be perceived by the public in general. The dentists should therefore proceed with caution. It may also be advisable to ensure the patient understands that her dental care will not be affected in any way by the gift. Keep a record of any discussions with the patient, along with the reasons for accepting the gifts, if they do so. While dental practices (unlike their medical colleagues) are not contractually obliged to keep a register of gifts worth in excess of £100, this is something the practice could consider doing in the interests of transparency.

Volunteer leave

Q One of the practice receptionists says he has been approved to act as an emergency statutory volunteer and has requested two weeks’ leave. How does this scheme work?

The Coronavirus Act 2020 introduces a new statutory right for workers to take emergency volunteering leave to help support essential health and social care services. Employees and workers who have been certified by an appropriate authority to act as an emergency volunteer will be able to take unpaid leave in blocks of two, three or four weeks. To take the leave workers must:

  • give three working days' notice
  • produce a certificate from the appropriate authority confirming they have been approved and will be acting as an emergency volunteer for the period specified in the certificate.

A UK-wide compensation scheme is to be set up to compensate volunteers for loss of earnings, travel and subsistence. Workers will remain bound by terms and conditions of employment (except those relating to pay) and there will be a statutory right to return to their job. Employers are not able to refuse unpaid leave to an employee who wishes to carry out volunteer work unless they have less than 10 staff. There is, however, nothing to prevent an employer with a headcount of less than 10 staff agreeing to such a request and it is worth bearing in mind that furloughed employees can take part in volunteer work.

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