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.

Annual leave in lockdown

Q What are the rules on annual leave during the coronavirus outbreak?

A Rules relating to carry forward of annual leave have been extended in response to the coronavirus outbreak. The statutory four weeks provided for under the EU Working Time Directive can be carried forward and taken in the two leave years immediately following the year it was due, where it was “not reasonably practicable” to have taken it because of the coronavirus. The guidance now confirms that employees are able to take annual leave during a period of furlough.

If an employee is on a period of annual leave, they should be paid their normal full-time pay for this time, with the practice able to claim back 80 per cent. You may wish employees to take any pre-booked annual leave to prevent large amounts being taken in the latter part of the holiday year. Employers are also able to require employees to take a period of holiday by giving them double the difference in notice: so 10 days’ notice is required for a five-day holiday period. See ACAS guidance on annual leave at www.acas.org.

Access to teen’s records

Q A 13-year-old patient at our practice has fallen out with his mother and is now living with his father. The mother has been in touch with the practice in regard to an ongoing health issue with the boy – but he no longer wants her to have access to his records. What is our legal position?

A Given the age of the boy it is possible he would be judged Gillick competent, with capacity to refuse disclosure of his personal information. We advise that the practice writes to the mother stating that, in order to consider whether information can be disclosed to her, the boy would need to be assessed regarding whether he is competent to make this decision for himself. It may be the mother would not want her child to be informed of her request. If she is content for this assessment and he has capacity but refuses, this would ordinarily be definitive. If he does not have capacity and the mother maintains parental responsibility, the key issue is what is in the child’s best interests to disclose.

Late attendance

Q We have a practice policy in place for patients who attend late for hygienist appointments. We offer the choice of either undergoing treatment within the time remaining or, if they pay a late cancellation charge, they can reschedule for a full 20-minute appointment at a later date. As most patients choose to continue with treatment in the shorter timescale, I’m worried the hygienist may feel rushed and that the quality of care will be compromised. Should we amend the policy?

A It should be up to the hygienist to decide whether she has sufficient time to provide appropriate treatment to the late-comer. If not, the patient should be asked to make another appointment. Should there appear to be sufficient time, the patient could be advised that the planned treatment can be carried out within the remaining period but if time runs out they will again need to reschedule. However, if the hygienist feels that the late arrival could compromise her ability to carry out satisfactory treatment, she should not feel pressured into offering a shortened appointment.

Remember, if a patient complains about a clinical outcome, the fact that treatment was rushed in order to accommodate their late attendance is unlikely to offer much of a defence. Any amended policy should be clearly publicised to patients, including late cancellation charges, or the practice could be open to complaints.

Work-shadowing

Q I’m a partner at a practice and have been asked by a friend if his daughter can shadow me for a few sessions. She is in her final year at school and is applying for dentistry at university. Is this problematic?

A Work-shadowing arrangements are not uncommon but there are a number of issues to consider. First a risk assessment should be performed and recorded prior to such an attachment to ensure that the work environment is safe for a visiting pupil. The Health and Safety Executive has published guidance related to work-experience pupils. It is also crucial to consider issues of confidentiality and consent. The pupil should be required to sign an agreement and given firm guidance that personal patient details (even the fact that someone has attended the surgery) are entirely confidential.

Patients must be asked for consent in advance (preferably in writing) for a school pupil to be present during a consultation and should also be advised that they may change their mind at any time. Notices in the waiting room to indicate that school pupil placements may occur are also helpful. Pupils should be informed that they cannot expect hands-on experience and will only be observing on a limited basis. Finally, it is important that the whole practice team are comfortable with the arrangements to ensure the pupil is appropriately supported and supervised.

Probationary employment

Q We hired a receptionist on a six-month probationary basis but there have been a number of issues arising in that period. These include not complying with practice protocols and procedures, despite being given repeated training. She has also stated that she will not be available to cover annual/sickness absence, which was clearly outlined in her interview. I have discussed these concerns and informed her that at present we will not be offering her a permanent employment contract. Are we within our rights?

A An employee with under two years’ service does not have unfair dismissal rights. As long as the decision to dismiss is not based on a protected characteristic issue (age, disability, gender reassignment, race, religion or belief, sex, sexual orientation, marriage/civil partnership and pregnancy/maternity), it should be straightforward to advise the employee that her probationary period has not been successful. She should be given her notice – which can be worked or paid in lieu – along with any accrued outstanding holiday pay up until the termination date. MDDUS members can request a template letter by emailing advice@mddus.com.

Police enquiry

Q Our practice received a police request regarding a patient, Mr A, who was recently assaulted. The officer has asked for a statement outlining the dental injuries Mr A sustained and the subsequent dental treatment he received from us. Am I allowed to disclose the information?

A The key issue here is consent. In order to disclose any information to police, you would need written consent from Mr A. Ask the officer if he has a signed medical consent form from Mr A. Alternatively, you could contact the patient and request a short written note explicitly authorising you to discuss his dental treatment with the police and, if necessary, to disclose relevant records.

Once you have consent, be sure to only speak to your own clinical records and remember that you are being approached as a witness to fact, not as an expert. Avoid any speculation regarding, for example, the cause of the dental injuries, any non-dental injuries or Mr A’s state of mind. It may also be advisable to avoid being drawn into discussions regarding the prognoses of teeth or restorations, unless you have already assessed Mr A and formed a clear treatment plan for any remedial work required.

Rural implant service

Q We are a medium-sized dental practice located in a rural area and have begun recruiting for an implantologist to provide an enhanced service to our patients. However, we are concerned that, should the implantologist leave the practice in future, we may have patients experiencing long-term complications who would have difficulty sourcing additional expert care or remedial work. Would it be reasonable to advise potential patients at the outset of treatment that a long-term implant service cannot be guaranteed?

A Should you proceed with plans for such a service it would be sensible to advise patients, in writing, that implants generally require periodic review and certain complications may not manifest for a period of years. Therefore, attendance at an implantologist over a significant period of time may be necessary. You could go on to advise that, at present, your implantologist will be retained on a sessional basis but it cannot be guaranteed that this arrangement will continue ad infinitum.

Given your geographical location, this could mean that in future years the implant service may not be available and follow-up would involve travel to a more distant centre. Clearly, individualised and case-specific consenting discussions will take place between the implantologist and the patient, but it would be reasonable for the practice to inform potential patients of this general point before they decide to proceed with treatment.

Carpal tunnel

Q I have recently been diagnosed with carpal tunnel syndrome, which has caused mild tingling and slight numbness in my hand. I am still able to carry out most dental treatments, but I have difficulty when attempting extractions. I may need surgery but I’m worried about the impact on my ability to work as a dentist. Is it okay for me to continue to practise?

A Unfortunately, MDDUS can offer only limited advice on this matter. We would draw your attention to the General Dental Council’s standards guidance which emphasises your duty to put patients’ interests first and to protect them from risks posed by your health or performance. You should seek occupational health or other appropriate specialist advice without delay.

You should also discuss the matter with your general medical practitioner or the surgeon to whom you have been referred for treatment. Only then can you make a decision on how to proceed. If you are assessed as fit to practise, then your MDDUS membership will not be affected. If you are unable to work for any significant period of time then you may wish to defer your membership until you are back at work – email membership@mddus.com for further information. Perhaps you also have independent sickness insurance cover and should contact your provider. There should be no need to contact the GDC about the matter.

Advice & Support

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