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.

Documenting COVID

Q We’ve reopened our practice for face-to-face treatment. Are there additional things we should be documenting?

A Dental practitioners should ensure patient records are completed with the appropriate detail. Be sure to have a documented risk assessment in place. Your operating procedure will evolve as the guidance evolves and it can be helpful to keep a log of when the guidance was checked in order to demonstrate how and when you have kept up to date. Consider nominating someone to take primary responsibility for checking/communicating updated guidance/advice. It is also helpful to incorporate version numbers and the date on which each version was introduced into your practice documents. This provides clarity for the team and means you can demonstrate which version was in place at what time. It may also be useful to keep COVID-related absence records for staff or dentists, including illness and caring for dependents. This will demonstrate the impact of the pandemic on a week-to-week basis.

Crossing boundaries

Q I have been treating a patient who I feel has started making flirtatious comments. In our last consultation she suggested “meeting for coffee” and asked to connect on Facebook. I’ve tried to gently emphasise that our relationship is a professional one but the comments have continued. What should I do?

A This is a sensitive situation and your first port of call should be the General Dental Council’s Standards guidance. Standard 9 is clear that: “You must maintain appropriate boundaries in the relationships you have with patients. You must not take advantage of your position as a dental professional in your relationships with patients.” In addition, the GDC’s guidance on using social media urges dentists to “think carefully before accepting friend requests from patients". It may be worth having another discussion with the patient and politely, but firmly, explaining that your relationship must remain strictly professional. It would not be appropriate for you to meet for a coffee and it would not be advisable to connect via your personal social media accounts. If you feel unable to re-establish a professional boundary, then you may need to refer the patient to another dentist. In extreme circumstances, you may need to follow the guidance in standard 1.7.8 which advises on ending your professional relationship with a patient.

Nurse needed?

Q I am due to start practising again but have heard that dentists who treat patients without the support of a nurse will not be indemnified. Is this true?

A The indemnity that MDDUS provides is not conditional on a member following a particular guidance document/standard operating procedure; nor is it conditional upon whether or not a member is assisted and supported by a dental nurse. However, be aware that if departing from the authoritative guidance and General Dental Council Standards, the ability to provide a meaningful defence if later challenged in respect of the care provided may be limited. You should use your professional judgement in these circumstances, perhaps in discussion with the practice principal where appropriate.

PPE barrier

Q We have begun seeing patients while wearing the required personal protective equipment (PPE) but the team are finding it quite difficult. Are there any ways to work more effectively while continuing to comply with the guidelines?

A We have heard from a number of MDDUS dental members who have raised similar issues around the use of PPE. Common complaints are that it is more difficult to communicate with patients, and it makes those using it feel hot as well as mentally and physically tired. Carrying out as much communication as possible with each individual patient before they come in to the practice can help, and may avoid any unexpected issues arising. Some pre-appointment discussions will need to be carried out by the clinician but other more general discussions, particularly in relation to the patient journey, can be carried out by another team member. Those discussions can be particularly valuable in reassuring the patient of the steps the practice is taking to ensure their safety. Some practices find it helpful to provide a pre-appointment digital document pack to patients which contains all the necessary documents (including medical history, risk assessment, patient questionnaire, practice COVID information, payment information) and can be returned electronically, further limiting the amount of time the patient requires to spend in the practice.

Threatening patient

Q One of our patients had been behaving aggressively. He made abusive comments and threats to members of the practice team on several occasions and, when he repeated this behaviour despite receiving a warning letter from us, we decided to remove him from the practice list. Now he is threatening to come back and cause more trouble, which has alarmed our employees. How can we deal with this behaviour?

A If the patient has been threatening and aggressive in the surgery then your team would be within their rights to call the police. If appropriate, speak to the patient first and emphasise that he should stay away from the practice or you will be forced to involve the authorities. You have a duty of care to your staff and to other patients and such aggressive behaviour cannot continue. It may be advisable to review the practice policy on dealing with violence/health and safety and to consult your CCG/health board’s guidelines. Consider, for example, whether staff are trained in how to deal with aggressive patients? Are there staff members working alone late in the evening? Would your practice benefit from a door buzzer entry system? Do team members have access to panic alarms? There may be some simple preventive measures that can be put in place.

WhatsApp group

Q I have recently been added to a WhatsApp messaging group that was set up for dental surgery assistants. It’s mostly just harmless content or ideas that are shared, but I’ve noticed some members use it to let off steam about patients they’ve had difficulties with – sometimes referring to them by name. Is this allowed, seeing as it is a private group?

A The short answer to this is “no”. It is a breach of confidentiality to discuss patients on such a forum (even in a “private” messaging app), particularly when mentioning them by name, but even if they could be identified from other details discussed. It is also unacceptable to criticise patients or use insulting language towards them and it could land you/your practice in professional difficulties. Bear in mind also that these messages may be private now, but it would only take one person to share them more widely for the content to reach the public domain. Employers take a very dim view of this kind of conduct and your job could be placed in jeopardy. The GDC may also take action in such circumstances, as this is likely to fall foul of its guidance on using social media and may be considered to bring the profession into disrepute. The other group members should be made aware of these risks and the fact that they could be in breach of their professional duties. It would be advisable to exit the group promptly and suggest that others do likewise, if this behaviour does not change.

Text updates

Q We need to send out a message to all patients to keep them updated about changes to opening hours and the limited face-to-face services that are available during the pandemic. Are we allowed to do this or do patients need to opt in first?

A Service update messages – such as “the practice will be open for urgent treatments next Monday” – would be allowed under the General Data Protection Regulation (GDPR). The intention is to inform patients about important service changes to prevent inconvenience and maintain the smooth operation of the service. Such texts are especially useful and important in the current COVID-19 pandemic. Specific patient consent is not required but the Information Commissioner’s Office (ICO) advises that a descriptor of such types of communication should be included in your privacy notice. Do not be tempted to text patients without their consent to promote a service (whether for profit or not). This constitutes direct marketing and would require explicit opt-in. Just because a patient has provided their mobile number does not mean the practice has open-ended consent to send messages.

Working on furlough

Q As practices are reopening and staff are returning to work, can we ask them to work while they remain on furlough leave?

A New rules allowing staff to carry out some work while on the furlough leave scheme came into effect on 1st July. From this date, employers have been able to bring staff back on a part-time basis, allowing them to work some days of the week while being furloughed for the others (although it remains the position that staff should not be asked to undertake any activity on the days on which they remain furloughed). Practices will be able to claim for the hours not worked under the Government scheme. This will only apply to employees who have already been furloughed, with the exception of those returning from statutory parental leave, including maternity, paternity, shared parental, adoption or parental bereavement leave. Also from 1st July, the three-week minimum furlough period ceased, although the minimum a practice will be able to claim for is one week. Practices must also claim for work carried out within a single calendar month and cannot submit a claim across two months. The reason for this is that, since 1st August, practices are required to pay the employer’s National Insurance and pension contributions. From 1st September, the Government’s contribution rate reduces to 70 per cent and then to 60 per cent from 1st October, making the practice liable to pay the difference of 10 per cent and 20 per cent respectively. Practices should discuss any new working arrangements with staff and seek detailed written agreement, which should be retained for five years.