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.
Q. Yesterday one of our recently employed practice staff was signed off work for four weeks by her GP. She has today handed in her resignation. We have checked her contract and her notice period is four weeks. Are we obliged only to pay her up until the end of her notice period?
Yes – the sick line covers her for her notice period so you would still pay the four weeks plus any outstanding annual leave she may have accrued but not taken during her short time with the practice. You should confirm in writing her end date.
PR form retention
Q. Our dental surgery (England) is moving to new premises and we are trying to reduce paper storage. Is it okay to destroy old PR forms?
NHS England’s Records Management Code of Practice (updated 02/05/23) requires that finance-related dental records, including PR forms, should be retained for two years following an adult patient’s last attendance. For child patients, the records should be retained until the 25th birthday (or 26th if the patient was 17 when treatment ended). You may therefore wish to include PR forms in this longer retention period. Find out more about record keeping in the MDDUS dental risk toolbox and on this NHS Business Services Authority advice page.
Leaflets for consent and risk information
Q. The practice is planning to write up some patient information leaflets that set out the key risks for various procedures such as extractions, root canal treatment etc. We plan to have the patient sign these to give their consent. Is there any guidance you can give on things like layout and content?
You will be aware that the only aspects of dentistry that require written consent are sedation and general anaesthesia. While a consent form can be a useful adjunct, the most important parts of a valid consent process are the discussion you have with the patient and the documentation of that discussion within the records. Any discussion should include the risks, benefits and alternatives of treatment – the details of which should be recorded in the notes. It is important to provide both pre-operative and post-operative warnings. Any consent form, if provided, should be patient specific, rather than being generic. You can read more about consent in the General Dental Council’s Standards guidance (principle 3), or in the MDDUS dental risk toolbox.
Data protection fee for expert work
Q. I am a GDP who undertakes expert legal work. A law firm has asked me to provide an opinion on a clinical negligence case, but they say I should be registered as a data controller with the Information Commissioner’s Office (ICO). Is this really necessary in order to write dento-legal reports?
Any organisation or sole trader who processes personal information needs to pay a data protection fee to the ICO, unless they are exempt. The ICO website has a useful FAQs page which includes a self-assessment tool to help assess whether you need to pay a fee. A key deciding factor is who takes responsibility for deciding how the information is processed. Expert witnesses will generally be considered to be third-party data controllers, rather than merely data processors. It is therefore likely that you will indeed require to register as a data controller.
Sign language interpreter
Q. We have a new patient to the practice who is deaf and has requested a British Sign Language (BSL) interpreter. The cost of arranging this, plus the longer appointment time, may be considerable. Are we obliged to provide this?
Under the Equality Act 2010, healthcare providers in both NHS and private care are obliged to make “reasonable adjustments” for people with a disability. The General Dental Council’s Standards guidance (1.6.3) also states that “you must consider patients’ disabilities and make reasonable adjustments to allow them to receive care which meets their needs. If you cannot make reasonable adjustments to treat a patient safely, you should consider referring them to a colleague.” In this case, the practice would have to assess whether arranging and paying for a BSL interpreter is “reasonable”. Note that it is unlawful for a dental provider to ask a deaf person to pay for a sign language interpreter that they arrange (section 20(7) of the Equality Act 2010). Some NHS providers may offer financial assistance with such costs. Be aware that refusing to provide this service may leave you open to legal challenge. It may be helpful to communicate with the patient in writing about what reasonable adjustments and support they require so they can understand and can make informed decisions about their care and treatment options. Read more in the Care Quality Commission’s dental mythbuster article on using interpreters.
Q. I noticed a heated debate amongst a group of dentists on Twitter recently in which one was attacked and criticised for a brief political comment he made. Some of the comments were very harsh and of a personal nature – is this kind of exchange seen as “online banter” or could it have more serious consequences?
Healthcare professionals must always think carefully before posting comments on sites such as Twitter. Dentists who are found to have made inappropriate comments could find themselves in professional difficulties. The standards expected of dentists do not change when they are communicating through social media - online debates can quickly become heated, but dentists are expected to behave with integrity and respect both in their professional and personal lives. Posting comments that could potentially cause offence or be deemed unprofessional in any way should be avoided. The General Dental Council is clear in its Standards guidance (principle 6.1.2) that “you must treat colleagues fairly and with respect, in all situations and all forms of interaction and communication. You must not bully, harass, or unfairly discriminate against them.”
In its Guidance on using social media (PDF) it adds: “Your professional responsibilities, such as patient confidentiality and professional courtesy, are still fundamental when you use social media. Do not instigate or take part in any form of cyber bullying, intimidation, or the use of offensive language online. If you share any such content posted by someone else, you can still be held responsible even though you did not create it.” Read more in this MDDUS article on the pitfalls of social media use.
This page was correct at the time of publication. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.