The ethical duty of the dental professional
Dental professionals have a duty to actively participate in the protection of adults at risk of harm. The GDC's Standards state that you must report a concern about the welfare of a patient to the relevant authorities, and that you must participate in any active investigations, including requests for information from third parties such as the police.
That being said, there are often competing concerns around consent and confidentiality to consider. Any decision to intervene must be made in a patient's best interests while also paying due respect to both their autonomy and their privacy.
The legal duty of the dental professional
In Scotland, there are three specific pieces of legislation dental professionals should be aware of.
- The Adult Support and Protection (Scotland) Act 2007 serves to protect adults who are 'at risk of harm'. These are defined as adults who are unable to safeguard their own wellbeing, property, rights or other interests, are at risk of harm, and because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than adults who are not so affected. Dental professionals would be expected to work with local authorities to ensure these individuals receive the support they need.
- The Domestic Abuse (Scotland) Act 2018 serves to protect victims of both physical abuse and psychological abuse. Dental professionals who have been confided in or have significant suspicions can report concerns to the police. A court order or police request may require you to provide clinical records to assist in an investigation.
- The Human Trafficking and Exploitation (Scotland) Act 2015 is about the illegal trade of human beings for exploitation, which also encompasses the offence of slavery, servitude and forced or compulsory labour. Dental professionals would be expected to assist those that reach out for help and raise concerns where appropriate, always in the safest way possible for both parties.
Reporting a concern
As a general principle, any intervention relating to a patient's welfare should only occur when it will provide a benefit to the patient which could not reasonably be provided without that intervention. The chosen intervention must be judged likely to succeed and be the least restrictive to the patient's freedom.
- Reporting with consent: in almost all situations consent should be sought from a patient before contacting any authority on their behalf. Adults are assumed to have capacity to give (or refuse) consent unless deemed otherwise by an appropriately trained healthcare professional.
- Reporting when the patient refuses consent: in rare circumstances it may be justifiable to proceed to contact an authority even if the patient has refused consent to do so. If you have a significant concern about the welfare of a patient who you believe is at risk of serious harm without intervention, then a report to an authority may still be justifiable - but you should still inform the patient you are going to do this.
- Reporting without seeking consent: there may be circumstances where seeking consent may put the patient at greater risk of harm. In such cases it might be appropriate to report without discussing it with the patient. Suspected cases of domestic abuse or human trafficking may merit a report to the relevant authority or the police without the consent of the patient, but only where it is evident that seeking consent may endanger the patient further.
The GDC's Standards require that you know who to contact for further advice and how to refer concerns to an appropriate authority. The specific procedures and contacts vary regionally, and it's therefore essential that dental professionals acquaint themselves with the relevant information. We would recommend this forms the basis of practice policy for reporting concerns.
Disclosing records to third parties
As a general principle, any information a dental professional holds about a patient should be treated as confidential and handled in accordance with GDPR and the Data Protection Act 2018. Any requests for information from a third party should be accompanied by a signed authorisation from the patient. The ICO registered data controller should handle any requests and should only release the information for which the patient has given explicit permission.
There are, however, some circumstances where a data controller might be required to disclose information without the express permission of the patient. There are certain requirements to be met and any members facing such a request for records should contact our advisory team for support and advice.
Dental professionals must be able to justify their decision to report (or not to) and should make detailed records that reflect the process they followed in reaching their decision. The communications with the relevant authorities should be included in the patient record.
Physical descriptions of injuries should remain purely clinical and factual. Any images that are captured should be acquired with consent from the patient and handled in line with the practice data protection policies.
Similarly, when complying with a request for records, the data controller must also be able to justify their reasoning for releasing (or not) confidential records. Where a signed authorisation exists this should be straightforward however, in the absence of permission, careful reasoning must be documented.
Members should contact the DDU for advice.
Dental professionals have both an ethical and a legal duty to report a concern about the welfare of adult patients under their care. Always seek consent before reporting a concern to an authority, unless you consider doing so may increase the risk of harm.
Local authorities or the police may request your assistance in an investigation by asking you to disclose clinical records. A signed authorisation from the patient is normally required to release records, but there are exceptions.
Careful documentation of the decision making process is essential when considering an intervention into the welfare of a patient. Again, DDU members can contact us for advice.
If you feel you require more training in the identification and management of 'at risk' adults, the GDC recommend 'safeguarding vulnerable adults' as a CPD topic. This might form part of your personal development plan (PDP).
This page was correct at publication on 11/09/2020. 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.