We have been able to reassure them that however they interpret the guidance they can seek our advice and support in the usual way. Here our dento-legal advisers discuss some of the most common queries and areas of concern. For more information, click on the link to watch the video and explore each topic further.
Can I depart from guidelines?
In our video from 18 June, David Lauder advised:
Dental professionals have had the challenge of keeping up with a swathe of new guidelines during the pandemic, as well as following their existing legal and ethical obligations.
For understandable reasons, many guidance documents have also been updated continually, while various organisations have been saying slightly different things at different times. And throughout, dental professionals have had to balance the oral health needs of individual patients with the measures required to protect the public.
It's not surprising that some members have asked about the status of guidelines and whether there are circumstances when they can depart from them.
Broadly speaking, guidelines are recommendations which are designed to assist clinicians with their clinical decision-making. They are not mandatory or universally applied like an Act of Parliament or a legal ruling in the courts.
As a dental professional, you are expected to consider relevant guidelines and use your professional judgement, based on the clinical situation. If you are unable to follow particular guidelines, it’s still important to document that you’ve taken them into account and your reason for departing from them. The GDC has said that while it expects decisions to be informed by current guidance, it “won’t be looking to second guess judgements made on [the] basis” of dentists’ professional judgement.
In order to successfully defend yourself against a claim, it is generally necessary to demonstrate that your actions were in line with ‘a responsible body of opinion’ at the time. Responsible bodies of opinion who have issued guidelines during the pandemic include the Departments of Health, the CDO, the GDC, Royal Colleges and various specialist societies.
Given the pace of change during the pandemic, the DDU advises you to check relevant websites regularly and map practice policies and procedures against the live guidance, rather than relying on a printed copy. Contact our advisers if you are concerned that you may have to depart from guidance and would like specific dento-legal advice.
What should I do about COVID-related complaints?
In our video from 22 July, Sue N’Jie advised:
As dental professionals adapt to new ways of practising dentistry, they may also find themselves having to respond to complaints from patients arising from the pandemic and its consequences for dental care.
Possible areas for complaint include access to urgent treatment during lockdown, the availability of appointments and the more limited treatments available. Some patients may already be anxious or in pain when they contact the practice to make an appointment; others might be worried about the detrimental effect of delays on their oral health.
However, as unwelcome complaints are in the current situation, practices still need to respond promptly and professionally. As far as possible, your approach should be consistent with your published complaints process and in line with current NHS guidance and GDC standards.
If your practice doesn’t have the resources to respond to a complaint within the timescale set out in your complaints process, amend your acknowledgment letter accordingly so the complainant knows what to expect and keep the lines of communication well and truly open. Most people will be understanding about the unavoidable delays but not all and it is important to have a clear audit trail of your communications. Good recording and tracking of the complaint progress will help avoid criticism.
Effective communication is also important to pre-empt complaints. Review your website and practice answerphone so patients have a consistent and current message about how they can make an appointment and the measures you are taking to protect them. Similarly, the limitation of treatment options and possible delays in the management of referrals should be explained in advance.
Now more than ever, the smooth running of the practice relies on excellent teamwork, working closely together to respond professionally and consistently when patients have concerns. Ensure frontline staff have been trained in complaints handling and understand the practice procedure.
Finally, continue to encourage patient feedback as you are developing your new surgery systems so you can pick up possible issues before they become the subject of a complaint and ensure patients feel at ease and well looked after.
What do I need to consider when carrying out remote consultations?
In our video from 28 May, Alison Large advised:
During the lockdown, dental professionals had to adjust to a different way of interacting with patients as telephone triage and remote consultations became the norm. While face-to-face dentistry has resumed, numbers are restricted and some patients may still need to be assessed remotely.
The key thing to bear in mind is that that the same GDC principles apply to remote consultations as if you were conducting a normal appointment, including confidentiality, record-keeping and obtaining consent. As well as Standards for the Dental Team, the GDC has also co-authored guidance setting out high level principles in remote consultations and prescribing.
The DDU has compiled the following practical tips to help you avoid the main pitfalls of remote consultations:
- Ensure both you and the patient are in the right environment to hold a confidential conversation, there is a good telephone signal and working technology (if using a video link). It will be immensely beneficial to have access to the patient’s existing dental records too.
- Identify the patient and confirm whether you are speaking to them or a representative. Bear in mind the normal considerations regarding confidentiality and consent still apply.
- Introduce yourself, explain your role and the purpose of the consultation. This is particularly important for new patients.
- Complete a COVID-19 screening assessment so you can tailor your advice appropriately.
- Record your assessment of the patient. When taking a medical history, make a note of all the questions asked, together with both negative and positive responses given by the patient. There may be occasions where, with the patient’s authority, you will need to liaise with their GP and these discussions should also be documented.
- When assessing a patient’s clinical needs and providing advice, document the rational for your proposed approach in case you are later asked to explain this.
- Recordings of consultations or images sent by the patient need to be added to the clinical records too and you should seek patient consent for this, explaining the reasons for storing the information, how it will be stored and the length of time it will be retained.
- Follow current guidelines when remotely prescribing analgesics or antimicrobials. The Human Medicines Regulations 2012 makes provision for dentists to contact pharmacies to allow the issue of a remote prescription. In an emergency, arrangements can be put in place whereby a pharmacist can dispense a dental prescription provided they receive a hard copy of the prescription, signed by the prescribing dentist, within 72 hours.
- Ensure the patient understands your advice and satisfy yourself that you have effectively communicated what happens next, such as follow up calls, how they can collect a prescription, or be seen face-to-face. Try to ensure the patient has realistic expectations about the treatment available and timescales.
How can I cope with the stress?
In our video from 17 July, Emily Howden advised:
Dental professionals are used to dealing with high pressure situations but the pandemic has led to uncertainty and additional strain for members who are juggling issues arising from their work, financial situation and home lives.
Recognising the impact this may be having on your mental wellbeing is important because the GDC expects you to look after your own health in the interests of providing safe and appropriate patient care.
There are some simple steps which should help you manage your response to the current situation:
- Only use trusted resources for news about the pandemic. Ignore rumours and speculation, which are rife on social media.
- Take regular breaks when you are working and away from work, try to exercise or do something you enjoy to escape the pressures of work and help you relax. Eat well, have adequate rest and avoid relying on alcohol or smoking as a coping strategy.
- Discuss your worries or concerns with trusted friends, family members or colleagues.
- If you think that your health is suffering, make an appointment to speak to your GP or an occupational health doctor and don’t self-prescribe.
- Make the most of the advice and help available, including the NHS Practitioner Health Programme (PHP); the Dentist's Health Support Programme (DHSP); the BDA Benevolent Fund; and the DDU if you need support through a claim or GDC case.
- Contact the DDU’s employee wellbeing helpline which provides 24-hour, confidential advice, support and information on areas including financial well-being, legal information and family issues and childcare support.
- Try the DDU’s e-learning course on health and wellbeing which is aimed at helping dental professionals recognise the warning signs for anxiety, depression and burnout, and to develop the skills to manage stressful situations.
This page was correct at publication on 30/07/2020. 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.