Returning to practice

Some dental practices are starting to resume face-to-face care for patients, and it's understandable to have questions about the dento-legal implications.

Can I open my practice?

The key question here is, "Can I open safely for patients and colleagues?" In deciding whether and how to resume routine dental treatments, you need to carry out a thorough risk assessment of your practice, taking into account a responsible body of opinion. This should consider appropriate measures in areas like infection control, PPE and social distancing. You should not be criticised if you follow guidance from organisations such as the FGDP, the relevant Chief Dental Officer (CDO) and local NHS arrangements.

In England, the CDO published a standard operating procedure for the phased transition for dental practice towards the full range of dental provision on 04 June. This sets out guidance for infection prevention and control as well as a practice checklist.

Scotland's CDO has set out a phased approach for the remobilisation of NHS dental services. In a letter of 20 May 2020, phase 2 covers the resumption of dental services. The Scottish Clinical Effectiveness Programme (SCEP) has also produced a 'live document' toolkit entitled Resuming general dental services following COVID-19 shutdown: A guide and implementation tools for general dental practice.

In Wales, details of the phased restoration of dental services are set out in the Novel Coronavirus (C-19) De-escalation Standard Operating Processes for Primary Dental Care Settings in Wales. This explains the principles of de-escalation as well as the role of dental teams during de-escalation.

The Acting CDO for Northern Ireland published a letter dated 2 June which sets out the details of the plans for the restoration of general dental services. This explains the phases for the re-establishment of care in general dental practices.

Given the backlog in patients needing treatment and routine appointments, I'm worried I will be faced with complaints about waiting times and delayed diagnosis.

Effective communication is essential to manage expectations and should cover areas such as arrangements for those requiring an appointment and the measures you are taking to protect them and members of your team.

Your practice may need to continue to remotely triage patients to determine the urgency and whether treatment can be provided safely. Consider proactively contacting patients whose appointments have had to be rescheduled to explain your plans for reopening and arranging a new date.

Finally, update your website and practice answerphone so patients have a consistent and current message. Be explicit about how you are following official guidelines designed to safeguard everyone.

I'm concerned about the risk of treatment. What's the position with AGPs?

The CDO in England has explained: "Progression to resumption of services of the full range of routine dental care will be risk-managed by the individual practice and can include aerosol-generating procedures (AGPs), subject to following the necessary IPC and PPE requirements". The CDO expects NHS England and NHS Improvement regional teams to work with local providers to agree which UDC sites remain operational and support the provision of AGP during the early stages of resumption of services.

In Scotland, AGPs will not be reintroduced in routine practice until phase 3. Patients requiring AGPs will continue to be referred to Urgent Dental Centres or designated dental practices for treatment in the meantime. Similarly in Wales, the CDO letter of 22 May says: "The need to avoid AGPs will remain necessary for some time, and so to manage that risk, they will continue to be undertaken in UDCs."

In Northern Ireland AGPs can start to be provided in a general dental practice setting during phase 3 of the restoration of General Dental Services.

Will the GDC take action against me if I have to depart from guidance?

The GDC has acknowledged that its guidance will not cover every potential scenario.

It advises that dental professionals will need to exercise their professional judgement and carry out an appropriate risk assessment. At the same time, it recognises that, "in highly challenging circumstances, professionals may need to depart from established procedures to care for patients and that should concerns be raised, relevant environmental and human factors would be taken into account". In the unlikely event of a GDC investigation, DDU members can look to us for advice and support.

The coronavirus has compromised the standard of treatment I can provide and I expect this will lead to claims. Will I be indemnified?

From a DDU perspective, our role is to assist our members. If your clinical decisions are criticised at this difficult time, you can look to us for our advice and representation in the usual way.

The DDU has argued there should be immunity for dental professionals from COVID-19 related legal claims. Of course, dental professionals will be accountable for their actions but the unprecedented circumstances in which care was provided must be remembered when investigating dental negligence claims arising from the pandemic. 

This article originally appeared in BDJ Team on 19 June 2020.

Need more advice? See all of our coronavirus dento-legal guidance.

This page was correct at publication on 17/06/2020. 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.

Leo Briggs deputy head of the DDU

by Leo Briggs Deputy head of the DDU

Leo Briggs qualified from University College Hospital, London, in 1989. He has worked extensively in the community dental service including a brief period overseas. He has also worked in general dental practice.

Leo gained a masters degree in periodontology from the Eastman in 1995 and is on the GDC specialist register for periodontics. From 1995-2017 he provided specialist periodontal treatment in both the salaried dental services and private practice. He started working for the DDU in 2005. Between 2007 and 2009 he worked part time at the DDU and part time as a clinical tutor at the School for Professionals Complementary to Dentistry in Portsmouth. In 2009 Leo went full time with the DDU. In January 2016 he became deputy head of the DDU.

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