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Leaving a practice, part 1: obligations to patients

30 January 2020

It is commonplace for practitioners to change practices through their career, but what are their obligations when doing so? This article by Dr Kiran Keshwara and Dr Simon Parsons, dentolegal consultants at Dental Protection, will explore the challenge of leaving a practice

 

Whether you have been offering extensive and complex treatment to your patients, or your appointment book has been largely recalls and simple restorative treatment, your departure from a practice can be a time of upheaval. The general principle for patients undergoing active treatment, irrespective of the reasons for leaving a practice, is to ensure that patients are informed of a clinician’s departure and have been appropriately referred or handed over to other clinicians for their ongoing care.

There may be many reasons, both personal and professional, that can lead to a practitioner moving on. Most are planned, like a further study or retirement, others are unforeseen like illness. Naturally, it is impossible to predict the unforeseen. However, regardless of the reason for the departure, the old adage of keeping your house in order applies. Do your current records and treatment plans outline the next steps for your patients? Can someone else pick up your patients’ treatment where you last left it? Incoherent and incomplete records frustrate the next treating clinician and leave one open to criticism, increasing the risk of a complaint. The last thing you want to have to deal with when moving into the next phase of your life is organising shambolic patient care or having to field complaints relating to your prior care of your patients. This is compounded if you have an unplanned absence due to ill health.

Transferring patient records

If you are closing your practice, there needs to be an arrangement in place to enable patients to have their records transferred to a new clinician of their own choosing. If you are leaving a practice it is helpful to discuss your plans for ongoing patients with the practice owner so that they may be able to assist once you have left.   

Patients can be disconcerted by the appearance of a new clinician when they arrive for their next check-up or for ongoing treatment. It is sensible for the practitioner or practice staff to let the patient know that they will be leaving and that the next time they attend, another practitioner will be there to look after them. Naturally, this is only possible if you know you will not be there next time. Communicating the change helps avoid disappointment while providing patients with an opportunity to exercise some choice as to who their next clinician will be.

Patients undergoing current treatment will need their records fully updated by the leaving practitioner so that any clinician taking over the treatment has ‘handover’ notes and is aware of what was planned. It is usually a good idea to inform the practice of your contact details so that a new colleague can talk to you if they have any questions.

Handing over complex treatments

For patients undergoing complex treatment, the practitioner should refer the patient to the most appropriate clinician and could consider sending the patient a letter detailing the treatment that has been completed to date, and the treatment outstanding. It is also important to highlight to the patient the importance of ongoing upkeep and to warn of the risks of no further treatment, especially in complex care. These patients may not understand that they need to have further treatment or ongoing care and the risks of not wearing their retainers or having regular hygiene and maintenance appointments may not have not been previously highlighted. Where specific warranty provisions may be in place, these should be clearly documented in the patient record so that there is less room for dispute later should treatment fail.

Some patients may have paid the full fee for their treatment in advance, and the fair apportionment of the payments received should be discussed with the practice owner. Similarly, where a patient has been extended credit, it is wise to discuss your share of these payments once they have been made. There will often be laboratory charges linked to work in progress and these payments require reconciliation. Third party payment schemes in place may need attention too.

Sometimes, the departure of a popular clinician proves to be a catalyst for patients to reconsider their treatment and move on to another practice. It may be necessary to offer such patients a partial refund where advance payment towards treatment has already been made.

But what if a denture case is part-way through and a patient doesn’t want to continue with a new clinician? We recommend you exercise discretion in these cases as there may be occasions where continuity of care overrides all other issues. At Dental Protection we know of situations where practitioners have ‘left’ a practice but have agreed to complete a handful of patients at the practice in the best interests of all parties. Whether such an arrangement is workable in your own circumstances will be something for you to collectively decide.

It is also wise to plan for how the release of copies of patients’ records will be managed should patients move on, as this can be a time-consuming administrative process. As always, written consent for record release should be obtained from each patient to ensure compliance with privacy principles, and the practice should not resist or refuse any reasonable request.

What about while I’m on holiday? 

If going on a few weeks’ leave but keeping your practice open with a locum, it is wise to inform your regular patients of this arrangement. Your locum needs to be able to decipher your treatment plans and your patients may wish to delay complex treatment until your return. It can be helpful spending some time briefing locums on any problematic patients and your typical approach to managing reworks and emergency care. Locums can be reluctant to perform corrective treatment for gratis given it can affect their earnings, so some understanding of compensation for these events is prudent.

If temporarily closing your practice instead, it is helpful that patients are abreast of emergency arrangements while you are away. Keeping patients informed about your return date is wise, as this can reduce the risk of patients seeking treatment elsewhere. Consider making arrangements for patients to book online or have a member of staff available to take calls, so that you don’t return to mayhem or a sea of disgruntled patients in pain.

What if I’m unsure about my plans to return?

You may be unsure when you will return to work from a planned absence such as maternity leave. It is also commonplace to be unsure of what level of workload you may want to commit to, or what hours may fit with the competing demands on your time. Most patients will be understanding in these situations and will remain loyal to you and the practice. Patients will have advance warning of a clinician’s absence in these situations and have had ample opportunities to organise appropriate handover.

However, the open-ended nature of a return to work can cause uncertainty about how many patients need to be managed and by whom. In fairness to all, it may be helpful to discuss a possible phased return to work with the practice owner. This can reduce the risk of being unable to meet expectations of billable hours at the practice and the risk of having to cancel patients at short notice.

Remember comments made before an event are an explanation, but those made afterwards are an excuse. Effective communication with patients is key to making a departure from a practice a smooth event, even when it is only temporary. Each scenario is different and so members are encouraged to contact Dental Protection on 1800 444 542 to discuss their options and to get situation-specific advice.

You can also listen to our podcast series for further guidance and advice.

© 2019 The Medical Protection Society Limited

DPL Australia Pty Ltd (“DPLA”) is registered in Australia with ABN 24 092 695 933. Dental Protection Limited (“DPL”) is registered in England (No. 2374160) and along with DPLA is part of the Medical Protection Society Limited (“MPS”) group of companies. MPS is registered in England (No. 00036142). Both DPL and MPS have their registered office at Level 19, The Shard, 32 London Bridge Street, London, SE1 9SG. DPL serves and supports the dental members of MPS. All the benefits of MPS membership are discretionary, as set out in MPS’s Memorandum and Articles of Association. “Dental Protection member” in Australia means a non-indemnity dental member of MPS. Dental Protection members may hold membership independently or in conjunction with membership of the Australian Dental Association (W.A. Branch) Inc. (“ADA WA”).

Dental Protection members who hold membership independently need to apply for, and where applicable maintain, an individual Dental Indemnity Policy underwritten by MDA National Insurance Pty Ltd (“MDA”), ABN 56 058 271 417, AFS Licence No. 238073. DPLA is a Corporate Authorised Representative of MDA with CAR No. 326134. For such Dental Protection members, by agreement with MDA, DPLA provides point-of-contact member services, case management and colleague-to-colleague support.

Dental Protection members who are also ADA WA members need to apply for, and where applicable maintain, an individual Dental Indemnity Policy underwritten by MDA, which is available in accordance with the provisions of ADA WA membership.

None of ADA WA, DPL, DPLA and MPS are insurance companies. Dental Protection® is a registered trademark of MPS.