Employers and practice owners have a duty of care to their team to ensure that the environment is safe to work in, and you should be clear about the actions and procedures that have been put in place to protect staff.

There is also the ethical principle of reciprocity which means that those who are asked to or redeployed to assist during this pandemic should be supported to do so and this includes the provision of appropriate PPE.

Your own health is important, and you should ensure that you value self-care activities to protect yourself, your colleagues and your patients.
If you have pre-existing health conditions that place you at increased risk of infection, you should discuss working arrangements with colleagues and your employer. It may be appropriate to ask another suitably qualified colleague to take over the care of patients with known or suspected COVID-19.

If you are worried about aspects of patient safety as a result of the pressures placed on you during the COVID-19 crisis, you should raise your concerns with the practice owner and/or employer in the first instance.  You should also record any concerns in writing, clearly and objectively setting out the reasons for the concerns and the potential impact on patient safety, with examples. 

Keep a record of any correspondence and/or discussions about any concerns you have raised and the steps that you have taken to try to address the issues. If an adverse incident does occur, then it is important to show that you took action. If you find yourself in this situation, please contact us for further advice.

A lack of PPE puts clinicians, supporting staff, and patients at risk of contracting a potentially fatal infection. It also presents clinicians with challenging decisions about whether to provide treatment in the absence of effective PPE.

If you believe you have inadequate PPE it is worth asking yourself the following questions:
What is the correct level of PPE you need in the circumstances?
Can you raise this urgently with your employer / practice owner?
Can the treatment be delayed or provided differently (including referral to another healthcare provider) while the PPE shortage is addressed?
Consider what course of action will lead to the least harm in the circumstances

If you have exhausted all reasonable methods to manage and mitigate risk, but you still do not have appropriate PPE to nationally recognised standards for the setting you are in, you do not have to undertake patient treatment until this is resolved. However, you should seek to arrange an onward referral for the patient. Regulators recognise that refusing to treat a patient when it is not safe to do so is a perfectly proper professional judgement which is unlikely to be challenged.

 In the event that you do decide to refuse/delay treatment for safety reasons then you should keep a record of your decisions, the reasons behind them and how you sought to manage safety concerns. You should also use local incident reporting procedures.

It is understandable that healthcare providers – including dental practitioners – will have concerns regarding their own health and the risk of contracting COVID-19 infection.

National guidelines in your country of practice may differ and you should check the latest advice from your government.

It is understandable that dental practitioners during the pandemic will have concerns regarding their own health and the risk of contracting COVID-19 infection. It is also essential that patients in urgent need should be able to access the dental care they require and should not be denied treatment because their medical condition may put them at risk. Should a patient attend the practice with COVID-19 symptoms in urgent need of treatment, it is important that you take all available steps to minimise the risk and refer the patient in accordance with local guidance.  

It is not uncommon for patients to take an interest in the cross-infection measures put in place at a dental practice. At the current time, it is likely patients will have a heightened awareness or anxiety and they may seek clarification from their dentist what steps are being put in place to provide them with safe care. In the first instance, it may be helpful to enquire with the patient whether they have any particular concerns in order to fully understand the reason for their question. They may live with a vulnerable family member or have underlying health conditions that put them at additional risk. Discussing any concerns with your patient openly and transparently may help to reassure them and allay any concerns.

 When responding to any enquiries of this nature, it may be helpful to reassure patients that dentists have always had to follow strict standards around cross-infection and as such, are well experienced to deliver the necessary precautions to keep patients safe. You may wish to expand on this and reassure patients of the guidance and standards being followed, and any additional steps you have put in place to ensure the additional risks posed by COVID-19 can be mitigated. This may include any changes to usual personal protective equipment (PPE) requirements, explaining the social-distancing measures being put into practice and/or the additional hygiene and decontamination processes you are delivering in surgery.

 Whilst there may not be a requirement to tell patients what additional measures are being put in place, maintaining a transparent and open dialogue with patients is likely to support a constructive patient-dentist relationship and should be encouraged.