This article was published prior to our new policy on vicarious liability as of 1 June 2021. You can read the latest information on this subject here
Even if it is only for a check-up and a scaling, do I need to provide a treatment plan and the cost of the treatment every time I see a patient and get them to sign it as well?
In business, it is always a good idea to ensure that people who are making a purchase are made aware of the costs involved before agreeing to go ahead. In this way, any misunderstanding about the price can be eliminated. By displaying a price list in the practice and on the website the curious patient can gain some idea about the cost of the initial examination. Indeed it is a good idea to tell all patients if the price list has been updated and to offer them a printed copy or indicate where it can be viewed. They should be encouraged to review it before seeing the dentist and for the avoidance of doubt, the cost of the examination (and any other requested treatment such as a scale and polish) can be included in the confirmation of the appointment and a note to this effect included in the patient’s record.
Although patients may also be able to see the prices of an x-ray or other items of treatment they will not necessarily know how many x-rays and what sort of films will be required, or indeed what other treatments might be clinically necessary and to which they will need to consent.
Any treatment plan that is proposed at the time of the examination needs to be discussed and priced accordingly and the patient should be handed a written summary which they can sign. The signed treatment plan is kept in the patient record and a copy is handed to the patient. This is important because many patients like to discuss treatment with friends and family, particularly if it involves significant cost. There are also patients who will need to share this information with carers, parents or guardians in order that they can involve them in facilitating their treatment.
In addition to explaining the cost of the treatment, section 1.7 makes it clear that the patient must be told clearly which elements of their treatment are available on the NHS and which are only provided on a private basis. The GDC includes a clear instruction not to pressurise or mislead patients over treatments that should be available to them on the NHS.
There is a co contractual requirement under the NHS to provide estimates for:
- All band 2 and 3 treatments
- When mixing NHS and private treatment
- Band 1 treatments upon request
Most modern computer systems and printers make it possible to provide a suitable priced treatment summary that complies with the GDC’s guidance.
Is it enough to ask a patient if they have seen our price list on the website or in the waiting room before starting treatment and to bill them at the end?
By displaying a price list in the practice and on the website, patients can gain some idea about the cost of the initial examination. Indeed it is a good idea to tell all patients if the price list has been updated and to offer them a printed copy or indicate where it can be viewed.
The GDC says that a simple price-list must be displayed and that it must list basic items of treatment including a consultation, a single-surface filling, an extraction, radiographs (bitewing or panoral) and treatment provided by the hygienist. For items which may vary in cost, a ‘from - to’ price range can be shown.
Patients should be encouraged to review the price list before seeing the dentist. Although they can read the prices of an x-ray or other items of treatment they will not necessarily know how many x-rays and what sort of films will be required, or indeed what other treatments might be clinically necessary. Clarification of the cost needs to be done before starting the treatment in order to avoid misunderstandings about the cost of treatment and the nature of the contract (private or NHS) under which it will be provided.
Do I need to provide an induction loop for patients using hearing aids?
The GDC says that you should recognise patients’ communication difficulties and try to meet their particular communication needs by, for example:
- not using professional jargon and acronyms;
- using an interpreter for patients whose first language is not English;
- suggesting that patients bring someone with them who can use sign language
- providing an induction loop to help patients who wear hearing aids
There is no mandatory need to provide an induction loop and provided that you are able to communicate with the patient by an alternative means (possibly by using digital tablet to write on) you should be able to demonstrate that you have made an adjustment to the patient’s particular needs.
Should I offer my patient a guarantee for their treatment as suggested by Standards?
The Office of Fair Trade recently investigated the business of dentistry and recommended that consideration should be given to providing guarantees for dental treatment. The GDC has wisely recognised that when treating a disease process there are a number of variables at play (not least being the active participation of the patient).
Consequently the requirement for a guarantee is not mandatory - instead the GDC advises that you should tell patients whether treatment is guaranteed, under what circumstances and for how long. You should also make clear any circumstances under which treatment is not guaranteed (for example, a lack of care on their part which leads to recurring problems or if the treatment is undertaken as a provisional solution in response to an emergency).
Unfortunately, guarantees fundamentally alter the nature of the contract between practitioner and patient, and may leave the practitioner unexpectedly exposed from a dento-legal perspective.
It is implicit in any contract to provide dental services that the clinician will carry out treatment with reasonable skill and care, exercising a level of skill that could reasonably be expected of someone holding himself out as possessing those skills.
A general dental practitioner is therefore expected to exercise the skills of a reasonable general dental practitioner.
Conversely, if the patient contracts with a specialist in a specific branch of dentistry, then the patient has a right to expect the specialist to display a higher level of care than that of a general dental practitioner. The same would obviously apply if the patient is seen by a recognised consultant in a hospital post.
If a dentist fulfils his/her ‘duty of care’ as described above, then, this is generally sufficient to rebut any allegation of negligence - although ultimately this is for the courts to decide.
However, if treatment is unsatisfactory or a problem arises, not due to any negligence on the dentist’s part, but simply because an alleged breach of contract on the dentist’s part, then an action brought against the dentist can still succeed, even in the absence of any clinical negligence.
There are no hard and fast rules governing how long a particular treatment should last, and indeed it would be curious if there were, given the infinitely variable nature of the human body and its function. A guarantee, however, imposes rules and standards which then become an integral part of the contract between dentist and patient, so that a dentist might be obliged to replace, at no cost to the patient, treatment which was neither negligent, nor which had failed to meet the normal terms, implied or otherwise, of a contract to provide dental services.
It is entirely possible, therefore, that a claim could arise which could have been successfully defended were it not for the presence of the ‘guarantee’ given by the practitioner when the treatment was provided. In such a situation, Dental Protection may not be able to provide assistance, if the practitioner had effectively given undertakings which had unilaterally, and without the knowledge of Dental Protection, extended his obligations to the patient.
Clearly it would not be equitable in a mutual organisation such as ours, if an individual member were to give binding ’guarantees’ (with a view to promoting his/her own practice), while expecting the cost of any claim upon these guarantees to be met by other members who had given no such guarantees.
If, on the other hand, it is clear that the patient’s claim would have succeeded whether or not the specific guarantee had been given, then clearly the member’s entitlement to assistance would merit consideration.
My written English is not very good. Is it acceptable to ask the practice manager to deal with all my correspondence and communications?
Whilst there is no reason why you should not employ a practice manager to correspond with your patients, this person would still be working to your instructions and it would be necessary for you to be able to check what has been written on your behalf to ensure that it accurately reflected what you were trying to communicate to the patient. We can all have trouble with spelling and grammar from time to time and help from a member of the team who can write good English can certainly be helpful in achieving a good professional standard.
If the communication is coming from you, then the signature on the communication should also be yours and not that of the practice manager (although the manager could sign it in your absence if this is stated alongside their signature). Ultimately you are responsible for all communications with the patient and you have a vicarious liability for the acts and omissions of any practice staff who are acting on your behalf.
The GDC requires that you must be sufficiently fluent in written and spoken English to communicate effectively with patients, their relatives, the dental team and other healthcare professionals in the United Kingdom. If you have any doubts in this matter there are recognised standards against which you can measure yourself
My written English is not very good. Is it acceptable to ask the practice manager to deal with all my correspondence and communications?
Whilst there is no reason why you should not employ a practice manager to correspond with your patients, this person would still be working to your instructions and it would be necessary for you to be able to check what has been written on your behalf to ensure that it accurately reflected what you were trying to communicate to the patient. We can all have trouble with spelling and grammar from time to time and help from a member of the team who can write good English can certainly be helpful in achieving a good professional standard.
If the communication is coming from you, then the signature on the communication should also be yours and not that of the practice manager (although the manager could sign it in your absence if this is stated alongside their signature). Ultimately you are responsible for all communications with the patient and you have a vicarious liability for the acts and omissions of any practice staff who are acting on your behalf.
Is it enough to ask a patient if they have seen our price list on the website or in the waiting room before starting treatment and to bill them at the end?
By displaying a price list in the practice and on the website, patients can gain some idea about the cost of the initial examination. Indeed it is a good idea to tell all patients if the price list has been updated and to offer them a printed copy or indicate where it can be viewed.
Although they can read the prices of an x-ray or other items of treatment they will not necessarily know how many x-rays and what sort of films will be required, or indeed what other treatments might be clinically necessary. Clarification of the cost needs to be done before starting the treatment in order to avoid misunderstandings about the cost of treatment