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Does requesting advice affect my annual membership subscription?

  • We actively encourage members to contact us for advice to provide peace of mind and to help prevent a concern or problem escalating.
  • MPS does not use the number of requests for advice as part of its risk assessment of a member. This includes determining their membership subscription.
  • In exceptional cases, where a request for advice involves facts or circumstances of a highly unusual or unique nature it might trigger a general review of an individual’s risk profile. However, we stress that this would be very unusual.
So, if you want to discuss a medico-legal issue or need advice on how to prevent a concern or problem escalating, please do let us know - we are only a phone call away.

I'm worried about something that's happened. Can I talk to MPS about it?

If you are concerned about any issue or incident which has occurred in your capacity as a doctor or other healthcare worker, we would encourage you to get in touch immediately to ask our advice. There is no stigma attached to seeking guidance or support, and we would rather you asked for help in time to avoid a problem instead of waiting and hoping for the best, only to find yourself in greater difficulties later.

Will you still help me if I leave MPS?

Where you are eligible for MPS’s occurrence-based protection you can seek assistance for any complaint or claim arising from an adverse incident that took place during membership of MPS – even if it is brought years later, or if you have long since left MPS. Occurrence-based protection means you do not need to make any further arrangements for long-term protection after your membership ends.

I am under pressure to make an in-house referral to our implantologist and if I do, I receive a referral fee from the owners.

Within this principle, standards 1.7.1 and 1.7.5 clearly explain that all referrals must be made in the best interests of the patient. Any financial transactions must be transparent and able to withstand independent scrutiny, without any hint of a decision being influenced by a financial benefit to the practice or referring dentist at the risk of harm to the patient. This is crucial where the practitioner has any concerns about the training or competence of the in-house implant dentist (for example) and is not permitted to refer out of house by the owner. Such a situation would be contrary to the best interests of the patient (see question above.)

The same logic would apply to any in-house fee paid for a private referral to a hygienist.

How can I ensure the patients’ interests when I am working in a busy practice which offers a monthly bonus when we achieve the productivity target set by the owners?+

This standard puts the interests of the patient as paramount when any decision is made about treatment or decisions about referrals. The GDC and the public will expect that any conflict will need to be resolved in favour of the patient.

Our NHS practice has a ‘policy’ which says that the hygienist will only see patients on a private basis. Is this acceptable now?

Looking at this principle together with standards 1.7.2, 1.7.3 and 1.7.4 there appears to be very little room for doubt. Patients must be given a real choice, and a practice cannot hide behind a ‘policy’.

If the practice uses the services of a hygienist, the practice may give the NHS patient an option of seeing the hygienist privately. However, if the patient does not want to have the treatment privately, then under the terms of NHS contract, there is an obligation to provide all necessary treatment on the NHS.

The GDC recognises that patients expect their interests to be put before financial gain and business need. Since the GDC’s function is to protect the patient it is likely to take dim view of those who do not meet patient expectations. ‘You must always put your patient’s interests before any financial, personal or other gain’ 1.7.1

The NHS does accept that patients may choose a private option - for example if in the opinion of the dentist, the treatment is not clinically necessary and the patient is insistent on having this done or simply because the patient preferred to have the treatment provided privately.

If a private charge is to be made for scaling and polishing, the mixing rules must be adhered to - with an FP17 DC form signed to confirm the choice made by the patient. In those circumstances, there is no cause for concern.

I am a dental therapist and an employee of the practice. If I get a complaint against me whose responsibility is it to reply - mine or the practice principal's?

Handling complaints is the responsibility of all members of the dental team although it is usually expected that the lead clinician or line manager will probably respond when the complaint is against an employed member of staff. Alternatively, and in particular if the complaint is clearly directed at you, you may feel that you would prefer to respond yourself. This is entirely up to you. 

The most important aspect is that the complaint is acknowledged (usually within two days of receipt of the complaint) and a full and detailed response provided to the patient as soon as practically possible (usually with ten days of receipt of the complaint letter). In our experience the earlier a complaint is addressed the more likely the matter will be resolved. 

That response does not have to be in writing and in some situations speaking with the patient directly or asking them to come into the practice to discuss the complaint may well be enough to resolve any issues. You may then choose to confirm that discussion in writing or simply respond fully in a letter. Before any response is made however you may well feel it would be helpful to obtain contact us for advice and ask for assistance with the written response.

Read our advice booklets on complaints handling

I'm an orthodontic therapist. Is it true that I have to have a dentist on the premises when I work?

Orthodontic therapists are perfectly entitled to work on their own if they wish without a dentist on the premises. To a large extent this is a matter of personal choice, competency and experience. 

Contact Dental Protection for more guidance on this issue.

Many of my patients think I am some sort of dentist. Do I have to tell them I'm a therapist?

It is particularly important that patients are not misled in any way, especially in relation to the provision of treatment and who is providing that treatment. There is no reason then not to be open and honest with a patient. Indeed most therapists are extremely proud of their position and would be horrified to be thought of as some sort of 'second class' dentist. Not only does it undermine their role in the practice but is also leads to patient misconceptions particularly when the further advice of the dentist is sought in relation to a treatment plan.

Patient misunderstandings often come from the most unusual of circumstances. It may be, for example, that the confusion occurs from how the dentist introduces you to a new patient, how your role is explained to them or even how the receptionist refers to you when talking to patients. It is wise then to discuss this within the practice and ensure that all members of the team know precisely what role you have and most importantly its limitations. 

Contact Dental Protection for guidance on the specific issue.

I'm a dental therapist. Am I allowed to get involved in tooth whitening?

The GDC's Scope of Practice document indicates the skills that DCPs are expected to have (by nature of their basic training) and the additional skills that they can develop during their career. In particular, the GDC has indicated that dental hygienists and therapists may become involved in tooth whitening, provided it is to the prescription of a dentist. The GDC make no reference to the technique to be used or favours in-surgery or home bleaching.

It is important to realise however that, as this is an additional skill, a DCP would need to be able to demonstrate that they have received the appropriate training and that they are competent to carry out the task. Unfortunately the GDC does not define what it would regard as 'sufficient and appropriate' training. Indeed it leaves this decision to the DCP. That seems a little unfair particularly as the DCP's opinion in this respect may differ from the GDC's and the first time the DCP is aware of this is when it is being questioned perhaps at a conduct committee hearing. 

Having said that it seems logical to assume that this training must be specifically designed with hygienists and therapists in mind (ie, it is not a course designed for dentists) and that the wider aspects of tooth whitening are considered (including the legal and ethical implications). Courses run by specific whitening companies may not necessarily comply, especially if these courses are in effect designed to promote a particular product. 

If then you are at all in doubt in relation to your own personal circumstances, please feel free to contact Dental Protection 

I am self-employed orthodontic therapist. Do I need a contract?

To a large extent this relates to the business of dentistry and therefore is entirely a matter for the therapist and the practice principal. Generally speaking a well worded contract protects both parties in the event of a disagreement, and therefore it is in everybody's best interests. It is however a matter of personal choice. 

Contact Dental Protection for guidance on the specific issue.

I'm a dental hygienist. Do I have to work with a dental nurse?

The GDC's guidance document, Standards for the Dental Team, makes it very clear that when any clinician is treating a patient they should make sure that there is somebody else - preferably a registered team member - present in the room who is trained to deal with medical emergencies. A failure to adhere to this guidance, particularly if something goes wrong, could mean that it is difficult for Dental Protection to defend your actions. Working alongside a dental nurse makes good sense in any event as it improves patient care and makes the treatment more efficient. Contact Dental Protection for guidance on this issue.

I'm a dental therapist. What if I am unhappy about the standard of cross infection control in the practice I work in?

It is the duty of any dental professional to put their patients' interests first and you should always act to protect them over any personal or professional loyalty. A poor standard of infection control in the practice is likely to put patients at risk and, if it can be shown that you have not acted appropriately or not brought the matter to somebody else's attention, then you too could end up in some difficulty. Initially it is best to speak to the dentist or your line manager if you have one and explain your concerns to them. In this respect it is best to be positive, rather than negative, and offer solutions to the problem, rather than being confrontational. If then you are still unhappy, it would be best to contact Dental Protection and ask for our guidance in relation to the specific issue.

I'm a dental hygienist. What if I do not agree with the dentist's treatment plan? Can I change it myself?

At present General Dental Council guidance (Principles of Dental Team Working, paragraphs 2.3 to 2.7) clearly indicates that a patient should have a full mouth assessment by a dentist and be provided with a treatment plan prior to the commencement of any treatment by a dental care professional. That treatment plan however is of course not always set in tablets of stone, and may in some situations be varied depending on a patient's needs. Be very careful that the changes you are proposing are in the patient's best interest and that your actions do not constitute an element of re-diagnosis.

Much depends on what is written in the treatment plan and to an extent how it is written. A very prescriptive treatment plan is unlikely to allow any variation (i.e. please place MO restoration in upper right E). A more general treatment plan allows the therapist a degree of latitude that in dentistry is often helpful (i.e. please restore upper right E). 

Major changes to a treatment plan should always be approved by the dentist (i.e. where a tooth that was previously treatment planned for restoration now requires extraction). Minor changes (ie. the number of appointments or what treatment is offered at any one appointment) may well be as a result of the patient's choice and therefore have no overall impact on the treatment plan itself. If possible however, it is always best to speak to the prescribing dentist before making any alteration. Any changes (and the reasons for those changes) should always be recorded in detail in the records. If you are at all in doubt then feel free to contact Dental Protection 

I work some of the time in practice as a clinical dental technician and the remainder as a dental technician. Do I need to make two sets of indemnity arrangements?

No. Your membership of Dental Protection as a clinical dental technician also provides access to indemnity for any acts or omissions as a dental technician.

I am an NHS employee in a hospital clinic. My boss tells me I am insured through Crown Indemnity, as he is, and I do not need access my own professional indemnity. Is he correct?

Firstly you need to understand that NHS/Crown Indemnity is not insurance. It is a discretionary indemnity that exists primarily to protect the Trust itself, not the individuals working for the Trust. There is a widespread assumption that individuals are 'covered' automatically, but this is not necessarily the case. For a clinical dental technician or a dental nurse who is following the agreed internal procedures of the Trust, it is highly unlikely that the individual would be left to meet the cost of a negligence claim against the Trust arising from their own clinical acts and omissions. But the Trust, like any other employer, does have a legal right to seek 'contribution and indemnity' from the employee personally if the employee has not followed agreed procedures or has acted in a particularly reckless or irresponsible fashion against the employer's interests.

Having access to your own professional indemnity arrangements gives you the peace of mind of knowing that you have the right to seek help, advice and financial assistance with any costs or damages involved. In addition, once you are registered a patient (or your employer or even a former employer with whom you are in dispute) could make a claim against you to the GDC. NHS/Crown Indemnity gives you no protection or support at all in this situation. Having your own Dental Protection membership means that you will have access to personal advice, guidance and support (including a 24-hour emergency helpline of experienced dento-legal advisers), and the right to request that the cost of representation by specialist solicitors and barristers (where necessary) is met on your behalf.

I'm a self-employed clinical dental technician and not yet a Dental Protection member. Will I have access to indemnity if I do something that results in a negligence claim when supplying work to a dentist who is not my employer?

Not at all - if there is a conflict of interest, we simply arrange for separate representation for each member. This gives all parties access to their own dento-legal adviser and, where necessary, separate firms of solicitors and separate barristers. In one complex case a few years ago we had 11 members involved, each of whom had entirely separate representation. Each of the members concerned was satisfied that their interests were never compromised at any stage.

I am a Dental Protection member in my own right working for a dentist who also has membership with Dental Protection. If a claim is made against us both, surely your first priority would be to look after the dentist and not me?

Not at all - if there is a conflict of interest, we simply arrange for separate representation for each member. This gives all parties access to their own dento-legal adviser and, where necessary, separate firms of solicitors and separate barristers. In one complex case a few years ago we had 11 members involved, each of whom had entirely separate representation. Each of the members concerned was satisfied that their interests were never compromised at any stage.