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Communication

  • Q
    How should I describe ‘Direct Access’ on the practice website?
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    11 May 2016

    Clear information for patients is vital. Practices which offer treatment via direct access should make sure that their practice publicity (eg, leaflets, brochures and websites) is clear about: what treatments are available via direct access; the arrangements for booking an appointment with a hygienist or therapist; and what will happen if the patient needs treatment which the hygienist or therapist cannot provide. It would also be helpful to have clear information prominently displayed in the practice about members of the team and their roles.

    Click here to read our briefing document on Direct Access.

  • Q
    A patient has requested their dental x-rays because they want to have dental treatment abroad where it is cheaper. Can I give them to the patient?
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    28 April 2015

    We recommend you only allow the patient to take away copies of your radiography, retaining the originals yourself. The patient is of course entitled to copies but could be asked to pay for your reasonable charges incurred in producing them.

    You have obviously made the patient aware of the potential problems associated with seeking treatment abroad, especially the provision of follow-up care which may be necessary should the treatment not go according to plan. You cannot be held responsible for the outcome of another practitioner's work.

  • Q
    A patient insists that a large asymptomatic amalgam restoration is causing medical problems and wants an extraction. Where do I stand legally on this issue?
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    22 October 2014

    Although the nature of this patient’s medical condition is not described, some patients trawl the internet seeking a remedy for what they consider to be an untreatable chronic condition.

    Historically, amalgam has been considered to be a safe restoration although there have been developments of global plans to control mercury pollution that could see amalgam being phased out over the next few years.

    When deciding how to respond, you obviously have to advise her on what is considered current best practice and to offer her treatment which would be considered to be in her best interests.

    There would clearly be a dilemma for the patient if there was no improvement whatsoever in her medical condition after you removed the tooth. Even if you did insist on this patient signing a disclaimer, it would be of little help should she decide to make a claim in negligence against you unless there was a cogent reason for you acceding to her request. You could also be asked to justify the reason for the extraction if an adverse incident occurred when extracting the tooth.

    You may wish to consider obtaining a second opinion from a Specialist in Oral Medicine or Oral Surgery, and if necessary with the patient’s permission, to liaise with her general medical practitioner before carrying out any irreversible treatment. It may also be worth discussing your concerns with this patient on the efficacy of the treatment she suggests and perhaps trying to persuade her to have the amalgam removed (which in itself can be a source of morbidity), and to restore the tooth on a temporary or semi-permanent basis to see whether it does have any effect on her underlying medical condition.

    Further information is available in Dental Protection’s Risk Management Module on Amalgam-free Practice.

  • Q
    As a hygienist or therapist will I start paying more for my membership subscription?
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    11 May 2016

    Not if you are working the same hours and your position has not changed in terms of whether or not you own and operate a practice of your own, employ staff and/or contract with third parties for the commissioning of services to be provided by others. Our dental subscription rates are reviewed annually, and members are notified of the new subscription level at the time of their membership subscription renewal. No additional subscription increases are being made as a result of direct access.

    Click here to read our briefing document on Direct Access.

  • Q
    Can I send a recall appointment to a patient using a postcard or must the card be enclosed in an envelope?
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    21 April 2015

    All communications sent to your patients should be enclosed in an envelope to protect confidentiality. This applies to all correspondence in connection with treatment as well as recalls.

    Announcements that are not patient-specific – for example a practice open day or the opening of a new practice – can be sent on a postcard.

    Postal charge increases will clearly encourage more dentists and practice managers to seek permission from patients to send out appointment reminders by text or email.

  • Q
    Can I withdraw from treating a patient?
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    02 June 2015

    Sometimes, for a variety of reasons, you may decide you need to withdraw from a patient’s treatment, or suggest they seek further treatment elsewhere. This has the potential to create a problem and it needs to be sensitively managed.

    Try never to lose your temper with a patient. Keep your cool and remain professional at all times, however testing it might be on occasions. If you are finding it difficult to treat the patient safely and to an acceptable standard, consider referring the patient to a suitably experienced colleague.

    You must never part company with a patient in anger. If for any reason you decide you cannot continue treating the patient, make it clear that you are withdrawing from the treatment in the patient’s best interests, not your own. Make the necessary referral arrangements, keep the patient informed and resist the temptation to insert any ‘one liners’ in the correspondence or in the clinical records, or worse still in any direct communication you have with the patient.

    Never give the impression that you are being arrogant, dismissive or petulant when deciding to end your relationship with a ‘challenging’ patient. A few ill-chosen words spoken in the heat of the moment can result in months or years of subsequent repercussions if you end up being sued or facing a complaint to the GDC or other agencies.

  • Q
    Do I need to provide an induction loop for patients using hearing aids?
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    18 September 2014

    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.

  • Q
    Does requesting advice affect my annual membership subscription?
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    11 December 2017

    tick smallWe actively encourage members to contact us for advice to provide peace of mind and to help prevent a concern or problem escalating.

    tick smallMPS does not use the number of requests for advice as part of its risk assessment of a member. This includes determining their membership subscription.

    tick smallIn 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.
  • Q
    How can I know if I am indemnified for the treatment I am about to offer?
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    19 September 2014

    Members are advised to get in touch with our Membership Services team prior to carrying out treatment to ensure they have adequate and appropriate indemnity for the particular treatment being planned.

  • Q
    How should hygienists and therapists respond to a patient requesting treatment that they cannot provide?
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    11 May 2016

    Dental hygienists and dental therapists offering treatment via direct access need to have clear arrangements in place to refer patients who need treatment which they cannot provide. In a multi-disciplinary practice where the dental team works together on one site, this should be straightforward. In a multi-site set-up where members of the dental team work in separate locations, there should be formal arrangements such as standard operating procedures in place for the transfer and updating of records, referrals and communication between the registrants.

    Where hygienists and therapists choose to practice independently and there is no dentist present, they should have clear referral arrangements in place in the event that they need to refer a patient for further advice or treatment and those arrangements should be made clear in their practice literature.

    If a patient requires a referral to a dentist with whom the hygienist or therapist does not have an arrangement, the DCP should set out for the patient, in writing, the treatment undertaken and the reasons why the patient should see their dentist.

    In all cases, the need for referral should be explained to the patient and their consent obtained. The reason for the referral and the fact that the patient has consented to it should be recorded in the patient’s notes. Relevant clinical information, including copies of radiographs, should be provided with the referral.

    If a patient refuses a referral to a dentist, the possible consequences of this should be explained to them and a note of the discussion made in the patient’s records. It may be helpful for members to contact Dental Protection for further advice.

    Click here to read our briefing document on Direct Access.

  • Q
    How should I record a patient's consent for routine dental treatment? Does it have to be put in writing for the patient to sign?
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    07 July 2015

    The concept of consent arises when a patient seeks advice, care and treatment from a dentist and that dentist carries out an examination of the patient and provides them with details of the treatment required together with the options, benefits and risks as well as the cost of that treatment. This is an on-going conversation that is picked up at every stage of the treatment being provided.

    Most dental procedures are carried out without the need for written consent but it is important that a record is made (either by the dentist or dental nurse) of the conversation during which the patient gave their consent.

    When seeing a patient for a dental examination there is likely to be implied consent that the patient wishes the dentist to look in their mouth and therefore opens it to facilitate this. When carrying out more invasive treatment such as taking radiographs and providing fillings, the dentist should obtain the express consent of the patient for each procedure.

    Certainly when carrying out fillings patients should be informed of the various options which are available to them, the costs of the treatment as well as the risks of not having a particular treatment carried out.

    In the UK, consent only needs to be obtained in a written form signed by the patient, when the treatment is being provided under general anaesthetic or sedation.

    Some employers make it a contractual obligation to obtain the patient’s signature on a consent form for a variety of procedures as well as anaesthesia. The employee has an obligation to respond to the terms of their contract. Indeed in complex cases it is a sensible precaution to have some form of written consent. This would apply to treatment plans for extensive restorative work or for patients undergoing treatment which could pose a significant risk, such as the removal of a lower wisdom tooth.

    The signature on a consent form does not automatically imply the patient has provided their consent to the treatment. All it means is that the patient has signed their name and may not in fact have understood the treatment which the dentist had discussed with them.

    The best way of ensuring consent has been obtained is to check with the patient if they fully appreciate the details of what has been discussed and to make good notes within the clinical records of both the discussion and the patient’s response.

    Read our region-specific advice booklets on consent in the UK

  • Q
    How should I respond to a negative comment about me that has appeared on the NHS Choices website?
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    18 August 2015

    An adverse comment placed on a website, be it NHS Choices or the practice’s own website can be upsetting, especially as it sits in the public domain for anyone to see.

    With regard to an adverse post left on NHS Choices, the website does have the advantage of allowing the practice to post a response. Whilst there is no requirement to respond to posts on this website and indeed it would be inappropriate to respond to a complaint in this way, it is advisable that a practice responds to such posts with a simple acknowledgment of the comments made and an invitation to the patient to make contact with a named person to discuss their concerns directly. This reassures both the patient who made the post and any other patients, potential patients and any others reading it that the practice takes patient feedback seriously and is keen to learn from patient experiences and to improve the service they offer. A suggested response is:

    Dear [name],
    I am sorry to read your comments posted on the website on [date] and to learn that you are unhappy with the service you received from the practice.

    We value patient feedback and welcome the opportunity to investigate and respond to any concerns. I would invite you to contact [named person] so we can fully investigate your concerns.

    I look forward to hearing from you.
    Yours sincerely

    Many practices have protocols for routinely reviewing posts left on NHS Choices and see them as an opportunity to improve services. Some practitioners also wish to thank those who have left positive feedback.

    A similar approach could be taken to comments placed on practice owned websites which have facilities for this, and sites such as Facebook. Practitioners could also consider inviting satisfied patients to leave positive reviews. These may be helpful in themselves and can also have the effect of balancing out and indeed outweighing any negative comments.

  • Q
    I am a dental nurse and most of the dentists I support are with Dental Protection. Would I be entitled to receive publications from you, if I were to become a member
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    16 September 2014

    Yes. You can receive our digital newsletters by simply registering your email address with us. In addition, the Annual Review is sent to each and every one of our 68,000 or more members worldwide. In addition to this, we also publish over 15 more targeted publications for different groups of members. Dental nurses who become dental members can access all our online publications via our website, and enjoy the substantial member discounts on offer, as well as being invited to attend our seminars and other events at a heavily reduced member price. 

  • Q
    I am a hygienist in an entirely private practice and I have concerns about the health of my principal. Where can I obtain advice and personal support for the issues involved before I notify my concerns to the GDC?
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    18 August 2016

    These situations are always difficult for all concerned. It can seem counterintuitive to take steps that may cause your practice to close, affecting your own livelihood. Health issues are challenging for all concerned - the best advice is to talk to one of our experienced advisory team who can listen to your concerns and help you balance your professional obligations with your own personal interests. If there is another dentist in the practice it might be helpful to talk to them as they may be able to seek practical support from their Local Dental Committee and perhaps the local PASS (Practitioner Advice and Support Scheme).

    In any case, where concerns are to be raised outside the practice, you would be wise to think about the following points to ensure you are not vulnerable to criticism during any ensuing investigation:

    • What is the real background to this episode, Is there a 'back story' that has not (yet) been disclosed, and about which you may be unaware?
    • Is there anything in my relationship with this person/the practice that might support an allegation that this concern was raised to gain a competitive advantage?
    • Could a reasonable and neutral observer detect any personal motive associated with raising your concerns?
    • Is there any objective evidence available to support and justify the concerns?
  • Q
    I am a hygienist with a Diploma in Dental Hygiene and want to print some business cards. Can you advise me please?
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    18 August 2016

    The General Dental Council’s advice indicates that however a clinician is being promoted, either inside or outside of the practice, the wording of that promotional material must be legal, decent, honest and truthful. Business cards would be regarded as promotional material and therefore must comply.

    Assuming that your Diploma in Dental Hygiene has been registered with the GDC, you are entitled to use the shortened version of this diploma on your business cards. Similarly, if you have any additional advanced qualifications (BA, BSc, etc.), these may be included too. However, you need to be careful not to potentially mislead patients by including details of qualifications that are unrelated to dentistry.

    It would also be advisable to indicate that you are a dental hygienist as part of your job title, simply to avoid any misunderstanding.

  • Q
    I fitted a set of dentures which the patient says are unsatisfactory, but he will not return the dentures so I can examine them.
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    14 July 2015
    I fitted a set of dentures which the patient says are hideous and demands that I refund his money. However, he will not return the dentures so I can examine them, saying they belong to him. I am happy to refund the money but would like my work returned.

    Generally speaking, the ownership of any item of dental treatment passes to the patient at the time the appliance is fitted. This is, however, not always at the same time as the treatment is completed.

    It follows that during the various stages of denture construction, the denture itself still belongs to the clinician. Once it is fitted, however, the patient then owns that denture, irrespective of whether or not a fee has been paid.

    If the patient is unhappy with the dentures and the clinician decides to refund the fees, there is no absolute right to demand the denture should be returned in lieu of the refunded fee.

    A patient who is unhappy with a denture for whatever reason would probably argue that the denture was not ‘fit for purpose’ as defined under contract law. As such the patient may ask for either a replacement item or their money back. On the basis that any replacement is unlikely to satisfy the patient (particularly if they have high expectations), the best option may be to refund the money.

    It is a simple matter to suggest to the patient that if they return the denture to the practice a full refund will be made. Most patients are happy to return the dentures as they are apparently of little use.

    However, if the patient insists they wish to keep the denture, a demand for its return could create an obstacle to the resolution of the patient's complaint. From a pragmatic perspective, whilst you may wish to ask for the dentures to be returned, if the patient remains unwilling to do so you may wish to refund the fees in any event.

  • Q
    I have a Master’s degree in implant dentistry and a special interest in endodontics. Can I include this information on the practice website and professional stationery?
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    18 August 2016

    The information used in promotional material must be legal, decent, honest and truthful. The content must not mislead patients and other members of the public in any way, or suggest any degree of pre-eminence over other members of the profession.

    You are perfectly entitled to include the qualification associated with your Master’s degree on your practice stationery, but for obvious reasons you do need to make sure it is accurate. Generally speaking, each degree that is awarded will have a shortened version that the relevant graduates are permitted to use after their name. You may like to contact the course organisers to be sure you are using the appropriate version. Any variations on that shortened version could be regarded as misleading, and therefore lead to a complaint against you.

    Web pages will be scrutinised both by patients and members of the dental profession. The General Dental Council receives a considerable number of complaints every year in relation to website content. Generally speaking, those complaints arise from poorly chosen wording that could lead the reader to think that the dentist’s name is included on one of the GDC’s Specialist Registers when in fact this is not the case. You should ensure that the website complies with the criteria set out in the GDC document Ethical Advertising Guidance.

  • Q
    I have just seen a new NHS patient with a badly broken down dentition. He was extremely aggressive and rude to both me and the dental nurse and I would prefer not to see him again. Can I refuse to treat him?
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    17 August 2016

    The provider holding the provider contract should write and tell the patient that the practice will not tolerate rudeness or aggression from any patient. You may also feel there has been a breakdown in the relationship between yourself and the patient. If you feel it is not right to continue treating the patient, you should say you are ceasing to do so.

    If you have completed the patient’s treatment, then this is relatively simple to achieve and you should tell your staff not to book the patient in again. However, if you are halfway through a course, you should bear in mind what the patient’s current situation is, and you may wish to offer 30 days’ emergency treatment, perhaps provided by someone else in your practice, but tell the patient they should seek out another dentist as quickly as possible. You should also provide the patient with a list of any outstanding treatment.

    Obtain a list of all the locally contracting dentists from the same NHS Authority that issued your contract in order to offer the patient a list of telephone numbers in order to make alternative arrangements.

    Aggression and violence from patients is not tolerated by the NHS.

  • Q
    If an NHS patient makes a verbal complaint, can it be resolved informally?
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    01 September 2014

    A complaint that is spoken is just as valid as one in written form and should be treated in the same way unless it fits one of the two exemptions described in paragraph 8 of the Local Authority Social Services & NHS Complaints (England) Regulations 2009:

    (a) a complaint which is made orally and is resolved to the complainant’s satisfaction not later than the next working day after the day on which the complaint was made

    (b) a complaint which has previously been investigated

    This can have the effect of speeding up and simplifying the complaints procedure, particularly if a practice has a nominated complaints manager who is known to the patients and who is easily available and accessible to them.

    Very often, taking the time to sit down and listen to a patient goes a long way to resolving their concerns. For this to be successful, the complaints procedure should be well publicised, the team has to be fully aware of the procedures, and the complaints manager should be available during normal surgery hours.

  • Q
    If I hold a practice open day providing free oral cancer screening, would I be responsible for the patients' dental needs or can I provide just the soft tissue examination and oral cancer advice?
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    12 May 2015

    The importance of good communication with members of the public who attend your open day cannot be overestimated. They should be made fully aware of the nature and limitations of the examination which is to take place both verbally and perhaps more usefully in written form.

    Since there are a number of techniques which serve as an adjunct to visual examination, and which may show up an early abnormality, patients should be advised of the scope and limitations of your examination depending on the technique you are proposing to adopt.

    Members of the public who agree to an examination of their mouth should be taken through the consent process before they are examined. They should be reminded of the scope and nature of your examination and whether you will be carrying out a full examination of their teeth and the gingival tissues.

    They should also be made aware at the outset that they may have to provide a medical history as well as a social history which may provide markers for an increased incidence in oral cancer. All this information should be documented in a clinical record for each person you examine. The record should also include personal details such as their name, address, date of birth, etc, together with the results of your examination. The records should be retained in the usual way.

    If your examination extends beyond the oral cavity and includes the face and neck, you should note both positive and negative findings.

    Your duty of care to each person you examine extends to whatever was agreed to be the nature of your examination – hence the importance of defining any limitations at the outset. It would also be desirable to advise patients of the importance of seeing a dentist on a regular basis especially if they fall into a high risk category.

    In the event of you discovering a suspicious lesion, you will need to discuss with the patient how this should be followed up. You should not follow this up with their dentist or doctor without the express consent of the patient, as you will still be bound by a duty of patient confidentiality. However, you should stress the importance of referral to a specialist and the need to involve their doctor and also their current dentist (if they have one).

    Dental members can save 20% on the two-hour interactive programme on oral cancer that has been produced by Smile-on

  • Q
    If I receive a complaint from a patient by email, do NHS regulations allow me to respond by email?
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    01 September 2014

    Paragraph 15 of Local Authority Social Services & NHS Complaints (England) Regulations 2009 states:

    1. Any communication which is required by these Regulations to be made to a complainant may be sent to the complainant electronically where the complainant

    (a) has consented in writing or electronically; and

    (b) has not withdrawn such consent in writing or electronically

    2. Any requirement in these Regulations for a document to be signed by a person is satisfied, in the case of a document which is sent electronically in accordance with these Regulations, by the individual who is authorised to sign the document typing their name or producing their name using a computer or other electronic means.

    Many patients have access to email, so when the email is acknowledged check with them to see that they are happy to receive further email correspondence about this subject before allowing the nominated complaints handler in the practice to respond to the complaint in any detail. If the patient is amenable for you to proceed in this way, it may expedite matters.

    However, care should be taken to ensure that any correspondence is sent in an appropriate format by the designated complaints handler for the practice. There is sometimes the temptation for a well-meaning instant response to be provided, which it later transpires is incomplete or inappropriate in some way.

    It can also be tempting, in order to strengthen the response, to copy the email to another party such as Dental Protection – but this can sometimes be counter-productive. Appropriate care should be taken in relation to the confidentiality of any response sent by email; some email addresses are more public than others.

    You can read more about the new NHS complaints regulations here [internal to page on Complaints Regulations 2009].

  • Q
    If I refund a patient their fees in response to a complaint, am I admitting liability?
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    18 August 2016

    It seems to be a common misconception that the clinician should avoid giving a refund to a patient. However, in certain circumstances dentists can give patients a refund which can resolve a difficult situation and eliminate further hassle.

    The refund should be given with a clear indication, preferably in writing, that it is ‘purely as a gesture of goodwill and with no admission of liability’. The refund does not increase the likelihood of any further action, nor does it provide the patient any additional grounds on which to base a claim.

    Dental Protection’s module on handling complaints can be downloaded for free.

  • Q
    If I refund the patient’s fees, am I admitting liability and risking a future claim?
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    01 September 2014

    There is a common misconception that giving a refund to a patient should be avoided because it implies there has been a problem. However, in certain circumstances where the patient is disappointed with the look or the comfort of the final result (e.g. dentures that the patient cannot wear or the degree of whiteness achieved with bleaching), the dentist can give the patient a refund. This can often resolve difficult situations and avoid further hassle.

    Provided the refund is given with a clear indication, preferably in writing, that it is ‘a gesture of goodwill with no admission of liability’, it is unlikely to increase the risk of any further action and does not provide any additional grounds on which the patient might base a claim.

    Members might like to explore this further by downloading the Risk Management Module 9 on complaint handling from the library here

  • Q
    In order to extract a lower first molar it was necessary to repeat the ID block three times. The patient now has some residual numbness of the lower lip. How should I manage the situation?
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    26 May 2015

    When a patient reports a persistent loss of sensation, the clinician needs to be sympathetic to their concerns residual numbness could lead to a distrust of future dental treatment and a real fear of a similar problem arising again.

    Management usually involves counselling and medication for any pain. In addition the patient needs to be reassured and given realistic expectations of recovery. Referral to a suitable oral surgery facility for assessment is also desirable. An explanation of why they were not warned of this complication may also be required.

     The risk of damage can be reduced if the clinician can:

    • Avoid multiple blocks where possible.
    • Avoid using high concentration local anaesthetic for ID blocks (for example, use 2% Lidocaine as standard).

    Always document any unusual patient reaction during local analgesic blocks (such as sharp pain or an electrical shock-like sensation) and contact Dental Protection for advice if the patient’s loss of sensation persists and the patient has made a complaint as a result.

  • Q
    Is it advisable for a dentist to apologise if a patient experiences pain after treatment?
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    01 September 2014

    An apology is not an admission of guilt but is simply an expression of regret; for example, ‘I am sorry you had so much pain after the extraction.’ This does not mean the dentist has done anything wrong but is more an expression of sympathy/empathy and an understanding of the difficulty the patient faced. An apology coupled with an explanation can provide reassurance to a complainant and is often all the patient is looking for.

    It is particularly important where a patient has been avoidably harmed; the lack of an apology in these situations is one of the many reasons why patients take complaints further. 

    Members can explore this further by downloading the risk management module on complaint handling from the library here

  • Q
    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?
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    18 September 2014

    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.

  • Q
    Is it okay for me to use an online radiograph interpretation service?
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    08 September 2015

    As with any other referral, it is the responsibility of the referring dentist to establish the suitability of the person/service to whom/which the referral is made. Even though teledentistry relies on digital files being exchanged between colleagues, the principle is the same. It is important for you to know who will be responsible for interpreting the patient’s records, as well as establishing that they are registered and what qualifications they have to provide this service.

    To protect the patient, it is also important to know that the distant colleague is suitably indemnified. Dental Protection recommends that members should contact us first if they are considering using a teledentistry service situated outside the UK.

    In addition, Dental Protection recommends that:

    • All patients are made fully aware of the involvement of any other named person(s) in their care and treatment, through teledentistry, and also that they properly understand any constraints, limitations or risks introduced as a result
    • You establish written protocols between yourself and any other clinician/organisation with whom/which you have any kind of teledentistry relationship. These protocols should specify the parameters of the relationship, the role and responsibility of each party, the arrangements in place for data protection, and quality assurance
    Read our position statement on Teledentistry
  • Q
    I've been offered a position in a practice six miles away. My current contract states I am not allowed to work within an eight-mile radius of the current practice. Is there any way around this clause?
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    16 September 2014
    In general terms a barring out clause, as long as it is reasonable, is considered to be an enforceable part of the contract. The reasonableness of the clause will be determined to some extent on whether the current practice is set in a rural or urban area; it would be considered to be unreasonable, say, for a six-mile barring out clause if the dentist worked in a small town. 

    This is a business matter and you might like to take advice from your representative body or a solicitor. You may also wish to consider discussing this move with your current practice principal to perhaps come to some agreement.

  • Q
    My practice principal and I belong to different defence organisations. He told me I need to join his organisation because my dental nurse will not have access to indemnity when I'm supervising them. Is that true?
    +
    02 December 2014

    No, it certainly isn't true. A dental member, who is working in general or specialist dental practice, could be held to be vicariously liable for the negligent acts and omissions of a dental nurse working under their direction and supervision, even if they are not the actual employer of the dental nurse.

    What makes our approach different from that of other defence organisations is that we offer several categories of membership in which an employer/practice owner can provide access to indemnity for registered dental nurses (or dental technicians) employed by them, in respect of negligence claims, whether or not they are working with them or directing/supervising them at the time of an adverse incident. We believe this flexible approach is fairer to practice owners, associates and dental nurses alike.

    Indemnity offered through an employer however only extends to claims in negligence and will not provide assistance for any GDC or disciplinary matters, or for the provision of individual written or telephone advice from Dental Protection.

    Indemnity, offering the full range of member benefits is available to all registered dental nurses either as direct members (following the payment of the appropriate subscription) or (free of charge) where the practice is part of the Dental Protection Xtra scheme.

    Read more common queries

    Browse our range of advice booklets

  • Q
    My written English is not very good. Is it acceptable to ask the practice manager to deal with all my correspondence and communications?
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    18 September 2014

    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

  • Q
    We are making a Facebook page for the practice. Are there any specific dos and don’ts that I need to be aware of?
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    27 August 2014

    Given the popularity of Facebook and its usefulness in the promotion of business, many dentists have been somewhat cautious in promoting themselves in this way, perhaps through fear of breaching the General Dental Council’s guidance.

    In reality, however, a Facebook page is no different to any web-based advertisement other than the fact that access to the page can be restricted. The contents of the Facebook page must conform to the GDC’s guidance and that of the Advertising Standards Authority; they must be legal, decent, honest and truthful. The contents of the page should not make any statements that cannot be substantiated, or would be regarded as misleading.

    It is quite possible to indicate to any patient who wishes to subscribe to the friends list that their name will be displayed on the website and will be visible to other members of the public. Their consent to this disclosure can then be obtained.

    For obvious reasons no other personal information should be displayed and certainly no indication of any treatment that has been provided for a patient unless they have provided their specific written consent.

    If a practice is considering whether a Facebook page is appropriate, it may wish to give thought to whether it will be possible for a ‘patient’ to use the Facebook page to post adverse comments that can be seen by other friends.

    Some disgruntled patients are seeking to use the internet as a forum to post their complaints. Thus if a practice is seeking positive reviews in this way, it may also receive negative comments. The practice may wish to consider how easy it would be to remove such comments. 

    With a little care, therefore, the use of a Facebook page to promote the practice should not necessarily cause the GDC any undue concern.

  • Q
    What are the criteria for becoming an expert witness?
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    26 August 2014
    Dentists may be instructed as experts in relation to two separate types of cases. Most dentists commence carrying out expert work in personal injury cases where the claimant is often the victim of some type of accident. The expert is normally asked to examine the claimant and to provide a report on the claimant’s current condition and prognosis. In providing such a report, the expert is expected to be able to advise the court on what injuries were specifically caused by the accident. 

    The other type of report which experts carry out, and which Dental Protection frequently commissions, are on causation and liability. These are provided in cases of medical and dental negligence when the expert is asked to provide an opinion on whether they believe the clinician has acted in a way which would be considered acceptable by a reasonable body of similar clinicians, and if not what harm if any has flowed from the treatment in question.

    There are various courses available, details of which will be available online or from the Law Society in London. Dental Protection has an advice booklet on providing expert reports and second opinions which is available here

  • Q
    What details must I give my patients about how to complain?
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    17 August 2016

    It is desirable to tell patients what your complaints procedures are, in simple terms, either in your practice leaflet or (if appropriate) in a separate leaflet given to all new patients and available in the practice (perhaps in the waiting or reception areas). The same information can also be displayed on the website or as poster in the waiting room. The important thing is to display details of the practice complaints process where it can be seen by patients, so that they do not have to ask for a copy.

    The details of the leaflet may vary from practice to practice according to manpower and other resources but the GDC requires that it:

    • is clearly written in plain language and is available in other formats if needed;
    • is easy for patients to understand and follow;
    • provides information on other independent organisations that patients can contact to raise concerns;

    In describing the complaints process it would be helpful to show that it:

    • allows you to deal with complaints promptly and efficiently;
    • allows you to investigate complaints in a full and fair way;
    • explains the possible outcomes;
    • allows information that can be used to improve services to pass back to your practice management or equivalent; and
    • respects patients’ confidentiality. 
  • Q
    What information do I need to display about members of staff either in the practice or on the website?
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    19 September 2014

    The new Standards document requires dental practices to display:

    • The GDC’s nine principles
    • Details of all registered staff working at the practice, including names, job titles and registration numbers
    • A reference to the GDC as the regulator
    • A price list, including NHS patient charges (if applicable to the practice) and indicative price lists for private care for, as a minimum, basic items such as consultation, single filling, extraction, radiography, dental hygiene treatments. Items that may vary in cost can be described in a from-to scale
    • You are also now required to give clear information on prices in your practice literature and on your website; patients should not have to ask for this information
  • Q
    What is best practice encryption for confidential patient communications over the internet?
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    18 September 2014

    Dental Protection is seeking clarification from the GDC as to their expectations in respect of sending patient information by email. Encryption will only work satisfactorily if both sender and recipient use the same encryption.

    Password protection is an alternative, but relies on the original information and the password being sent to the same email address. If the email address is incorrect in the first instance the password will also go to the incorrect address.

    Even posting patient information by special delivery cannot be considered entirely secure. Where possible you should try to remove sensitive patient information from communications between third parties. However Dental Protection will require some patient information, such as name and date of birth, in the initial correspondence, in order to be able to provide the most appropriate advice. On-going correspondence may be dealt with by the use of case reference numbers and patient initials. Please review this page for updated advice as it becomes available.

  • Q
    What is the best way to stop a complaint arising?
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    19 September 2014

    It is impossible for any professional person to stop every complaint from arising. It is better to adopt a positive state of mind and accept that occasionally you will get a sub-optimal result or that for a variety of reasons (some beyond your control) that the patient is disappointed or unhappy with something that happened during their visit.

    By encouraging patients to express themselves as they leave the treatment area you can often get them to tell you what could have been done better from their perspective.

    There are many ways of identifying dissatisfaction:

    • Prominently displaying your complaints procedure so that patients don’t have to ask for it and encouraging them to share any negative views with appropriate staff
    • Train all staff to identify the ‘body language’ associated with dissatisfaction. The aim is to encourage patients to tell you if they have a problem, before they tell someone else
    • Comment or feedback cards - usually only completed by patients who are particularly displeased or delighted with service. It is, of course, helpful to collect positive feedback as well as negative and neutral feedback

    By handling this issue at a local level it may be possible to contain the issue and prevent it from escalating out of your control. It can also help to avoid the dissatisfied patient from bottling up a store of complaints.

    Dental Protection’s Handling Complaints advice booklet offers lots more guidance on this subject. It can be found in the Risk Management section of the website.

  • Q
    What should I do if the dentist involved in a complaint is away on holiday and I am unable to stick to the time limits described in our practice complaints leaflet?
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    19 September 2014

    The GDC doesn’t define specific timings for managing a complaint but it does expect you to respond to complaints within the time limits that the practice has set out in its own complaints procedure. The NHS has its own guidance on limitations for dealing with complaints and these can vary according to the country you work in.

    Read our advice booklets on complaints handling

    Sometimes things can take a little longer to investigate, particularly if key staff members are on leave or off sick. If you find that need extra time to investigate a complaint, you should tell the patient when you anticipate being able to respond. If there are exceptional circumstances which mean that the complaint cannot be resolved within the usual time scale, you should give the patient regular updates (at least every 10 days) on progress.


  • Q
    Who owns a denture that is yet to be paid for?
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    01 September 2015

    Generally speaking, the ownership of any item of dental treatment passes to the patient at the time the appliance is fitted. This is, however, not always the same time as the treatment is completed. It follows then that during the various stages of denture construction, a denture itself still belongs to the clinician.

    Once it is fitted, however, the patient then owns that denture, irrespective of whether or not a fee has been paid. Before demanding the outstanding fee, it is wise to check that the patient is happy with the denture. Allow them to express any dissatisfaction they may have and deal with this before deciding if you want to pursue the fee.

    If the situation cannot be resolved, you may want to acknowledge that no fee has been charged and leave the denture with the patient as gesture of goodwill, to potentially mitigate an escalation of the patient’s dissatisfactions.

  • Q
    Why should I explain my infection control procedures to patients?
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    20 July 2016

    Patients are likely to be a lot more aware of infection control issues following the recent publicity surrounding a look back exercise involving 20,000 dental patients in the UK. If the cost of their dental care increases, patients are likely to be more critical in their choice of dental care provider. Choice and quality are two of the most important components of consumerism.

    Patients who have come to appreciate the steps that are being taken by a practice to ensure their safety will be far less likely to move to another practice where it is not immediately obvious that the same standards of infection control apply.

    Many of those patients who move from one practice to another never tell the original practice why they have left. They often have unspoken concerns and dissatisfaction and these can include doubts over infection control and the quality of care generally. A visible infection control policy and a willingness to explain to patients what is being done for their safety, and why, can address concerns and reinforce the patient’s decision to stay with the practice.

    A deliberately high-profile and visible commitment to infection control can also help to justify a patient’s perception of value, especially if they have just agreed to pay privately for their dental care.

    There are many different ways to get the point across – a poster in the waiting room or a page on your website can outline the basic principles. You can also reinforce the message every time you open bagged instruments from the steriliser or a new set of instruments by mentioning that they have just been sterilised. Disposable, single use items can also be pointed out to patients instead.

    It is paradoxical that patients may be questioning standards of cross infection control in dentistry at a time when they are generally higher and safer than ever before.

    Topics of inadequate infection control make good stories and help sell newspapers. Take the initiative and get your own story out there first.

    With the help of the rest of the dental team, share the evidence of your own infection control measures with patients before they even have to ask. Whether it is new gloves or the large quantity of disposable item that are used – each of these topics can be turned to a marketing advantage. 
  • Q
    Why would I want to draw attention to the practice complaints procedure? Surely that will encourage patients to sue me?
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    18 September 2014

    Patients should not feel intimidated, or that complaints are unwelcome. Many complainants are fearful or uncertain about the likely response from the dentist or his/her staff and this might encourage them to take their complaint elsewhere. It is better to eliminate any such potential barriers to patients, and make it clear to them that you are keen to resolve any complaints or dissatisfaction in-house.

    It is counter-productive to view complaints in a negative light. Although it is not always easy, complaints can and should be seen as an opportunity to:

    • resolve the patient’s dissatisfaction in-house, limiting the damage caused by the complaint;
    • rebuild relationships with the patient, by showing them that you and your staff are truly professional, that you have their best interests at heart, and that you genuinely want them to be happy and satisfied with the treatment and care provided. Very often a patient, whose complaint has been satisfactorily resolved, can become the greatest and most vocal ambassador for the practice. A professional approach to a complaint bodes well for the practice’s approach to patient care and treatment generally;
    • improve procedures so that the same problem doesn’t arise for other patients.

    By offering patients a prompt and constructive response you can demonstrate that you have engaged with their complaint. A complainant who feels that they have been ignored or overlooked is very much more likely to take matters further into another forum. Showing that you care, exploring solutions and getting things done is the key to achieving an amicable resolution.

    Practice owners should note that the new standards guidance places an emphasis on training the team to handle complaints from patients and the importance of being able to demonstrate that the training has happened. It is also a CQC requirement under the provisions of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 to bring the complaints system to the attention of service users.