Nov 21, 2023
Introduction
The advent of social media has revolutionised the way information is shared and communicated, impacting various aspects of our lives. This includes the field of dentistry, where social media platforms such as Twitter, Facebook, WhatsApp, and Instagram have opened up new avenues for dentists to engage with their patients and create value. However, it is essential for dental professionals to be aware of the legal implications associated with social media use. In this article, we will explore the do’s and don’ts of patient engagement on social media, ensuring compliance with legal and ethical obligations.
Managing Patient Confidentiality
Patient confidentiality is a primary concern when dentists utilise social media platforms. Dental professionals have a legal and ethical obligation, as outlined in Regulation 4.2.3 of the Standards For The Dental Team to protect the privacy and confidentiality of their patients’ health information. While certain social media platforms may appear to be private, it is crucial to remember that anything posted online has the potential to be shared and redistributed publicly.
To maintain patient confidentiality:
- Do remember that even private posts can be disseminated publicly, so exercise caution.
- Do consider the potential audience of your posts and avoid sharing any details that could violate patient confidentiality laws under the General Data Protection Regulation (GDPR).
- Do train your staff on appropriate online discussions regarding patient-related matters.
To ensure legal compliance:
- Do not discuss specific patient cases or share identifiable patient information.
- Do not engage in patient enquiries that could reveal confidential information.
Establishing Appropriate Boundaries
The General Dental Council (GDC) emphasises the importance of maintain appropriate boundaries when interacting with patients on social media. While it is acceptable for dentists to use social media for practice-related updates, caution should be exercised when accepting friend requests from patients on personal accounts. Even if information is shared under an assumed user name without explicitly identifying as a dental professional, confidentiality cannot be guaranteed, and dental professionals can still be held accountable.
To establish appropriate boundaries:
- Do keep personal and professional social media accounts separate to maintain professional boundaries.
- Do ensure that any information you provide to patients complies with the GDC guidelines on social media use.
To ensure legal compliance:
- Do not use personal social media accounts to engage in patient discussions.
Instead, redirect patients to the appropriate channels, such as your practice’s website or contact information.
Reputation Management
Online reviews play a significant role in customer interaction, and dentists often receive feedback through social media platforms. While positive reviews can enhance a dental practice’s reputation, negative reviews can be detrimental. Therefore, managing online reviews becomes crucial.
When responding to patient feedback:
- Do maintain professionalism and consider addressing concerns privately or offline.
- Do refrain from sharing any specific patient-centred information on public forums.
To ensure legal compliance:
- Do not post replies that may violate patient confidentiality laws.
- Do not engage in online disputes, regardless of the temptation.
Raising Concerns via Social Media
As a trusted professional, you may become aware of patient concerns during visits. However, social media should not be used as a platform to voice these concerns, especially when dealing with vulnerable adults or children. Such actions may breach the guidelines outlined in the GDC’s Standards For Dental Teams document, specifically section 4.3.3 on maintaining and protecting patient information.
To address concerns appropriately:
- Do voice your concerns through the appropriate channels or safeguarding partners.
- Do act promptly and seek further legal advice if necessary.
To ensure legal compliance:
- Do not share information about a vulnerable patient on a public platform, even if coerced to do so.
Conclusion
Dentists can effectively utilise social media platforms to engage with patients, promote services, and build trust. However, it is crucial to prioritise patient confidentiality, manage online reviews appropriately, and set suitable boundaries.
Once these legal considerations are understood, there is no reason why you cannot fully embrace the power of social media while maintaining your professional and ethical obligations.
If you are in any doubt, we’re here to help.
Dental Defence Society provides expert dento-legal advice, including how to appropriately manage social media issues and navigate any pitfalls. We also have a ton of handy resources designed to guide you through many of the legal aspects of being a practising dentist, plus tailored indemnity packages to give you the added security you need.
Want to know more? Get in touch today.
Oct 12, 2023
Introduction
Community dentistry plays a crucial role in providing oral care to patients with complex needs or medical vulnerabilities. However, this specialised field also poses unique challenges for dentists, and if not managed properly, it can lead to legal implications.
The Importance of Community Dentistry
In the United Kingdom, there are over a million people with complex needs, including severe learning disabilities, who struggle to access dental care. Additionally, approximately 140,000 individuals are bedbound, making it impossible for them to visit a traditional dental clinic. Consequently, treating vulnerable patients in the community has become increasingly common but remains challenging.
Challenges and Legal Issues
Patients with complex needs may present communication difficulties, struggle to follow instructions, or require dental treatment outside of a clinical setting, such as in their own homes. These unique challenges make the administration of oral care more complex and increase the likelihood of legal issues arising if situations are mismanaged.
Tip #1: Always Obtain Informed Consent
Obtaining informed consent is an essential part of the clinician’s duty of care, particularly when dealing with patients who have limited decision-making capabilities or difficulty understanding complex information. Written consent is highly recommended in these cases to ensure patients or their guardians fully understand the proposed treatment plan, including its risks and benefits. Failure to obtain informed consent can be considered negligent. For vulnerable adults unable to make welfare decisions, it is crucial to obtain signed consent voluntarily from a dedicated guardian.
Tip #2: Ensuring Patient Safety
Patient safety is well-established in a controlled clinical environment. However, when treating patients with complex needs or providing home visits, maintaining safety becomes more challenging. Lawsuits related to safety malpractices are unfortunately common in these situations. To mitigate risks, dental practitioners should have protocols in place to manage worst-case scenarios, such as situations where a patient becomes agitated or uncooperative. Maintaining a calm demeanour, speaking softly, reassuring the patient, and treating them with respect can help diffuse difficult situations while minimising harm to the patient and the dental team. Alternatively, when a patient needs to be treated in their own residence, ensure safety protocols are in place like:
- Initiating pre-arrival instructions – Prior to a visit, confirm patients do not smoke before arrival, pets are kept separate, and patients are correctly positioned to receive dental treatment.
- Zoning for infection control – Even in a small space such as a bedroom, it is imperative to designate a work area for infection control and to maintain cleanliness at all times. A pre-visit inspection is helpful to be able to plan zones and declutter.
- Carrying the correct kit – Emergency drug kits, defibrillators, clinical waste and sharps boxes, and dirty instrument boxes are all essential to manage patient safety. A kit checklist is helpful when doing domestic visits and helps ensure no equipment or instruments are left behind.
Tip #3: Understanding Legal Requirements
Dental practitioners in community dentistry must be aware of legal requirements and regulations related to accommodating patients with complex needs, mobility issues, or challenging behaviours. In the UK, if you fail to make your practice accessible for those who are less mobile or have complex needs, you are likely to be in breach of Principle 1 of the Standards For The Dental Team and Regulation 9 of the Quality Care Commission’s Health and Social Care Act 2008. Understanding these legal principles enables practitioners to assess their practice’s needs, make necessary adjustments, and comply with the law.
Conclusion
To avoid potential legal implications in community dentistry, it is essential to establish clear procedures and policies for treating patients with complex needs, mobility issues, and challenging behaviours. Retraining staff, implementing systems for informed consent, and understanding the legal requirements for treating vulnerable patients are critical steps in minimising the risk of legal action.
Feel free to contact us at Dental Defence Society for comprehensive support and legal advice and to gain peace of mind and ensure compliance with legal considerations in community dentistry.
Sep 11, 2023
Breakingbury vs Croad, a 2021 case, resulted in a judgement that holds important implications for the legal responsibilities of dental practice owners in the UK.
In Breakingbury vs Croad, the court ruled in favour of the patient, Mrs. Lynda Breakingbury, who had received negligent bridgework from three associate dentists over a period of several years. However, two of the three associate dentists were no longer registered with the General Dental Council (GDC), were not UK residents, and had no evidence of indemnity cover. As a result, the claimant had no recourse against the associate dentists or the means to seek financial compensation for corrective treatment.
In this particular case, the court passed the judgements of vicarious liability (VL) and non-delegable duty of care (NDDOC) against the retired dental practice owner, Mr. John Croad, despite him having sold the practice nine years prior. Although this ruling is not a binding precedent, it is likely to have persuasive influence on future cases.
Vicarious liability holds that practice owners may be held accountable for the negligent actions of associate dentists working at their practice. Similarly, under NDDOC, practice owners can be held responsible for the negligence of a third party from the time they delegated the work, even if it occurred years earlier. However, while vicarious liability is well-defined in most industries, it becomes less clear-cut in the dental field.
The confusion arises because many dental associates are not employees of the practice but instead work as self-employed individuals. In the past, practice owners could argue that associates were independent contractors, and claims would typically be directed at the individual dentist rather than the practice owner. However, the Breakingbury vs Croad case suggests that future vicarious liability claims may not be as straightforward.
Even when vicarious liability cannot be proven, the obligations of non-delegable duty of care may still hold the practice owner responsible, as this responsibility cannot be legally passed on. Therefore, practice owners must take steps to protect themselves against these risks. Here are four simple steps to better safeguard against vicarious liability and NDDOC claims:
1 – Check and update indemnity policies
Practice owners should review their current indemnity policies to ensure they are covered for vicarious liability and claims related to non-delegable duty of care. If unsure, consider discussing with your indemnity provider and obtaining additional practice insurance to cover these aspects.
2 – Ensure robust contractual obligations are in place
When taking on new associates, establish solid contractual commitments that require appropriate indemnity cover, which should be renewed annually. Additionally, ensure that your indemnity covers the risk of vicarious liability claims against the associates.
3 – Maintain contact details
Retain contact information for all clinicians working at the practice, including after they leave. This enables prompt traceability in case a claim arises relating to an associate who is no longer working at the practice.
4 – Seek legal advice where necessary
When in doubt, consider seeking legal advice. Dental Defence Society provides comprehensive dento-legal advice to our members whenever needed, ensuring you have the guidance necessary to navigate potential legal challenges.
Taking action now ensures that dentists and patients are fully protected, mitigating the risk of reputational damage and costly compensation claims. At Dental Defence Society, we are here to help. We offer affordable, bespoke, and secure indemnity packages without the need for run-off cover.
For a tailored quote, fill in our online application form, call us on 020 8242 6226 or email us at advice@dentaldefencesociety.com.
Even if you are not yet due to renew your indemnity, you can register your interest, and we will be happy to contact you once you are ready to renew.
May 3, 2023
It is widely recognised that the NHS dental contract and Units of Dental Activity (UDA) system is not fit for purpose, and that a radical overhaul is needed for NHS dentistry to be sustainable and effective in improving patients’ oral health.
NHS England finally implemented some long overdue changes to the contract during 2022. Here, we recap those changes and look at their likely impact on provision of dental care. In particular, what are the key updates to the UDA system and are dentists now rewarded more fairly or is further reform needed?
Changes to the dental contract by NHS England
On 19 July 2022, NHS England announced long-awaited changes to the contract for 2022/23, following 12 months of discussions with dental teams, patients, and other stakeholders. Billed as the first step in a process of reform, the changes focus on improving access to dental care and shifting the emphasis of financial reward towards treatment of patients with higher clinical needs.
Key legislative and administrative changes implemented since the announcement:
- A new minimum indicative UDA value of £23.
- Enhanced UDAs under Band 2, for higher needs patients requiring treatment of 3 or more teeth or complex root canal treatment.
- Steps to maximise access from existing NHS resources, including funding practices to deliver up to 110% of target UDAs, where affordable.
- Promotion of effective use of the range of dental professionals, including nurses, hygienists, and dental therapists.
- Personalisation of recall intervals, with supporting materials
- Improving patient information by requiring practices to regularly update the NHS Directory of Services with appointment availability.
Updates to the UDA system
The changes to the UDAs awarded for Band 2 claims were introduced from 25 November 2022. Band 2 claims are now split into three categories:
- Band 2a (3 UDA): all Band 2 treatments other than Band 2b or 2c.
- Band 2b (5 UDA): course of treatment involving non-molar endodontics to permanent teeth or a combined total of ≥3 teeth requiring permanent fillings or extractions.
- Band 2c (7 UDA): course of treatment involving molar endodontics on permanent teeth.
NHS guidance notes that to attract the appropriate number of UDAs for a course of treatment, dental professionals should provide accurate information in the Clinical Data Set (CDS) regarding fillings, extractions, number of affected teeth, and molar or non-molar endodontics.
Impact on provision of care in practice
The need for NHS dentistry has never been greater as patients face a nationwide lack of access to appointments. However, dental practices have been struggling to maintain it as a viable option due to issues including the shortage of staff available and willing to do NHS work, as well as inflation pressures and the difficulties of meeting UDA targets (reflected in record claw back in 2022/23).
While the contract changes received both positive and negative reactions, they are unlikely to substantially improve the provision of care. The British Dental Association (BDA) characterised them as “modest and marginal fixes”, which will do little to retain dentists in the NHS or ensure access to care.
According to the BDA, only about 3% of practices will benefit from the introduction of the minimum UDA value. Furthermore, although the enhanced UDAs for more complicated procedures have been welcomed as recognising the additional time and skill involved, the BDA argued that the change does not go far enough, and the system still penalises dentists for treating the most complex cases.
The administrative change to enable dental therapists to do more NHS treatments, including fillings, sealants, and preventative care has been positively received but may not make a big difference in practice since there are fewer than 5,000 registered dental therapists.
Hopes for further reform
Many dentists believe that the NHS dental contract will continue to be unworkable until there is fundamental reform and substantial government investment. However, hope remains that reform is a possibility.
In December, the Health and Social Care Committee launched a parliamentary inquiry into the state of NHS dentistry. This will assess:
- Steps to improve access to NHS dental services and address inequalities in access.
- The possible impact of Integrated Care Systems and Integrated Care Boards becoming responsible for the provision of dental services from April 2023.
- To what extent the NHS dental contract disincentivises dentists from taking on new patients, and whether further reform is needed.
- Incentives to recruit and retain NHS dental professionals, and the role of training.
The BDA, which has been lobbying for an overhaul of the system for years, said this “may represent a last best hope to save the service”.
If you need dento-legal advice about provision of NHS dentistry, our expert team is here to help. Please contact us at Dental Defence Society.
Apr 13, 2023
The rise of clinical negligence claims has been a hot topic of conversation amongst UK dentists in recent years. In a poll of over 1100 dentists, 89% fear being sued by patients, while 74% suggest the threat of litigation affects how they practise, with many making far more referrals than they used to.
Of course, fear isn’t without foundation. One leading dental organisation states that UK dentists are twice as likely to receive a dental negligence claim as ten years ago. This is fuelled by a combination of tighter sanctions placed on NHS staff, plus the growth of no-win no-fee law firms that are increasing awareness and driving up the number of clinical lawsuits.
So, as a practising dentist, can you do anything to protect yourself against a dental negligence claim?
Here are 5 top tips:
Tip #1 – Be open and transparent
As dentists, we have a professional responsibility to be open and honest with patients. So, before any treatment starts, patients must understand their treatment options, including the benefits, costs, and risks involved.
It’s imperative to provide patients with information in a way they understand while giving them sufficient time to decide what they want to do.
If treatment doesn’t go according to plan, it’s essential to:
- tell the patient,
- apologise,
- offer a remedy to put matters right (if possible); and
- explain fully the short and long-term effects of what has occurred.
Note: NHS Resolution (formerly the NHS Litigation Authority) state that offering an apology is not the same as admitting liability and suggest that this is always the right thing to do.
Tip #2 – Document everything
Diligent record-keeping goes a long way to preventing a successful malpractice lawsuit. As long as regular protocols are followed and high standards of patient care are delivered, meticulous dental documentation is your first line of defence against a dental negligence claim.
If you use abbreviations and acronyms, ensure they are common knowledge or can easily be explained.
And, if you have to make corrections, the golden rule is never to obliterate an entry. Instead, run a line through it, initial it and make the re-entry.
Professional liability insurers have long asserted that errors or inadequacies in patient records have prevented them from successfully defending a clinician against a malpractice lawsuit. Therefore, always ensure diligent record keeping and never leave anything to chance.
Tip #3 – Thorough follow-up protocols
Patients have numerous reasons for missing an appointment but maintaining good rescheduling protocols is essential for dentists where possible litigation is concerned.
When an appointment is missed, it creates scope for a patient to suggest a poorly timed diagnosis. Unfortunately, an untimely or late diagnosis is one of the most common types of claims filed against dentists.
Initiating sound follow-up procedures ensures that every patient who has missed or cancelled an appointment has been contacted. Doing so offers a further layer of protection against a dental negligence claim.
Why?
Because it highlights the fact that the patient has refused to show rather than placing the onus on the timing of any diagnosis.
Tip #4 – Refer when necessary
As mentioned earlier, the rise in dental negligence claims across the UK has caused many dentists to rethink how they practise, resulting in an uptake in referral cases.
This isn’t necessarily bad, especially when dentists are unsure whether to treat a particular case or refer out.
Don’t be tempted to use your existing knowledge and skill to treat a case if you think the outcome may differ from normal. If in any doubt, seeking advice or referring the patient to a specialist is the right thing to do.
When a treatment fails, it isn’t uncommon for litigious patients to suggest that a specialist could have resolved their problem. So, always err on the side of caution.
Tip #5 – Taking prompt action when things go wrong
In the latest year of reporting (2022), 21 million people sought NHS dental treatment, and around 14,285 (0.06% of cases) ended in complaints. While only 22% of these complaints directly resulted from clinical treatment, it highlights that things can and do go wrong.
When patients are unhappy with their treatment, ensure fast action is taken to provide the best possible outcome.
Firstly, apologise and explain the situation. Take ownership of the problem immediately and assure patients you will rectify the situation.
Where applicable, offer appropriate remedial treatment at no further cost and/or give a goodwill gesture. These steps, although relatively simple, are often enough to ease patients’ concerns, lessening the risk of a dental negligence claim.
So, there you have it; 5 top tips to protect yourself against a dental malpractice lawsuit.
At the Dental Defence Society, we have your back. With an executive committee of dental professionals, we’re acutely aware of the everyday challenges facing the UK’s dentists in 2023 and beyond. So, if you face a complaint, a negligence claim or a legal issue, we can help.
With 24/7 access to dento-legal advice and assistance from highly trained professionals, our team provides ongoing support and tailored indemnity packages that allow you to do your job without worry.
Want to know more?
Get in touch today.
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