Ask Dental Protection

In business, it is always a good idea to ensure that people who are making a purchase are made aware of the costs involved before agreeing to go ahead. In this way, any misunderstanding about the price can be eliminated. By displaying a price list in the practice and on the website the curious patient can gain some idea about the cost of the initial examination. Indeed it is a good idea to tell all patients if the price list has been updated and to offer them a printed copy or indicate where it can be viewed. They should be encouraged to review it before seeing the dentist and for the avoidance of doubt, the cost of the examination (and any other requested treatment such as a scale and polish) can be included in the confirmation of the appointment and a note to this effect included in the patient’s record.

Although patients may also be able to see the prices of an x-ray or other items of treatment they will not necessarily know how many x-rays and what sort of films will be required, or indeed what other treatments might be clinically necessary and to which they will need to consent.

Any treatment plan that is proposed at the time of the examination needs to be discussed and priced accordingly and the patient should be handed a written summary which they can sign. The signed treatment plan is kept in the patient record and a copy is handed to the patient. This is important because many patients like to discuss treatment with friends and family, particularly if it involves significant cost. There are also patients who will need to share this information with carers, parents or guardians in order that they can involve them in facilitating their treatment.

In addition to explaining the cost of the treatment, section 1.7 makes it clear that the patient must be told clearly which elements of their treatment are available on the NHS and which are only provided on a private basis. The GDC includes a clear instruction not to pressurise or mislead patients over treatments that should be available to them on the NHS.

There is a co contractual requirement under the NHS to provide estimates for:

• All band 2 and 3 treatments
• When mixing NHS and private treatment
• Band 1 treatments upon request

Most modern computer systems and printers make it possible to provide a suitable priced treatment summary that complies with the GDC’s guidance.

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.

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.

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.

It means that when assuming responsibility for the care of a patient, a registrant must be mindful of the impact that any decision taken about oral health may have on the general health of the patient. Taken simply it means that no decision about an individual item or items or treatment can be made without considering the wider implications for the patient.

This standard (1.4) is particularly relevant when patients seek one off cosmetic treatments that have limited or no therapeutic benefits. It also means that when seeing a patient on referral for an item of treatment, an overview of the oral health of the patient should be taken and the treatment plan discussed in that context, rather than in isolation.

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. 

This almost certainly means that you would be unwise to rely upon the indemnity arrangements of the dentists with whom you are placed from time to time. The locum agency may only be insured or otherwise indemnified for the acts and omissions of nurses who are employed by or working under contract with them, at the time when a claim is made. This may be months or years after the date of the relevant treatment, by which time you may no longer be involved with that agency. To best protect yourself, you would be wiser to ensure that you have access to full indemnity in your own name, so that you are not dependent upon the indemnity arrangements made by, and maintained by, others with whom you may have only a short-term relationship.

The GDC position statement giving advice to dental registrants on this subject (Sept 2013) is as follows:

'If you are relying on arrangements made by your employer, you must check the indemnity position with them. You must not make any assumptions about whether or not you are covered by their arrangements – you must always check as you will have to provide proof of your cover if a patient decides to make a claim against you, or in the event that a complaint about your fitness to practise is made to the GDC. If all your work is carried out at your employer’s workplace, then your employer should have made arrangements which cover all the relevant risks but you must check that this is the case.'

If you think that you have been included in any dentist's membership for the purposes of providing you with access to indemnity against negligence claims, you can ask for a copy of a membership certificate confirming this. 

This is one of the advantages of occurrence-based indemnity. With access to this type of indemnity offered by Dental Protection, all that matters is that you were included in your former employer's indemnity arrangements at the time of the incident. This means that we can still help you, irrespective of how many years ago the incident took place, and whether or not you are still working for that dentist (or working in dentistry at all). 

Over 70% of the UK dental profession are already with Dental Protection, so it is not unusual for us to have two or more members involved in the same case. In some countries of the world, 90% or more of the dental profession are dental members. If we (or the members involved) believe that there is an actual or potential conflict of interest, we simply arrange for entirely separate representation of each member, giving them access to separate dento-legal advisers, 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 which had entirely separate representation. They were all entirely satisfied that their interests were never compromised at any stage.

However if you would prefer to arrange professional indemnity in your own right, this can be done at a very reasonable cost. The choice is yours.