Ask Dental Protection

Can you advise me about the Data Protection Act as it applies to collecting our patients’ email addresses? I'd like to hold a prize draw for all emails that are collected within a five-week period so I can send a newsletter and promotional offers.

Under the Data Protection Act, you need to explain to the individuals concerned why data are being collected and for what purpose they are being used. As such, you need to think whether or not your patients are likely to reasonably expect you to use their personal data for anything other than contacting them in relation to appointments, etc. Individuals should then be able to choose whether or not they are happy for their email address to be used in this way. At the time of collection you would need to make this information abundantly clear.

Many people get very upset about receiving what they consider to be ‘junk email’. Consequently, if they are made aware of your intentions it could be that an avoidable complaint is raised. In addition, you should make it clear that you do not intend to disclose this information to a third party without their consent.

The idea of entry into a prize draw in exchange for an email address might well appeal to some but may not appeal to everyone. The most practical way to collect such information is simply to ask the patient at the time they attend, or when booking a follow-up appointment.

The Information Commissioner’s website has more information on this subject.

It is difficult to give an unconditional answer as to whether an associate needs to register with the Information Commissioner. The British Dental Association advises that in its interpretation, associates are data controllers since they are responsible for their patients’ clinical records, as well as the manner in which the processing takes place.

While the requirement for registration could potentially be countered by seeking to argue that practice records are the property of the practice owner, Dental Protection considers this interpretation could be open to challenge. If in the course of practising dentistry, you provide treatment as a performer under the NHS with no element of private practice, there could be an argument that you are processing data on behalf of the practice. However, if you are providing any element of private treatment, Dental Protection considers this interpretation may not be able to be supported.

Additionally, if you are seeking to provide services as a self-employed practitioner rather than as an employee, you may consider registration with the Information Commissioner’s Office [http://www.ico.org.uk/] is just one feature that goes towards establishing your self-employed status for tax purposes.

While it may be possible to successfully argue that associates do not need to register individually, on balance you might decide the benefits of incurring the small annual fee as a business expense outweigh the potential issues that could arise should you be challenged.

The senior partner says he recognises the British Dental Association’s infection control guidelines but because they are ‘guidelines’ they can be interpreted as he sees fit. Where do I stand?

In some respects what the senior partner says is correct. However, there is no guarantee that the individual’s interpretation of these guidelines will be correct, or that the dentist would be able to defend that stance, particularly if the rest of the profession did not agree with that interpretation.

In many situations, the BDA guidelines are not really open to interpretation. They represent good clinical practice and demonstrate a standard that would be regarded as appropriate. Generally speaking, the guidelines are realistic and take account of the difficulties that most clinicians face in their practices. They are by no means fixed, and indeed the guidance is regularly updated.

The GDC guidance clearly indicates that a clinician must place the best interests of a patient first. If patients are perceived to be at risk, and the principal will not agree to alter the cross-infection procedures, the DCP would have to think carefully about whistleblowing. Indeed to fail to do so might mean that criticism would be levelled against the DCP.

The decision to raise concerns is a personal responsibility. Most clinicians, when faced with a similar situation, vote with their feet and simply look for another job, arguing that they cannot work with the individual. Although this is disappointing and effectively ducks the issue, it also reflects the reality of human nature.

Before making any decision, it is best for the DCP to speak with a defence society and ask for guidance. Every case will be different and there is no single answer that will fit every occasion. Doing nothing, however, is not an option. 

The simple answer is ‘yes’, although the need for another person present is not necessarily related to the chaperone issue. As a male or female DCP, you do not know the sexuality of the patient sitting in the chair, and therefore there is perhaps as much as a problem for a female hygienist or therapist as there is for a male. Thankfully allegations of a sexual nature are extremely rare, but are certainly not unknown.

It is much more likely that a clinician could find themselves dealing with a medical emergency while treating a patient. In that situation a clinician working alone is faced with an impossible dilemma – do you provide emergency CPR or do you call for help? You certainly will not be in a position to do both, particularly if the surgery is some way from the reception area, as is often the case for hygienists and therapists.

Having CCTV in dental practices does raise some interesting issues. The first is the issue of patient confidentiality, particularly if CCTV is utilised in clinical environments. While these devices do not usually record sound, they are liable to be considered an intrusion by patients who will have no control over what happens to the recordings. Even at the reception desk, patients will be easily identifiable from these recordings, which they may feel is an infringement on their right to have their confidentiality in a healthcare setting protected.

If CCTV cameras are in use, it is important that patients are made aware of the fact and that signs are placed in suitably prominent positions to that effect. It may be sensible (or in some countries a legal requirement) to explain the purposes of the recordings, who will have access to them and how long they will be kept.

The Resuscitation Council UK’s guidance lists an automated external defibrillator as a minimum requirement. Although such guidance does not automatically create a statutory or mandatory obligation, a failure to follow the views of a reasonable, respected and competent body of opinion could be challenged. This would be particularly the case if a failure to use an AED on a collapsed patient can be shown to have had an adverse effect on the outcome.

As an orthodontic practice your patients (and their parents, etc) may represent a slightly younger subset of the population when compared to a typical general practice. However, the guidelines draw no such distinctions.

By failing to have this piece of equipment readily available, you would be seriously compromising your position in the event of a medical emergency.

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In general terms, it is good practice to use an aspirating technique, especially for inferior dental block analgesia, if not for all local anaesthetics.

If you believe that aspirating is a part of the acceptable technique for ID blocks, then you should ensure you use an aspirating syringe. If you are working in somebody else’s practice, you should ask whoever supplies your equipment if they would make aspirating syringes and suitable cartridges of local anaesthetic available.

If you are not provided with these tools, then you would have to make a decision as to whether you could continue to work in a setting where it is not possible to treat patients in a manner you consider to be correct.