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Dental practice during a pandemic

Practices across the country are rising to the challenge of providing essential dental care to patients during the COVID-19 emergency, but this is uncharted territory and many dental professionals have contacted the Dental Defence Union (DDU) with a variety of dento-legal concerns. Leo Briggs, Deputy Head of the DDU, answers some of the most common queries.

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What should I do if a patient complains because their appointment has been cancelled?

All the UK's Chief Dental Officers (CDOs) have said that dental practices should cease carrying out routine dentistry and the vast majority of people accept the need to stay at home.

Unfortunately, there may be instances where patients behave unreasonably, perhaps out of frustration or anxiety. In such cases, you might like to ensure that the advice you provide is in line with the guidance that has been issued by the CDO of the country where you work. Any complaint can then be responded to by explaining that you were following the appropriate guidelines that were in place at that time.

Clear communication with patients will also help, so update your website and practice answerphone messages to make it clear how patients can access dental services during the coronavirus pandemic.

What do I need to consider when carrying out remote consultations?

While there has been a pause in routine appointments, practices have been asked to provide a basic telephone service for patients and be prepared to work in alliance with other local practices.

When talking to patients by telephone, it is important to be aware of the limitations of this kind of consultation. Obviously, it is harder to make a clinical assessment if you cannot pick up on non-verbal communication or carry out an examination.

The General Dental Council (GDC) directs dental professionals to its basic good practice principles (https://bit.ly/2ReXKqd) for remote consultations. In the current situation, it says (https://bit.ly/39Gym2L) you should make and record an appropriate risk assessment which takes into account 'the infection risk of COVID-19, both from and to the patient, as well the apparent seriousness of the need for treatment and the extent to which it has been possible to make a clinical assessment'.

The GDC's existing prescribing guidance (https://bit.ly/2JHCSDD) says you can prescribe remotely if you believe this is in the best interests of the patient and you have no viable alternative. In an emergency, you can ask pharmacies to supply the medication on the condition that you will provide a prescription within 72 hours, as set out in Section 224 of the Human Medicines Regulations 2012 (https://bit.ly/2RasmJg)

If the patient's situation is serious, they may need to be directed to the local Urgent Dental Care service, using arrangements in your area.

Will I be indemnified if I am redeployed to help the NHS during the emergency?

The CDO for England has told NHS practices that staff may be redeployed to support the NHS during the COVID-19 emergency and all medical work away from a dental practice setting to be NHS indemnified as set out in the Coronavirus Act 2020 (https://bit.ly/2x3cRMr), sections 11-13.

The GDC guidance (https://bit.ly/39Gym2L) encourages dental professionals to draw on their skills and experience. However, it also says: 'Registrants should satisfy themselves that they are competent to perform the tasks being asked of them, or are given the training necessary to equip them to do so. We understand that the health services are preparing guidance on the mapping between dental skills and wider medical tasks, which registrants will want to take into account.'

DDU members who are deployed to work in different roles can continue to contact our helpline for advice and assistance.

“The health services are preparing guidance on the mapping between dental skills and wider medical tasks, which registrants will want to take into account.”

Will the GDC take action against me if I depart from guidance?

In the first place, it is important to keep up-to-date with the latest authoritative guidance from the Chief Dental Officers, the NHS and the GDC. The DDU recommends that you:

  • Check relevant websites regularly. The DDU has produced a dento-legal update (https://bit.ly/2V1RvHp) on COVID-19 which is available on our website and includes relevant links

  • Appoint a lead person with responsibility for checking advice regularly and disseminating it to all concerned

  • Keep a log of when you checked the COVID-19 advice so you can demonstrate what you have done to stay up-to-date

  • Make sure you view documents from the website, rather than relying on a saved copy, so you are working from the most up-to-date guidance

  • Contact your dental indemnity organisation if you have dento-legal concerns.

Of course, the guidance may not cover all circumstances so in some cases you will need to use your professional judgement. The GDC has said that dental professionals should not provide treatment 'unless, in their professional opinion, it is safe to do so for both patients and the dental team'. While it expects your decisions to be informed by current guidance, the GDC has said it 'won't be looking to second guess judgements made on that basis'.

In the unlikely event that your practice is criticised, you won't be alone. DDU members can look to us for advice and support, however you have interpreted the guidance.

I have noticed a lot of misinformation about the coronavirus on social media. Should I respond?

It is better to report misleading posts rather than allow yourself to be caught in a war of words with another user which could simply draw attention to the original misleading post.

You can use social media to post links to authoritative sources of public health information about COVID-19 such as the NHS (https://bit.ly/2xLuWie) but avoid straying into areas beyond your expertise. The Government has launched a campaign (https://bit.ly/2xR2pHM) against hoax coronavirus stories on social media and set up a rapid response unit to work with social media firms to remove harmful content.

Will the GDC take action against me if I am behind with my CPD?

With many CPD events being cancelled, the regulator has told dental professionals it is acceptable to log zero hours of CPD for this year, if ten or more hours have been completed in the previous year. The GDC will also look sympathetically on those with a CPD shortfall who are submitting a declaration this year. However, it is possible to do online CPD. For details of DDU online CPD courses please visit https://www.theddu.com/learn-and-develop. [Editor's note: Don't forget BDJ Team CPD too! https://bit.ly/2RaPO9t]

I have been notified of a GDC complaint and I am now worried that this won't be resolved for months. What should I do?

If you haven't already, inform your dental defence organisation. DDU members can find advice on our website about how to access our support if they have received a letter from the GDC.

Although they will not halt all investigations during the COVID-19 outbreak, the GDC has said that it does not want fitness to practise cases to be a distraction for dental professionals during the current crisis and has pledged to keep requests for information to a minimum and to take 'a pragmatic and reasonable approach' to investigations. It is also postponing almost all fitness to practise hearings, except in a small number of cases where there is an immediate perceived risk to patient safety. These hearings will be run remotely where possible.

The information above was correct at time of writing. To keep up-to-date with the latest information on COVID-19 please visit https://www.theddu.com/coronavirus.

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Correspondence to Leo Briggs.

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Briggs, L. Dental practice during a pandemic. BDJ Team 7, 20–21 (2020). https://doi.org/10.1038/s41407-020-0288-y

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