Medical Protection Society (MPS) – of which Dental Protection is part – has today launched the MPS Foundation; a new, global, not-for-profit research initiative to help shape the future of patient safety through the funding of ambitious healthcare and dental research.

The Foundation will invest in research and analysis, with the key focus being on areas of patient safety and clinician wellbeing – both medical and dental.

The Foundation is part of MPS – the world’s leading protection organisation – which currently supports more than 300,000 doctors, dentists and healthcare professionals, and has almost 130 years of global healthcare experience and expertise.

The MPS Foundation is being launched across each of the countries and regions where MPS has a member base, including the UK, Ireland, South Africa, Australia, New Zealand, Hong Kong, Singapore, Malaysia and the Caribbean, and is open to applications from both members and non-members.

The research projects supported by the MPS Foundation will have to be academically robust and evidence-based. Available funding will range from £5,000 to £200,000, or equivalent in local currency, depending on the scale, focus and duration of the proposal.

Dr Graham Stokes, dentist and MPS Foundation Chair, said: “Patient safety is dear to the heart of all healthcare professionals. By establishing the MPS Foundation, Medical Protection Society will support research to help improve patient safety and care, enhance clinician wellbeing and reduce clinical risks.

“As the world’s leading protection organisation, our aim is simple: to create sustainable global change through ambitious research.

“The MPS Foundation will develop an international knowledge base that can be applied locally, leveraging our organisation’s global reach.

“I am proud to launch the MPS Foundation, which will help both members and other healthcare professionals navigate the challenges of modern practice and find research solutions.

“All projects must be academically robust and evidence based. While funding will be available up to £200,000, smaller grants from £5000 will also be available and I would strongly encourage healthcare professionals to consider applying for support whatever the scale of their proposal.”

MPS Foundation funding is focused in four main areas:

• • The impact of human factors on patient safety, outcomes and risk
  • The impact of processes and delivery models on patient safety, outcomes and risk
  • The personal and professional wellbeing and development of clinicians
  • The impact of digital integration and technology on patient safety, outcomes and risk.

Healthcare professionals can register their interest by visiting www.thempsfoundation.org and entering their details via the online grant portal.

Dental Protection member Mr Raj Rattan has successfully challenged a vicarious liability claim at the Court of Appeal – an outcome that will benefit many practice owners in England and Wales.

The claim was brought by a client of the Dental Law Partnership (DLP) for treatment carried out by associate dentists at Mr Rattan’s former practice – Mr Rattan did not carry out any of the patient’s treatment.

Mrs Hughes, represented by DLP, pursued a claim against Mr Rattan under both vicarious liability and non-delegable duty of care, despite the fact that the treating dentists had been identified and remain willing to respond to the claim. DLP and their client refused to engage with them and instead pursued Mr Rattan as practice owner.

The Preliminary Hearing judgment in July 2021 made clear that Mr Rattan’s conduct as a practice owner was not being criticised, however it ruled that he was vicariously liable for the self-employed associate dentists working at his former practice, and that he owed Mrs Hughes a non-delegable duty of care when she attended his practice for dental treatment.

While Dental Protection has extended its benefits for current and new practice principal members to include additional protection against vicarious liability and/or non-delegable duty of care claims relating to treatment provided by self-employed, contracted dental practitioners, it supported Mr Rattan in appealing the High Court judgment as a matter of principle.

Geoff Jones, Executive Director, Member Protection and Support, at Dental Protection said: “We have supported Raj Rattan as a Dental Protection member in fighting this case which has significant repercussions for the dental profession. We are extremely pleased the judgment on vicarious liability has not been upheld, and will now explore whether we can take the fight on non-delegable duty of care to the Supreme Court.

“These mostly unnecessary claims cause real distress for practice owners, some of whom have long since retired, and pose a risk to the long-established arrangements that exist between practice owners and their associates.

“The self-employed dentists who were involved in the patient’s care were willing to respond to the claim from the outset, but DLP and their client refused to engage with them. Mrs Hughes had nothing to gain by refusing to engage with the treating dentists and pursuing Mr Rattan personally. 

“DLP has been pursuing a number of claims like this against the practice owner rather than the self-employed dentists who provided the treatment. In the majority of those cases, where a liability was established, the treating dentists are also willing to settle and the claimant could have received compensation much sooner.

“Now, due to the Court of Appeal decision in this case, many of these vicarious liability claims brought by DLP on behalf of their clients, may fail unless it can be shown that the practice owed them a non-delegable duty of care in relation to the treatment carried out by the treating dentists.

“We are carefully considering the implications of the Court’s finding in relation to non-delegable duty of care and will provide further guidance to practice owners as soon as possible.

“While eligible Dental Protection practice principal members can request assistance with vicarious liability and non-delegable duty of care claims where they are named as the defendant, we remain committed to fighting them on behalf of members and the wider profession.

“If any Dental Protection practice principal members with an open vicarious liability case would like to discuss the implications of this judgment, they should contact their case handler.”

Dental professionals must receive better support for their physical, emotional and financial wellbeing in a future pandemic situation, to ensure patients continue to get the best possible care and treatment and avoid long-term impacts on the profession.

In its submission to the Scottish Government’s inquiry into the handling of the Covid-19 pandemic, Dental Protection said that during Covid-19 the dental profession desperately needed priority PPE, support measures to mitigate potential financial viability issues due to safety protocols limiting access to dental services, and consistent guidelines.

The organisation said the Scottish Dental Clinical Effectiveness Programme (SDCEP) provided well received clinical guidance at a time when dental professionals around the world sought clarity about operating procedures, and this was a positive learning for the future.

However, Dental Protection said there was an overall sense that dentistry has been “overlooked” throughout the Covid-19 pandemic, and a number of lessons must be learnt should we face a further pandemic.

Helen Kaney, Dental Protection Head of Dental Services, Scotland, said: “Dental professionals have faced significant challenges as a result of the pandemic. The clinical challenges have centred on availability of the required PPE, virus transmission risk and restrictions of the type of clinical interventions that could be undertaken for patients. There have also been and remain, significant financial challenges which may impact on the long-term provision of NHS dentistry in Scotland.

“These challenges were enhanced by a sense that dentistry has been overlooked throughout much of the pandemic. Dental professionals are well used to dealing with and managing risk, but the scale of risk and uncertainty for dentistry throughout this time has been unprecedented.

“Dental Protection has throughout the pandemic been providing dentolegal advice to those dental professionals grappling with these new challenges, to enable them to practise in different ways, comply with guidelines and to help them protect their wellbeing.

“But the profession as a whole needs greater support from the outset should we face a pandemic situation in the future – this includes swift publication of clear, consistent guidelines, appropriate PPE as a priority, and effective financial support measures to protect the financial stability of practices and ensure that patients can continue to receive optimal care within the safety protocols.

“Addressing the shortfalls from this crisis will be vital in ensuring patients continue to get the best possible care in any future pandemic, and in safeguarding our profession. We hope the challenges we have raised will be considered as part of the inquiry.”

Dental Protection’s full recommendations to inform the inquiry:

1. Professional bodies, associations and Dental Defence Organisations should work together to ensure there is consistency in the guidelines that are issued in exceptional times, and that the focus remains on patient care. The specific areas of concern should be documented for future reference to ensure that timely advice is issued from the outset should there be another pandemic in the future. The resources published by the SDCEP, and the speed of their production, were valued by the profession and are positive learning.
2. The inquiry should consider what further action should be taken to monitor the number and type of complaints being made to the GDC about dental professionals during this pandemic, and seek ongoing reassurance from the GDC that the extremely challenging context in which dental professionals have been practising continues to be taken into account.
3. Dental professionals should be recognised at the start of any future pandemic as a group at particular risk, and be given priority PPE so they can continue to treat patients safely, protect themselves and their teams.
4. Dental professionals should be rewarded and incentivised to treat patients in the way that is most effective and safe during a pandemic, so that the safety protocols which make more normal levels of activity impossible, do not threaten the financial viability of practices in the long term.
5. Policies and guidelines should offer broader guidance on coping with the psychological aspects of managing workload and the clinical challenges and limitations for dentists and their teams during a pandemic situation – such support would help to safeguard the wellbeing of the profession.

Handling patient complaints about delays in treatment due to backlogs, and situations where staff refuse a Covid-19 vaccination, are the key areas dental professionals have sought advice and support from Dental Protection in 2021, according to the leading dental indemnifier.

Dental Protection has revealed some of the most common advice themes from March 2020 when the pandemic hit, right through to the present. Throughout the past 18 months, dental professionals have sought advice and support from Dental Protection on a range of evolving challenges, from providing emergency care during lockdown, through to managing with limited PPE, interpreting guidance and returning to work safely.

Dental Protection’s Director Raj Rattan, said dental professionals should take some comfort in the fact that they are all seeking advice from their dental defence organisation on similar challenges, and be reassured that the team at Dental Protection remains responsive and agile to the changing dental landscape.

Some of the most common advice themes

March 2020 at the beginning of the pandemic:

• Provisions for emergency care during lockdown following the closure of dental practices
• The practicalities and indemnity for running/working within Urgent Dental Care Centres and redeployment to other services
• Shortages of PPE
• Teledentistry/remote consultations and triage

Summer 2020:

• Queries about reopening of surgeries and returning to work
• Interpretation of the Public Health England/Chief Dental Officer (CDO) guidance in the different UK jurisdictions about the return to work and provision of modified services e.g. AGPs and fallow time
• Queries in relation to the reopening of private practices
• Fit testing of FFP3 facemasks, ranging from who can do this, where they do it and who for, and appropriate indemnity arrangements
• Individual staff difficulties with wearing FFP3 facemasks and returning to work.
• Issues relating to lone working

Autumn 2020:

• Return to the more usual (non Covid-19) queries about clinical care and patient complaints in relation to their treatment
• Assisting with the flu vaccination roll-out

January 2021 onwards:

• Covid-19 vaccination queries – administering the vaccine and appropriate indemnity arrangements
• Advice about when a member of staff refuses the vaccine
• Assisting members in managing complaints from patients because treatment has been delayed due to Covid-19 restrictions
• Advice in relation to challenging interactions with patients because of continued Covid-19 restrictions in healthcare environments and difficulties in accessing treatment due to accumulated demand
• Healthcare worker self-isolation queries

Raj Rattan, Dental Director at Dental Protection, said: “Due to the rapidly changing dental landscape over the last 18 months, dental professionals have sought advice and support from Dental Protection on a plethora of often complex issues, including deciphering and adhering to evolving guidance, while doing their best to provide necessary care and treatment to their patients.

“We know it has been a challenging time for members, both from a professional and personal perspective and that the cumulative effects of stress have affected many dentists’ sense of mental wellbeing. The social isolation over a prolonged period has also taken its toll in many cases.

“During recent months, requests for advice and support have centred around handling complaints from patients because treatment has been delayed or because they can’t access their dentist quickly because of backlogs of work. Alongside this, many dental teams are experiencing abusive behaviour, as patients have become increasingly frustrated.

“We want to reassure all members that Dental Protection is here to offer support. Throughout the pandemic, members have and can continue to rely on us for advice and assistance. Our teams remain responsive to the evolving challenges, demonstrating thought leadership and agility to ensure that we are doing our very best to help and support.

“Please remember that Dental Protection also offers confidential counselling services as a membership benefit.  This is delivered by ICAS’ independent, qualified counsellors who are available 24/7. A range of wellbeing resources are also available including apps, podcasts and webinars at www.dentalprotection.org/uk/wellbeing.”

The Health and Social Care Committee has launched a new inquiry to examine the case for the reform of NHS litigation against a background of a significant increase in costs.

Commenting, Raj Rattan, Dental Director at Dental Protection, said: “We welcome the new Health and Social Care Committee inquiry examining the high cost of clinical negligence claims and the case for legal reform.  It is important that there is reasonable compensation for patients harmed following negligence, but a balance must be struck. When the cost of clinical negligence increases, the cost of professional protection must also increase to reflect this – and we recognise the pressure this places on dental professionals.

“We know that working in an increasingly litigious environment day in and day out is also challenging, and is taking its toll on dentists when they are striving to provide the best possible service and care to their patients during very difficult times. 

“Dental Protection will be responding to the inquiry in order to ensure the impact of litigation on dentistry is not overlooked. A package of legal reforms to help tackle the rising cost of clinical negligence, and the challenging claims environment for dentists, is long overdue. This should include reforms that would stop lawyers charging disproportionate legal fees, as well as measures that would reduce the cumulative cost where minor injuries are sustained.

“The Government committed to publishing a strategy to tackle rising clinical negligence costs in September 2018, and while we recognise it currently has more pressing priorities, we must not lose sight of this. We hope this inquiry will help to keep the issue high on the agenda.”

Dental Protection member Mr Raj Rattan has said he will appeal the decision of the High Court that he, as a practice owner, is liable to Mrs Hughes for the treatment carried out by associate dentists at his former practice. He did not carry out any of her treatment and sold the practice six years ago.

Mrs Hughes, represented by the Dental Law Partnership (DLP), pursued a claim against Mr Rattan under vicarious liability and non-delegable duty of care, despite the fact that the treating dentists have been identified and are willing to respond to the claim. DLP and their client refused to engage with them and instead pursued Mr Rattan as practice owner.

The vicarious liability claim focused on the relationship between Mr Rattan (as the practice owner) and the self-employed treating dentists, to ascertain whether it could be considered by the Court to be “akin to employment”. The non-delegable duty of care claim focused on Mr Rattan’s relationship with the patient and whether he owed her a duty that was of a nature that could not be delegated.

In relation to vicarious liability, the Dental Protection legal team argued that the associates worked in and for their own business and at their own risk as to profit or loss, and that their relationship with Mr Rattan was therefore not akin to employment.

In considering the preliminary issue of non-delegable duty of care, the judge focussed on the wording of the (2006) Standard General Dental Services contract between the then Primary Care Trust and Mr Rattan’s practice.  This was challenged by Dental Protection on the basis that Mr Rattan, as the practice owner, had not assumed a positive duty to protect the claimant from harm which means the requirements of the decision in the 2014 Woodland v Swimming Teachers Association & Others case were not satisfied.

The Preliminary Hearing judgment made clear that Mr Rattan’s conduct as a practice owner is not being criticised in any way. However, it ruled that he is vicariously liable for the self-employed associate dentists working at his former practice, and that he owed Mrs Hughes a non-delegable duty of care when she attended his practice for dental treatment.

Mr Rattan, who is also Dental Director at Dental Protection, took the decision to fight this case in the High Court as a matter of principle given the potential repercussions for the dental profession.

Dental Protection recently extended its benefits for current and new practice principal members to include additional protection against vicarious liability and/or non-delegable duty of care claims relating to treatment provided by self-employed, contracted dental practitioners. But it said it would continue to challenge the principle of these often-unnecessary claims.

Geoff Jones, Executive Director, Member Protection and Support at Dental Protection, said: “We have supported Raj Rattan in fighting this case both for himself and for his fellow practice owners. Its potential impact cannot be understated and we will continue to support him in an appeal.

“The self-employed dentists who were involved in the patient’s care were willing to respond to the claim, but DLP and their client refused to engage with them. Mrs Hughes had nothing to gain by refusing to engage with the treating dentists and pursuing Mr Rattan personally. 

“Sadly, there seems to be a growing trend in DLP pursuing claims like this against the practice owner rather than the self-employed dentists who provided the treatment and against whom negligence is alleged. It is disappointing as they cause real distress for the practice owner and pose a risk to the long-established arrangements that exist between practice owners and their associates.

“We remain committed to fighting the principle of these often-unnecessary claims on behalf of members and the wider profession, but we also want to reassure practice principal members that they can request assistance from Dental Protection with these types of claims and are as protected as they can be in a rapidly changing dental landscape.”

Dental Protection has announced that it will extend its benefits for current and new practice principal members to include additional protection against vicarious liability and/or non-delegable duty of care claims relating to treatment provided by self-employed, contracted dental practitioners.

Dental Protection says there has been growing concern about these claims and that the dental claims environment is becoming ever more complex. As a member first organisation, it says it wants to ensure the protection it offers responds to the changing external challenges.

The additional layer of protection is included at no additional cost with effect from 1 June 2021 for current and new practice principal members who own, or have previously owned, up to three dental practices. Membership will be updated automatically. 

The enhanced protection enables these practice principal members to seek assistance with vicarious liability and/or non-delegable duty of care claims arising during both their future and past membership with Dental Protection. Members who own four or more practices can apply for an extension to their membership to include this additional protection.

Further details on the extended benefits for practice principal members can be found at: https://www.dentalprotection.org/uk/vicarious-liability.

Geoff Jones, Executive Director, Member Protection and Support, Dental Protection, said: “Sadly, there is a growing and unnecessary trend in some dental law firms pursuing claims against the practice owner rather than the self-employed dentists who provided the treatment and against whom negligence is alleged. This has resulted in practice owners feeling vulnerable.

“We are disappointed to see these claims being brought as they can cause real distress for the practice owner – they also pose a risk to the long-established dental practice model and the traditional arrangements that exist between practice owners and their associates.

“The law requires that individual practitioners hold appropriate indemnity to ensure patients have access to compensation in the event of a successful claim. There is no legal requirement for practice owners to also hold indemnity for treatment carried out by other practitioners, the majority of whom work as independent contractors.

“Dental Protection exists to protect the careers, reputations and financial security of our members. We remain committed to challenging the principle of these often unnecessary claims on behalf of members and the wider profession, but we also want to reassure practice principal members that they can request assistance and are as protected as they can be in a changing dental landscape.”

The ‘Equality, Diversity and Inclusion within Dentistry – a profession wide commitment’ report, released last week by the Diversity in Dentistry Action Group (DDAG), is highlighted by a commitment to collaborative action and shows the dental organisations that have pledged to some key principles for change, including actively committing to addressing racism and discrimination, exploring and developing opportunities for representation and inclusion, and organisational commitment to change at all levels.

Welcoming the report, Raj Rattan, Dental Director at Dental Protection and a member of the DDAG stakeholder group, said: “We welcome this vital report and are pleased it has been supported by a wide range of dental organisations. There is a duty on all of us in the dental profession to ensure we play our part in creating a culture of equality, diversity and inclusion.

“An ongoing commitment is needed if we are to reap the many benefits of cultural competence within the profession and reduce the risk of ethnocentricity. This can affect the patient experience and may also have a detrimental effect on treatment outcomes.

“We know that inclusivity lies at the heart of progress and at Dental Protection we are committed to taking active steps in this area – that’s why we have set up a Diversity and Inclusion forum within MPS to drive this forward, reflect on our own diversity and inclusion, and ensure we are providing the best possible support to all healthcare professionals.”