Dental Protection

Covid-19: Half of UK dentists feel pessimistic about the future

45% of UK dentists feel their mental wellbeing is worse compared to the start of the pandemic, and nearly half (48%) say they feel pessimistic about the future, according to a survey.

In the Dental Protection survey of nearly 500 dental professionals, 60% said that concern for the health of their family and friends was the main factor affecting their mental wellbeing. 58% cited loss of income/financial worries, and half of the respondents (50%) said adapting to new policies and guidance – including restrictions on appointments – was having the most impact on their mental wellbeing.

A third (33%) of dentists also said they had experienced verbal or physical abuse from patients or patients’ relatives – largely due to not being able to offer an appointment soon enough. A further 5% said they had experienced verbal abuse outside of the surgery.

A number of dentists commented on their experiences anonymously in the survey. One dentist said: “People are very angry in general, short tempered and impatient. They lack understanding of the protocols we have to follow. It is very draining.”

Another said: “I often receive verbal abuse in nearby shops from irate patients.”

A further dentist commented: “I am routinely verbally abused when unable to offer out of hours treatment to other practice patients who are still not open, or from patients not registered with any practice.”

Raj Rattan, Dental Director at Dental Protection, said: “Dental professionals have faced a range of challenges throughout this pandemic, and many have returned to practise in equally challenging circumstances – working in different ways, adapting to additional PPE, worrying about their health and that of their families, staff and patients, and facing a backlog of patients with outstanding treatment due to the unavoidable delays in recent months.

“Many dentists have also expressed their frustration about guidance which they believe is unsupported by a strong evidence base. In particular, they have commented that guidelines are not always easy to decipher and adhere to and are having an adverse impact on the operating capacity of the practices. The design, capacity and internal configurations have meant that some practices have been more impacted than others.

“Dentists continue to care for their patients and provide high quality treatment in these difficult times. However, many patients have had their care and treatment delayed and not all are equally understanding of the circumstances. We are starting to hear about patient complaints and as shown in our survey, some patients are expressing their anger more directly towards dentists and the team. Their zone of tolerance may of course be exacerbated if they are in pain or discomfort.

“Such delays frustrate and create stress for clinicians who may feel they cannot act in their patients’ best interests for reasons beyond their control. This presents yet another source of anxiety for dentists at a time when many have expressed concerns about their mental wellbeing.

“We want to reassure all members that Dental Protection is here to offer support. Throughout the pandemic, members have been calling us for our interpretation on guidance and advice on what they should and should not do. Our teams have been responsive to the challenges, demonstrating thought leadership and agility to ensure that we do our very best to help.

“I would also encourage members experiencing work-related stress to make use of our free counselling service. The service is provided through a third-party partner and is completely confidential. We also have a range of wellbeing resources available including apps, podcasts and webinars at www.dentalprotection.org/uk/wellbeing.”

The survey was conducted by Dental Protection. It ran from 28 September – 19 October and achieved 497 responses from dental members in the UK.

Top 10 factors that UK dentists say are impacting on their mental wellbeing.

  1. 60% – Concern for the health of my family and friends
  2. 58% – Loss of income/financial worries
  3. 50% – Adapting to new ways of working (e.g. new policies, guidance, restrictions, wearing PPE etc.)
  4. 47% – Fear of further waves of Covid-19
  5. 47% – Backlog of work (referrals etc.)
  6. 44% – Concern for the health of patients
  7. 41% – Concern for own health
  8. 40% – Fear of investigations or claims arising from difficult decisions made during Covid-19, or disruption to care
  9. 34% – Low morale at work
  10. 33% – Adhering to social distancing and other Covid-19 safety measures

Dental Protection calls for GDC leniency as third of dentists say fear of investigation is affecting mental wellbeing

Dental Protection has called for the GDC to take a lenient approach to complaints related to the treatment of patients during this Covid-19 crisis.

This comes as a Dental Protection survey of over 500 dentists – which was completed by dentists following their return to practise – shows that a third (33%) feel their mental wellbeing is worse than two weeks ago. 55% of dentists in the same survey said that working in unfamiliar ways is a key concern, with 33% also saying that fear of regulatory investigation is having the most impact on their mental wellbeing.

In a letter to the Professional Standards Authority (PSA), which oversees work of all professional regulators of healthcare in the UK, Dental Protection has stated that guidance for the GDC and other regulators is needed that would provide more reassurance on the issue of when an investigation would be conducted or not.

Raj Rattan, Dental Director at Dental Protection said: “Dental professionals have faced a range of challenges throughout this pandemic, and many have now returned to practise in equally in unsettling and challenges circumstances – working in different ways, worrying about their health and that of their patients, and facing a backlog of patients with problems potentially due to the delay in treatment.

“The GDC and other regulators proactively issued a joint statement in March confirming they will fully consider the context which dentists have been practising in during this time when reviewing any complaints they receive. While we welcomed this statement, we believe members would welcome clear guidance from the PSA which would demonstrate in more detail how the regulators will ensure a proportionate approach will be taken, especially as it will likely be a number of years before such complaints might be handled and at a point when memories of this time have faded. A more lenient and considered approach to investigations seems entirely appropriate given the unique circumstances.

“The pressure and stress involved with working in unfamiliar ways, and the prospect of a regulatory investigation down the line, is clearly taking its toll on dentists’ mental wellbeing. I know that more reassurance on this issue would be greatly valued by our members who are doing their very best for their patients.

“I would also like to remind members of our counselling service for those experiencing work-related stress. The service is provided through a third-party partner and is completely confidential.”

The survey was conducted by the independent market research organisation, Research By Design (www.researchbydesign.co.uk). It ran from 18th to 29th May and achieved 506 responses from dental members in the UK.

Dental Protection reassures members of support if unable to wear a fit-tested mask

Dental Protection has reassured its members that their membership and ability to request assistance is unaffected if they are unable to wear a fit-tested mask and that they can seek assistance from Dental Protection in the usual way. This reassurance follows several queries from dental professionals contacting Dental Protection in recent weeks concerned about their inability to wear a fit-tested mask for a number of reasons.

There may be legitimate reasons why it is not possible to wear a fit-tested mask, including for health reasons or because it is not possible to achieve an adequate seal when wearing a mask. Dental Protection recognises that for a variety of cultural and religious reasons, removal of facial hair and beards is not an option and in turn means passing a fit-test is not possible.  

The primary purpose of PPE, and in particular RPE masks, is for the dental professional’s own safety. For those who are employers, they would also need to consider the safety of their employees if they cannot pass a fit-test. Dental Protection recommends that members identify the overall risk to themselves, their team, and patients in situations where the fit-test has failed and ensure steps are taken to mitigate the risk.

Raj Rattan, Dental Director at Dental Protection, said: “We know our members are facing a number of challenges related to the reopening of practices and resuming of face-to-face care. We would like to reassure members that their membership and ability to request assistance will not be affected by the inability to wear a fit-tested FFP2 or FFP3 mask.

“The primary purpose of PPE and in particular RPE masks is for dentists’ own safety,” he continued. “We recommend that employers identify the overall risk in all situations where the fit test has failed and ensure steps are taken to mitigate the risk. These are challenging times, and as a profession, we may not know what the future looks like, but I can assure you that Dental Protection will be there our members.”

Dental Protection welcomes ‘No Appeal’ decision on pension suspension ruling

Dental Protection has welcomed the Court of Appeal decision to deny the Government permission to appeal the ruling which overturned regulations allowing the health secretary to suspend the payment of pensions to NHS professionals who had been charged with certain criminal offences but not yet convicted.  

This ruling follows the High Court decision in January this year that it was unlawful for the Government to suspend doctors’ pensions, after a judicial review brought by the British Medical Association (BMA). Public sector pension schemes contain provisions for the suspension of a person’s benefits but only after the point of conviction. The Department for Health and Social Care changed NHS pension rules last year, which meant that NHS professionals would be the only public sector workers to have a threat to their pensions at any time from the charges being made.

Dental Protection wrote to the Secretary of State last year setting out serious concerns about this policy, arguing that it went against the principles of natural justice which assumes that one is innocent until proven guilty. The changes also run the risk of dentists and their families experiencing an additional psychological and potentially economic strain from what is already a stressful investigation process.

Raj Rattan, Dental Director at Dental Protection, said: “In 2019, I wrote to the Secretary of State setting out our opposition to the proposals and we were very pleased that the judicial review brought by the BMA was successful. We now welcome the decision by the Court of Appeal to reject the Government’s application to appeal the case. Dentists facing unproven allegations should not find their pension rights put at risk prior to any conviction being made. This change went against the principle of natural justice which assumes that one is innocent until proven guilty.

“Dentists are increasingly working under pressure and if things go wrong they can face complaints and claims from patients, reputational damage in the media and restrictions on their license to practice by the regulator. These changes to pension arrangements only added to the profession’s fear of being exposed to excessively punitive consequences.”

Covid-19: Dental Protection survey reveals top 5 worries for dentists

A survey of dentists in the UK has revealed the key issues affecting their mental wellbeing during the pandemic. In the Dental Protection survey of nearly 500 dental professionals, five in 10 (53%) said financial worries were having the most impact on their mental wellbeing. Lack of work and lack of adequate PPE were cited by nearly 4 in 10 (37% and 38% respectively).

The survey also shows that dentists are more concerned about their patients’ health, than their own, with 43% saying concern for the health of patients is having the most impact on their mental well-being, and 34% saying they are concerned for their own health.

In March 2020, Dental Protection announced a support package, worth the equivalent of two months’ subscription for free, to acknowledge the concerns of dentists who have experienced a significant drop in their workload and a dramatic fall in income due to Covid-19.

In addition, it extended its counselling service for those dentists experiencing work-related stress due to the crisis. The service is provided through a third-party partner and is completely confidential.

Last week Dental Protection also reassured all members in England who choose to return to work that they will continue to be supported and set out some points for those operating in the private sector to consider when making the decision. 

Raj Rattan, Dental Director at Dental Protection, said: “Dentists are among the most dedicated healthcare professionals in the world. I am not surprised that so many have put the concerns of their patients’ health before their own in this survey. The extent to which financial worries are impacting on our members’ mental well-being is also evident and concerning. We hope that the subscription relief we have provided has made some difference, along with access to counselling. Many dentists have been hard-hit by the loss of income in recent months with the private sector most affected. It is difficult to predict how long it will take before practice activity returns to levels seen prior to the pandemic. We want to reassure all members that Dental Protection is here to offer support and in the event of a claim, complaint, or related inquiry arising from your decision to re-open, we are here if you need to request assistance.”

Dental Protection offers support to dentists deciding to re-open practices

Dental Protection has reassured all members working in England who choose to return to work that they will continue to be supported. While the situation with NHS practices reopening is clearer due to a general acceptance that the Chief Dental Officer (CDO)’s guidance will be followed, the position regarding private practice has been less clear and has left those dentists – many of whom are facing financial difficulties – concerned about when they can return to work and whether they would be protected if they choose to do so.

Dental Protection has said members operating in the private sector who decide to return to work can be reassured that the indemnity provided by Dental Protection will continue to meet their regulatory and legal obligations, as long as they are in active membership and paying the correct subscription for the work they will be undertaking.

It added that members will have access to support and advice if needed, and if a complaint or claim should arise from the decision to re-open, members can request assistance.

In an email to members, the organisation said that the decision to re-open rests with the individual practice owner and that while Dental Protection cannot make such decisions for dentists, it can advise members of what they should consider when making the decision, such as:

  • The GDC statement that ‘Practitioners providing NHS services will of course need to adhere to the directions given by  the CDO; other practitioners will want to take that into account in making decisions.’
  • The CQC’s stated position that it ‘cannot require providers of dental care services to close, unless we find clear evidence of a breach of our regulations that requires consideration of the use of our powers under the Health and Social Care Act 2008 and associated regulations. It has also said that ‘The decision to offer dental care services is one for the provider to take.’
  • The need to adhere closely to central Government guidance on social distancing and to the most recent dental guidance documents from various agencies including PHE and the prevailing CDO guidance.
  • If you operate in the private sector, you should review existing protocols and standard operating procedures (SOPs) and take these into account when developing your own protocols, individually or within groups, and ensure practice protocols/SOPs meet the standards set in the prevailing guidance. 
  • Undertaking a thorough clinical risk assessment of the operating environment and of the patient journey.

In the event of a complaint or claim regarding the decision to re-open or the care that was provided, Dental Protection also it would be important to be able to evidence the following:

  • Written SOPs consistent with the widely accepted evidence-base and at least as robust as those issued by the NHS
  • Evidence of understanding and adherence to the SOPs and protocols by all team members
  • Clinical records which, in additional to usual record keeping requirements, clearly show the process of care, the rationale of the clinical intervention(s), the PPE used together with details of the relevant guidance considered in clinical decision making.

Raj Rattan, Dental Director at Dental Protection said: “Our team at Dental Protection includes experienced clinicians, associates and practice owners, and we understand the myriad of challenges facing members during the current crisis, including the welfare of their staff, their patients and themselves. We also recognise the financial pressures they may be facing, which is why we have offered members the equivalent of two months’ subscription relief. As a profession, we may not know what the future looks like, but I can assure you that Dental Protection will be protecting members as the situation evolves.”

Further information is available at: https://www.dentalprotection.org/uk/articles/information-for-members-considering-re-opening-their-private-practice

Dental Protection celebrates first women in dentistry

International Women’s Day – celebrated 8 March every year – aims to, among other causes, honour the achievements of women throughout history and across the globe. Dental Protection is proud to support women in healthcare across the world and has today unveiled information about its first women members.

Dental Protection is part of MPS, which currently has over 155,000 female members around the world. This represents more than half of our membership – and that figure is on the rise.

Historically, it wasn’t easy for women to enter the profession, since medical and dental schools were not  opened to women and they had to pass their exams incognito before being able to officially register. The first female dental professionals appear to have joined the register in the late 19th and early 20th century.

Research by MPS has revealed that two of the earliest women dentists to join the organisation – then known as the London and Counties Medical Protection Society – did so within a few years of it being founded in 1892.

Ruby Grace Halliday was the first female dentist member, having joined in 1902. Ruby worked at the Endell Street military hospital in London during the First World War, which was the only hospital entirely staffed by suffragists and led by one of our earliest women medical members, Louisa Garrett Anderson.

Eva Mary Handley was the first woman dental surgeon at the Royal Free Hospital, joining three years later in 1905.

These two women could be regarded as the pioneers of dentistry in the UK and certainly led the way for female members of what is now Dental Protection.

Professor Dame Jane Dacre, President of the Medical Protection Society, said: “Although it wasn’t until the turn of the century that women were seen as entering the medical and dental profession officially – and being able to study, register and be remunerated for their work –healthcare began at home and within communities, and caring for the infirm had long been the responsibility of women.

“Nowadays, although almost half of healthcare workers are women, we still have structural barriers to overcome in order to improve the access of women to senior positions.

“It has not been an easy journey, but I am proud of the work of Dental Protection and the wider MPS does to support the efforts of women – who now account for more than half of our membership.”

Data reveals 40% of claims costs relate to treatment started over 10 years ago

New data published by Dental Protection reveals that almost 40 per cent of its estimated annual claims costs in 2018 related to cases where treatment started ten or more years ago before the claim was made.

Claims that relate to treatment that started many years ago are also being made for larger amounts, sometimes up to £100k. Of the top 100 largest claims made against Dental Protection members in 2018, 60 related to where treatment started ten or more years ago before the claim was reported.

The majority of these late reported claims involve allegations relating to the management of periodontal disease, but also include allegations about management of caries over many years.

Patient care is now very different to that provided several decades ago. There is increased understanding of the importance of record keeping as well as much better education and training on the screening, diagnosis and management of periodontal disease and caries. However, the claims environment will continue to be challenging with increased public awareness of periodontal disease, changes in patient’s expectations about dental care and claimant law firms actively targeting periodontal claims and long-term care.

While predicting the future cost of claims can be difficult, it is an essential part of what Dental Protection does. It is vital to price accordingly in order to meet the possibility of future claims.

This data supports the importance for dentists to maintain their membership of a dental defence organisation that has a long-term understanding of risk and who will continue to support dentists in years to come.

Raj Rattan, Dental Director at Dental Protection, said: “We clearly live in an increasingly litigious environment and dentists need to be confident that they can request support from their indemnifier in 10, 20, or even 30 years time. Dentists can ask us for support in relation to claims brought against them even where they have since moved practice or retired, as can Executors/Personal Representatives where claims are brought against the estate of a dentist who has passed away.

“At Dental Protection we can confidently say we are here to stay. Our subscription rates reflect the cost of our long-term commitment to protecting you to the highest standard long into the future, not a short-term requirement to generate profits.

“Dental Protection membership provides excellence as standard; supporting not just when a claim or a complaint arises but through our education programmes, to prevent any issue from happening in the first place. To learn more about the nature of periodontal claims and what can be done to reduce the risk of a claim, Dental Protection members can take a free online e-module and also join a webinar on 17 September”.