February 11, 2015

1. Why are young dentists facing more litigation?

  • Young dentists have less clinical experience than their predecessors.
  • New graduates are stepping into an environment where there are more complex treatment needs.
  • Patients are acting as consumers, are paying ever-increasing amounts of money and have higher expectations.
  • Patients’ lawyers have a no win no fee system and this has encouraged litigation (though this system is likely to change in the future).

2. Do you think this trend in going to continue in England?

The trend in England is likely to decrease partly because of the change in the legal situation – LASPO (Legal Aid, Sentencing and Punishment of Offenders Act 2012) will improve the no win no fee issue. We are therefore likely to see a change in environment over the next few years and claims are likely to go down in England.

3. How does this compare to GDC cases?

  • Whilst claims may reduce in England, the number of GDC cases may stay the same or increase.
  • There has been a 100% increase in the fitness of practice claims going through in the last 2-3 years. With the introduction of case examiners this may change.

4. Any tips to help those starting their dental career?

  • Practice is a safe environment. Control the variables that lead to increased risk – time, experience and team. Controlled risks will lead to better rewards.
  • Go at your own pace. It can be tempting to follow your peers e.g. on Facebook, and you may feel there is a race to catch up with other colleagues. But find your own reason and rationale for doing things. Pick the things you want to do, enjoy them and find your own route to success.

5. Are there any differences in claims received between age groups?

  • Yes – bell-shaped age distribution in claims.
  • Peak 35-45 years and tails off at higher age group.
  • Influencing factors: Workload, dentists’ expectations of earnings, complacency and lack of face-to-face CPD.

6. What are the components of a good record?

  • This has changed over the last 10-15 years – far more stringent requirements now.
  • Have a system in place and do the basics right first – e.g. thorough pain history, medical history etc.
  • When you have a challenging patient or complex situation and you’ve recognised there is a higher risk of a complaint/litigation, implement ‘risk record keeping’.

7. Any tips of making record keeping more effective?
Custom screens – excellent checklists that you can pre-prepare and populate as you treat the patient. They ensure you include all the details in a quick and efficient way.
8. What are the key documents relating to record keeping?

  • CQC guidance
  • FGDP Clinical Record Keeping Guidance
  • GDC Standards Guidance

9. What is the key issues relating to gaining consent?

  • The most important aspect is making the sure the patient understands exactly what you are going to do.
  • Consent is a process not a one-off event. Signing a form just before treatment is not the only component of consent. It is an on-going process.
  • Deliver consent in easy-to-understand chunks, ask questions to check understanding, give the patient opportunity to ask questions and provide written information to take home for later consideration.
  • Give the patient a cooling off period if possible especially for more complex treatment e.g. orthodontics, dental implants and even crown/bridge-work. This will give the patient some time to weigh out the benefits, risks and costs of treatment. It will also help ensure the patient doesn’t feel pressurised in having treatment against their will.

10. What’s the latest on the NHS contract?

  • The NHS contract reform pilots are moving onto the next phase – prototypes. The Department of Health and the BDA are negotiating the format of the prototypes. Likely to be issued in January and will go live in Autumn 2015.
  • Likely to be a blended contract – the prototypes will review the different percentages/blends in the areas of: capitation, quality and activity.
  • The earliest the new contract will come in is April 2017.

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