At some point during your professional career you will no doubt have been faced with an unpleasant patient; you may have been unlucky enough to come across a few. However, in what circumstances can you refuse to treat them?
Alternatively, what if a patient refuses to be treated by you or someone in your practice? What if the reasons for such a request are or could be discriminatory?
At a time when instances of every day discrimination and sexism are rife in all walks of life, it is not hard to see why some dentists and doctors feel like they are walking on egg shells. This week BBC Radio 4 Today Show presenter John Humphrys, asked the tennis player Johanna Konta a series of questions regarding her origin, culminating in, ‘So, what are you?’; questioning whether she was truly British. Johanna Konta has represented Great Britain at the Olympics and the Fed Cup. She has been a UK citizen for almost half her life. Chancellor Philip Hammond, has been criticised for allegedly saying driving a train is so easy 'even a woman can do it'. We’ve even seen uproar over the “sex” of a fictional character with two hearts.
But is there ever a situation where someone’s nationality or sex can affect their ability to perform their role?
Refusing to treat a patient
With so much regulation in place and a fear of patient complaints being escalated to the GDC, you may feel as if patients hold all the power. However, there are situations when you are entitled to refuse to treat a patient. Below are 6 legitimate reasons for refusing to provide treatment:
1. When a patient questions your clinical judgment. If a patient questions your clinical judgment or expresses a lack of confidence in your abilities, we would recommend you stop treatment immediately. At this point explain to the patient that it is important they have confidence in you as their treating physician and that to carry on treating them would be unethical. Try not to take this personally, and certainly avoid arguing the toss with the patient; this could result in a complaint against you. Everyone has different views and personalities and whilst you and the patient may clash, there will no doubt be another dentist who gels with the patient.
2. When there has been an ‘act of God’. If a dentist is hospitalised or suspended, or there is an emergency, such as a flood in your practice, it will be impossible for you treat the patient at that time. Keep the patient updated and make alternative arrangements where possible, otherwise the patient may go elsewhere.
3. When a patient fails to pay a bill or continuously misses appointments. If a patient fails to pay bills or continuously misses appointments, then you should give them a warning that this conduct will not be accepted and future similar conduct will result in them being removed from the Practice. Put information on your website regarding the circumstances in which treatment may be withdrawn.
4. When there is a conflict of interest. Whilst, this is unlikely to arise that often in a dental practice, there may be circumstances, for example where a patient is pursuing a claim against your colleague, where it would not be appropriate for you to treat. If the patient comes to you and you know about the claim, there could be a perceived conflict and it would be better not to treat the patient at all. However, if you are part way through treatment, you should highlight to the patient that you are aware of a potential conflict and let the patient decide whether they wish for you to continue treatment.
5. When a patient is violent or abusive. If a patient is violent, or even threatens violence, to you or any of your staff, depending on how serious this is you may wish to call the police. In terms of treating the patient in the future, you should assess the situation and why the matter escalated. For example, was it honest misunderstanding that has got out of control, or has the patient been violent for no reason? Do you think the patient can be managed in the future without putting your staff members at risk. The more serious the incident the more justification you will have for refusing treatment. Write to the patient and confirm that you will no longer be treating them and, if you are an NHS practice, contact the NHS Commissioning Board.
6. When a patient has complained. You should avoid the temptation to refuse treatment in these circumstances as it could result in a further complaint. However, if the complaint is about your clinical treatment or is shown to be entirely unjustified or malicious you can follow the process in point 1 above.
Patient’s freedom of choice
Generally speaking, a patient has the right to choose which dentist provides them with treatment, just as you are entitled to choose who supplies your materials for your practice. Therefore if a patient requests a specific dentist to provide treatment you should seek to accommodate that request.
What if the request to be treated by a specific dentist is racially motivated? You have no obligation to treat a patient in those circumstances except in an emergency. Bear in mind, the patient also has to consent to treatment, and they can refuse treatment on bigotry grounds if they wish.
However, there is a grey area in all this. What if a female patient requests a female dentist on religious grounds? Or a Polish patient requests a Polish dentist as a result of not speaking English? In these circumstances, we would recommend accommodating such requests where possible, to prevent allegations of discrimination against you.
You should create a practice policy for dealing with such requests so staff know what to do and can identify when such requests might be reasonable.
Laura Pearce, Senior Solicitor
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With recent and foreseeable changes within the UK dental sector, it is crucial that dental care providers continue to evolve. The demand for excellent patient care and treatment remains high and indeed many will agree that it is intensifying with modern societal pressures and increased awareness among the public.
Alongside this requirement for clinical excellence and outstanding patient care, is the need to expand services and increase access to both NHS and private dental treatments across the nation. As such, leading dental providers have been developing their services and attempting to deliver the care and treatment needed in different areas of the country.
Someone that understands this need for growth and the processes involved is Richard Smith.
Richard has a huge wealth of experience and expertise in running and developing companies and groups within the dental and pharmaceutical sectors. He began his career at Unilever before spending 30 years working in a series of roles across customer service, multisite operations management, marketing, finance and operations, including a senior role at Somerfields Stores plc. Richard later became Managing Director of Lloyds Pharmacy in 2005 and then CEO of IDH in 2010. Richard is also the Chairman of Europe’s largest diagnostic and cancer care business, Affidea, and is therefore heavily involved in healthcare across Europe.
“Having previously developed a dental business over four years to become the largest in the world, as well as being actively involved in the expansion of a pharmaceutical chain company, I have a fair amount of experience regarding what happens when an organisation grows. With my responsibilities in previous roles including management of the financial, legal and technical aspects, I have also developed an extensive network in these areas.
“As with anything, you often learn the most when faced with situations where something has gone wrong. I have witnessed a variety of circumstances throughout my career in the dental, pharmacy and retail sectors, which have contributed to my understanding and knowledge of such projects. Even for companies that are very well run, some changes must still be made in order to ensure the new business structure is well supported.
“Despite growth plans, I believe it is very important for dental providers to remain true to their original ethos and values. Care for patients should always remain the top priority; it’s crucial to maintain this alongside increasing access and developing the business.”
This is a view share whole-heartedly with Rodericks, a leading dental group in the UK committed to providing excellent patient care and service and increasing access to NHS and private dentistry.
Richard recently joined Rodericks as a Non-Executive Director and he is looking forward to sharing his expertise in order to help drive the group forward.
“I initially met Shalin Mehra, Managing Director of Rodericks, when I co-founded the Association of Dental Groups and he became a member. A very down-to-earth and personable man, his passion for dentistry is evident and I quickly became impressed with his organisation. As a dentist running a dental group, he naturally brings dental excellence to the fore and I believe his group to be the best quality operation in the profession. When Shalin asked me to get involved I was delighted by the opportunity – I don’t think I would have gone anywhere else in dentistry.”
Concerning his new role with the dental group, Richard clearly has an abundance of experience and skills on which to draw.
“It is still early days for my involvement with the dental group, but my major focus with be on what we can bring to the growth plan of the business. As changes are implemented to facilitate growth, I hope to help make sure the transition is as easy and as effective as possible. Based on my previous experience, I hope to help the group avoid any potential pitfalls as it continues to expand with a key focus on excellent patient care.”
For Richard, a huge benefit of returning to dentistry is the opportunity to visit practices and meet the staff on the ground.
“I have really enjoyed visiting the practice and management teams – it’s probably the main element I really missed when I took a break from dentistry. It’s great to meet the team in-person and discuss any concerns or successes, and I am looking forward to doing this again.”
Looking to the future of dentistry, Richard comments:
“There is a definite move towards consolidation of the dental market, but approximately 85% remains independent. While I believe there will always be a place for the independent practices, I think there will be a growing place for corporates to introduce brands and collective ways of working in dentistry.
“What’s more, the future of dentistry might soon encompass other primary care. In various industries I have experienced diversifying from the core services provided, because there is the opportunity to provide more for patients within the existing setting.
“In my opinion, Rodericks’ clinical background will make it well-placed to capitalise on these prospects in the future. However the ownership looks in 20, 30 years time, the organisation could be the embryonic beginning of a very successful, major force in corporate NHS and private dentistry. Whatever happens, the group will be an incredibly good platform from which to successfully develop a model synonymous with the future dental sector.”
But, as captain, there are many different responsibilities that simply cannot be ignored. Compliance, recruitment, administration, discipline and finance: these are just a small selection of the duties that a principal dentist must manage on a daily basis – on top of their busy schedule of treating patients.
This presents a very real problem for a great many principal dentists. Indeed, one of the most common factors for job dissatisfaction amongst practice owners is actually the stress of running a practice. Even with a practice manager (or first-mate, to continue the maritime analogy) taking some of the strain, there are a multitude of unavoidable day-to-day tasks that are necessary for success.
But most dentists are not businesspeople – and, in all honesty, why should they be? They did not spend years at dental school to become anything but a dentist so it is understandable that some of the extraneous obligations that principals inevitably find themselves dealing with become the reason for professional failings and shortcomings.
And, of course, this can have very serious ramifications for the rest of the dental team. After all, if a ship’s captain has lost their way, what hope is there for the crew? Indeed, it is well documented that a large majority of workplace issues and employment tribunals in dental practices stem from the inability of a principal to treat their staff as business employees.
There is a solution to this. Research has shown that dentists who join with a larger dental group exhibit greater work satisfaction than those who forge ahead alone. The two main benefits that were highlighted were an increase in downtime and the elimination of administrative stress.
In fact, those dentists who joined dental corporates found themselves with more time to concentrate on the things that attracted them to a career in dentistry in the first place: practising dentistry.
Admittedly, dental corporates have acquired a negative reputation in the UK. Some professionals see them as profit-driven conglomerates that are intent on eliminating autonomy and imposing stringent uniformity. But while these unfortunate views persist, they are simply untrue.
A dental corporate strives for one thing above all others: excellence. Whether that is clinical excellence, or the very highest standards in all other aspects of the dental business. Corporate leaders understand that the best way to promote excellence is to allow people to do the jobs they are best suited for. That is why they are enthusiastic about bringing together experts in all parts of the dental profession – from practitioners to nurses, IT gurus, marketing experts, recruitment leaders and compliance professionals.
By working together, and supporting each other, it becomes far easier to achieve the best. Whether its in matters of compliance, recruitment or discipline, there will always be a network of understanding, like-minded professionals to depend on.
So, joining a dental corporate should not be thought of as surrendering your ship to another captain: it’s far more like joining a fleet – a fleet formed of many individual ships, each with an individual captain, who all share a common direction, who can depend on each other for support and who are administered by a dedicated and experienced Admiralty.
Portman Dental is a dental corporate that truly promotes this idea. With around 30 practices across England, from Sheffield to the Isle of Wight, Portman Dental strives to make each individual practice the best it can be. It does this not by introducing radical changes that force its members to work in a certain way, but by providing the right support, direction and staff to allow for excellence to propagate naturally. Management is maintained on a local level, and supported by a central team of experts and only principals who are truly committed to the idea of cooperation and progression are taken on.
Don’t allow workplace pressures and dissatisfaction to affect your practice’s success – or your wellbeing. Join a dental corporate and strike the truest course, for you and your team.
For more information about joining the Portman Dental team, please visit www.portmanhealthcare.co.uk or call on 0207 281 9489
 theyoungdentist.com – Working for a dental corporate – Is it for you?; published online: 2011; link: http://www.theyoungdentist.com/uk/careers/34-working-for-a-dental-corporate-is-it-for-you [accessed 02/09/15]
 British Dental Association (BDA) – Advice and support; link: https://www.bda.org/dentists/advice/Pages/index.aspx [accessed 02/09/15]
 American Dental Association – Practice setting may determine dentists’ satisfaction; published online: 2015; link: http://www.ada.org/en/publications/ada-news/2015-archive/july/practice-setting-may-determine-dentists-satisfaction-research-shows [accessed 02/09/15]
Cost-benefit analysis ahead of 2016
Louisa Buckingham of Patient Plan Direct explains why practices should consider performing cost-benefit analysis ahead of 2016.
The dental industry continues to become an ever more competitive industry with a generation of tech savvy and business-minded dentists. More than ever, dental practices are looking to differentiate themselves, create competitive edge, provide a unique patient experience and embrace digital dentistry all whilst endeavouring to generate healthy profits and deliver the best in patient care.
A cost-benefit analysis is the exercise of evaluating a planned or existing action by determining what net value it will have for your practice. A cost-benefit analysis finds, quantifies, and adds all the positive factors; the benefits. Then it identifies, quantifies, and subtracts all the negatives; the costs. Should the benefits derived from the action outweigh the costs of implementing that action, then the action should be taken and vice versa.
As practices increasingly seek to cut costs and improve productivity and care, cost-benefit analysis has become a valuable tool for evaluating a wide range of business decisions and opportunities for dental practices; the prospect of a move away from the NHS, which consumables supplier to work with, which plan provider to work with in administering and developing the practice’s private dental plans.
When undertaking this review you should ask yourself questions such as; what value does this opportunity/action represent? What other alternatives do I have and how do they compare? When did I last review this area of my business?
Take for example, dental plan administration. It’s alarming how many dental practices aren’t aware of the fees they pay to their plan provider and nor do many assess what value these fees represent.
Many plan providers profess to offer a range of additional ‘non-plan’ related services, hospitality and support alongside core plan administration. This ‘optional’ access to additional elements of service aside from plan development is rolled in to the fee structures charged by some plan providers. Many practices don’t actually utilise these additional elements, effectively paying for something they don’t fully leverage and therefore not seeing value.
When performing a cost-benefit analysis in relation to working with a plan provider you should make a list of what the provider delivers; the benefits. For example; How many times a year do you see your representative? Do you fully utilise additional services such as regulatory advice, ‘key client’ forums, or clinical events? This should then be compared to the costs of the service and also weighed up against other provider propositions in the market.
If you already work with a dental plan provider, the Patient Plan Direct business development team can help your practice conduct a cost-benefit analysis, a very useful technique you may then consider to assess and analyse other areas of your business.
Patient Plan Direct is a dental payment plan provider working with practices across the UK, recognised for its cost effective (£1 per patient per month) approach to support and administration, as well as its innovative web-based management platform. Patient Plan Direct support practice with; New payment plan launches, NHS to Private conversions and Plan provider transfers
This study looked in detail at the patient journey and found that: “for most participants [this] involved feelings of trepidation and anxiety in the lead-up to the appointment.” It went on to state that, “Much can be done to set patients at ease through good communication and friendly and relaxed staff.”
While plenty has been achieved since 2009 in regards to improving the patient experience, many practices could still benefit from addressing the fundamental communication issues that lie at the heart of the patient journey. After all, whichever business model your practice follows, whether Private, Mixed, NHS or multi-practice, the key aim will be to increase sales and profitability, and at the centre of that is the patient journey. This is what keeps your patients coming back or encourages them to attend your practice in the first place.
So by understanding your patient journey, looking at each stage in turn – and clearly communicating it to your patients – you will naturally create a more successful practice. Some do this extremely well, while others are far less consistent. For instance, a practice that has taken into account their patient journey might have a clear description on their website, detailing everything from first contact right through to aftercare and follow-ups.
This approach empowers patients with the foreknowledge of what to expect. Which in turn creates more and better quality leads, happier patients who appreciate you and are easier to serve and a more efficient business where you can cope with increased patient numbers without the need for more team members.
This might all seem too good to be true; it isn’t – but it does take a lot of hard work to achieve and is not an overnight project. Central to it all is understanding your own patient journey, providing clear communication and enhancing and enriching the patient experience.
What is the patient journey?
The patient journey comprises everything from the first visit to your website to any treatment itself and beyond. It covers every interaction or point of contact between patient and practice and is impacted by everything you do, this includes:
· Phone calls (in and out bound)
· Communications by post
· Text messages
· The service provided in reception
· Interactions with the dentists and associates
· Interactions with the dental nurses and treatment co-ordinators
· Posters, advertising, leaflets
· The content of your website
· Follow-ups post treatment and aftercare.
In order to get to grips with your patient journey and understand how this affects your patients and their decisions, it is crucial to analyse each interaction, deciding what you want those exchanges to say about your practice and what the desired outcome of each is.
To get this right you will need to focus on your brand and consider exactly what it stands for. You might decide your brand is clinical and professional, or friendly and welcoming, but whatever message you want to deliver must be consistent throughout each and every interaction; from the tone of voice to the way your practice is described.
Each point of contact will likely have a slightly different key message, so it is also vital that this is clearly communicated. For instance an email sent to a prospective patient should have a very different message and content to that of a phone call to arrange a follow-up.
Whatever the message, medium or content of your interactions, it is crucial that each one works to build trust in your practice and services.
Most dental patients don’t understand what they’re buying – they know their teeth hurt, or they look bad, but they don’t understand how to make the right choice. This means you have to assure them they can trust your practice and every member of your team.
To do that you need to be consistent: have the same branding everywhere, with every communication to the same standard, and all the team in the same uniform. You must be accurate, having the correct pricing on every document, good spelling and grammar, and their paperwork ready when they come in. You also need to be up-to-date – not having pictures of old team members on the website; and provide all the necessary details when asked, explaining exactly what’s going to happen, and what the differences between treatment options are.
Once you’ve spent time considering and designing your patient journey, looking at the ways you build trust and communicate with your patients, you will need to find the best way to implement these changes. This is where turning to a proven solution can help. 7connections, along with software giant Infusionsoft can assist your practice in implementing the ideal patient journey using the much-discussed Artisan Lifecycle Marketing approach. A marketing and lead generation system, it addresses the patient journey from start to finish, so that you can begin to grow your business through increased efficiency, higher productivity and more satisfied patients.
A strong patient journey is one of the most fundamental aspects of creating a successful practice. By spending time focusing on how your patients experience your practice from start to finish, you will ensure the service you provide is always of the highest calibre.
Alternatively, please visit the new website www.7connections.com.
 The Patient Perspective, 2009. Available at: http://www.gdc-uk.org/Aboutus/policy/Documents/RevalidationThePatientPerspective.pdf [accessed 29.4.15]
The companies have already benefited many patients across the US and UK, and continue to grow through their new partnership with Toothpick, the UK’s leading online booking platform for dental appointments. The new partnership aims to further increase accessibility to private dentistry, ultimately reducing the gap between NHS and private care, and it all begins with the introduction of the ‘Toothpick VIP’ card.
How does it benefit the patient?
The ‘Toothpick VIP’ card is cost effective and simple to use, and through its use, patients can benefit from an immediate 20% discount on private dental treatment at participating practices in the UK.
The card is available for a low annual fee and it is possible to include family members into the plan. This money-saving scheme offers unlimited use, and can be used for both pre-existing conditions and emergency dental treatment.
How does it benefit practices?
Because this scheme is not an insurance policy – it is a money saving option – it is beneficial to dentists and patients alike. Essentially, any practice in the UK that is registered with Munroe Sutton can offer this service, which is likely to attract new patients, in turn increasing practice profit. What’s more, practices are likely to receive positive reviews and build a good rapport with new and existing patients.
Working with Munroe Sutton offers copious opportunities for networking and free promotion, as it liaises with customers of leading companies within insurance, finance and healthcare. Ultimately, involvement with this scheme could allow you to develop and unlock your business potential and it is completely free to join the network.
With studies showing that only 61% of people in England attend their dentist regularly[i], it is crucial that schemes such as ‘Toothpick VIP’ continue to be implemented. As prices continue to rise, so will the number of people that miss out on necessary treatment.
For more information please call 0808 234 3558 or visit www.munroesutton.co.uk
[i] British Dental Health. National Smile month. Facts and figures. May 18 - June18, 2015. Accessed online June 23rd 2015 http://www.nationalsmilemonth.org/facts-figures/
National surveys reveal that around 36% of patients experience moderate dental anxiety and 12% of adults were classified as having extreme dental anxiety. There is not always a clear-cut reason for dental phobia but many patients explain that they have been scarred by a previous traumatic experience. Others are afraid of the unknown and many have simply inherited dental fear by association from their peers or parents.
The most common fear among patients is pain. A phobia of needles is also reported by thousands of men and woman and the thought of having an oral injection understandably exacerbates their anxiety. A significant number of patients become anxious when they feel out of control, confined or helpless. Some people are terrified of not being able to breathe or swallow, have a fear of gagging or vomiting and others cannot cope with hands or instruments in their mouth or near their face.
Any practitioner will be aware that anxious patients need understanding and empathy, a level of support that makes them feel as comfortable and relaxed without prying into their inhibitions. It is important talk reassuringly to the patient whilst respecting their wishes. It’s critical to take plenty of time to explain every detail, maintain eye contact and encourage them to take deep breaths to calm down.
Even when fearful patients attend for a check up, they have made a terrific effort to be there. They may not be able to respond to your questions or feel like making small talk but you can put them at ease by being kind, gentle, patient and most importantly, non-judgemental. If the patient has severe dental or oral health problems due to neglect it may be ideal to break the diagnosis down and explain it in stages to avoid increased anxiety.
If the diagnosis is complex, you might need to refer the patient to a specialist practice, but you will need to be confident that they have the ability and empathy to treat anxious patients. London Smile Clinic is a referral practice with a team of specialist dental practitioners that are experienced in treating nervous patients. It is a centre of excellence with exceptionally high standards of dentistry and offer orthodontic, implantology and periodontal treatments as well as cosmetic dentistry. The dental team strive to make patients as comfortable and relaxed as possible and take the time to be gentle and understanding.
On facing their fears, patient can often feel surprised at how well they have been able to cope. Practitioners can boost their confidence by praising them and assuring them that they will look forward to their next visit, which will hopefully be less worrying.
For more information, please contact 020 7255 2559 or
 Adult Dental Health Survey 2009. www.dhsspsni.gov.uk/adultdentalhealthsurvey_2009_firstrelease.
pdf [Accessed 25th February 2015]
 Stan Lindsay & Chris Jackson. Fear of routine dental treatment in adults: Its nature and management DOI:10.1080/08870449308403174