It is essential that you understand the options open to you in terms of indemnity cover, so that you can make the right decisions for you and your practice. Here we provide impartial information about the different types of indemnity cover available.
Overview of key concepts
overview of key concepts will help you better understand indemnity. It covers issues such as:
- Contract insurance and discretionary cover
- Occurrence-based and claims-made cover
- Financial security and oversight of insurance and discretionary providers.
Members can also read
the latest on indemnity from the BDJ.
Indemnity during the COVID-19 pandemic
The following information is for BDA Indemnity policyholders. Members who have cover with other providers should seek confirmation there.
In the last eight weeks of the pandemic of strictly limited dental activity BDA Indemnity policyholders have been increasingly concerned about the extent of their cover for a range of work either in the practice providing telephone triage or at urgent dental centres treating patients in pain.
During this time we have spoken to many members who had specific patients for whom they wished to provide urgent care as they had not been able to access this through urgent dental care centres.
We advised them to do a
risk assessment. If they felt, having gone through that risk assessment that managing that patient face-to-face with interventive dental treatment was in the patient's best interest, then they could be assured of cover under the policy.
clinical records are required and the template has been made available to all BDA Indemnity members. This advice has been consistent to all policyholders throughout this time whether they were working under NHS or private contractual arrangements.
Policyholders who work under private contractual arrangements have requested reassurance about the extent of their cover at a time that there are perceived and actual restrictions on the extent of treatment allowed by NHS contractual arrangements in the four devolved nations.
Dental services is defined deliberately widely in the
BDA Indemnity policy. If a policyholder is providing dental services to patients they can be assured of cover.
In the event of a challenge from a patient, regulator or any other body, the quality and success of a policyholders defence will always be determined by the factual matrix of what happened at the particular incident time, what the allegations are and what the dentist did or did not do at the time or afterwards, and the contemporaneous clinical records. It will also depend on the prevailing context of the guidance, laws and directives that were in force at the time.
BDA Indemnity members can be assured that under their contractual insurance cover we are not able to exercise our discretion not to cover them. They can therefore confidently look to us to be by their side through these challenging times as they provide dental services in the coming weeks and months whether under NHS or private contractual arrangements.
A series of decisions in the UK’s Supreme and lower courts have focussed attention on vicarious liability in dentistry. Vicarious liability means that an employer can be held responsible for the negligent acts and omissions of an employee. We recommend dentists take steps to mitigate against these risks.
What do you need to know?
In dentistry, the greater the level of control exerted by the practice owner and the more unequal the balance of power and freedom to make decisions between them and the associates is, the easier it becomes to argue that vicarious liability exists.
Associates and practice owners should be aware of the growing legal precedence relating to vicarious liability. In a case heard in a County Court in 2019, involving a dental practice and the allegedly negligent care provided by an associate dentist, the judge concluded that the practice has a non-delegable duty of care and vicarious liability.
Many traditional indemnity providers don’t offer vicarious liability as part of their cover. However, the courts and the public are troubled by patients, like those seen in the Paterson case, going without compensation due to how healthcare providers set up their business arrangements.
We recommend you consider take some of the steps below to:
- Mitigate the risk to the practice of being vicariously liable for self-employed dental associates
- Support the clinical care delivered by the practice and the dentist
- Provide systems to ensure quality of care is assessed and improved.
As an associate how can I protect myself?
Give some attention to how you manage complaints. Early interventions and well-handled complaints can make a difference to the outcome of any adverse event.
Advocate a practice-level focus on managing performance concerns. This could be a review of audits/clinical incidents/ patient complaints.
You should avoid seeing this as a practice owner's responsibility. As an autonomous clinician it's something you could drive as well as participate in.
As a practice owner how can I protect my business?
The best way to mitigate risk is to consider the process end-to-end. Extra and Expert members can get in touch with our advice team for more information on the following topics:
Recruiting and retaining staff
Check GDC registrations; check the professional indemnity cover of each relevant individual noting the provider and the type of indemnity ( some types leave practice owners more exposed)
Quality improvement processes
Adverse incident reporting and reviews
Evidence based practice
Clinical dental meetings
- Peer review and sharing of good practice
- Clinical pathways
- Risk management reviews
Managing performance concerns
Review of audits/clinical incidents/ patient complaints
|Learning||Handling complaints and managing difficult patients|
Friday 18 September 2020 - London
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