PRACTICE MANAGEMENT

Changing practices – planning your exit well

There are many important considerations to bear in mind when leaving a practice, to ensure a smooth handover of patients, and deal with possible difficulties that may arise after you’ve left.

At Dental Protection, we are regularly asked for advice when disagreements arise between colleagues – especially between principals and associates. This can be particularly challenging when the parties have parted on less than amicable terms. Some of the resultant issues and disputes could have been mitigated if there were more clearly defined and thought-through parameters in place from the beginning.

Your contract

Before entering into a new agreement, it is important to carefully review any contract. You may wish to consider whether you want to agree to a certain notice period to be given by either party to terminate the contract. Are there any restrictive covenants after departing the practice, e.g., preclusion from working within a specified geographical radius? What are the financial arrangements for outstanding patient bad debts when you leave? Dentists are provided with very little training in this area prior to graduation, and we do see instances of disputes between parties that can rapidly escalate. Dental Protection would encourage anyone starting in a new role to have their contract reviewed by a suitably qualified legal professional.

Dental Council guidance

In the Dental Council’s Code of Practice relating to Professional Behaviour and Ethical Conduct (2012) it states that “you must arrange to look after your patients if you leave your dental practice”, and that “if you accept a patient for treatment, you must complete the agreed course of treatment safely and to a satisfactory standard”. There are important considerations to bear in mind when leaving a practice. Are all outstanding treatment plans completed? If not, what are the arrangements for continuity of clinical care? If you had a specific clinical interest, e.g., short-term orthodontics, will your successor or the practice itself be able to provide followup care? The simplest way of overcoming the difficulties thrown up by continuity of patient care is to plan your exit from a practice well in advance. By doing so, you can notify your patients ahead of time and this will help you avoid any surprises. This approach may also allow you to refer complex treatment plans to colleagues, to avoid the patient having to change clinician mid treatment.

Dr George Wright

Deputy Dental Director, Dental Protection Record keeping

Robust record keeping is one of the central pillars in clinical risk management. Ensure that your clinical records are of an adequate standard – that is, your records should facilitate another practitioner who replaces you. A helpful exercise would be to review some records from a few months back and consider whether you can easily understand what discussions you had with the patients, what treatment options were explored, what risks and benefits were considered, and the final agreed treatment plan. If this basic information is missing, then it would be harder for any dentists taking over the patient’s care.

Complaints

Before you move to another practice, it is important to discuss what process is in place for any patient issues or complaints once you have moved on. Consider posing the following questions: 1. How will you be informed and asked for your comments? 2. Will you be notified of all patient complaints or just the ones the practice considers to be significant? 3. Who will respond to the patient – yourself or the practice? 4. If remedial treatment is required, what financial arrangements are in place (especially regarding retained sums)? 5. What if you disagree with the approach to the complaint?