The business of dental practice can be pressured and competitive, so it is not surprising that financial or contractual disputes will occasionally arise. When this happens, it is in everyone's interest for differences to be resolved quickly and amicably before they become disruptive.

It is much more difficult to resolve disputes when feelings are running high or if others are dragged in, such as practice staff, patients or regulators. More disappointingly, it is not unknown for a dental professional to report a business adversary to the GDC - a decision they may later come to regret (see box below).

As well as being counterproductive, many business disputes could have been avoided altogether if there had been formal written contracts in place, limiting the opportunity for misunderstandings. This is particularly true for high stakes transactions such as practice sales where there has to be clarity over every aspect of the sale, including Goodwill valuations, the transfer of NHS contracts and staff contracts.

Retention fees are another aspect of dental practice where informal arrangements can often lead to resentment. In principle, it is a good idea for a practice and associate to agree a sum which can be used to pay for any remedial work after the associate moves on. However, difficulties can arise if it is not clear how long the retention period will last or what types of treatment can be funded. For example, it makes sense to agree a limit at which the associate will be consulted or there is a danger that a fee of (for example) £5,000 could be swallowed up by a couple of implants.

We strongly advise dental professionals to seek professional advice when drawing up business agreements. Other useful sources of guidance on contractual and business matters include the BDA, the Confederation of Dental Employers (CODE) and the National Association of Specialist Dental Accountants and Lawyers (NASDAL).

If a dispute does arise, it is important that both sides try to resolve it seamlessly behind the scenes so that patients do not lose out. The GDC expects dental professionals to put the best interests of patients first and to maintain public confidence in the dental profession. These ethical principles should trump any temptation to gain the upper hand through social media or by trying to elicit the support of third parties.

If a disagreement is proving intractable, it is worth considering alternative dispute resolution with a neutral third party, such as mediation or arbitration, rather than embarking on costly and time-consuming legal proceedings.

The DDU does not provide commercial advice but members do seek our advice when business conflicts get out of hand. In our experience, dental professionals who draw on the skills they use in every day practice - a willingness to listen to others and communicate clearly - are usually best-placed to emerge from disputes with their reputation and sanity intact.

Don't 'weaponise' the GDC

According to the GDC's most recent Annual Report, 6% of 2,630 incoming fitness to practise complaints in 2016 were made by other registrants. Dental professionals have a duty to raise concerns if they genuinely believe patients are at risk (Principle 8 or Standards for the Dental Team). However, this should usually be done locally unless this option is not practical, has been tried and failed, there is a fear of victimisation or the matter is so severe that the GDC needs to be involved; for example, if there are issues of violence, indecency, serious crime, dishonesty or illegal practice. The DDU can provide advice if you are unsure how to raise concerns.

On the other hand, the GDC is not the right forum to pursue business and contractual disputes or professional disagreements. Threatening to refer someone in this context is unprofessional and can easily backfire, as the GDC may find the behaviour of both parties gives it enough cause for concern to justify a fitness to practise investigation.

Scenario

An associate with a particular interest in orthodontics attended a training course on aligner appliances. A few months after beginning a patient's treatment, the associate moved on and no one else at the practice was trained and competent to take over.

The practice owner contacted the associate, demanding that he return and complete the treatment. The associate replied that he would be pleased to see the patient if she was referred to his new practice but would not return unless he had assurances about payment.

Neither would give ground and the dispute became more heated, with both dental professionals seeking advice on their legal position. Meanwhile, the patient took matters into her own hands, demanding a refund and moving to another practice which successfully completed her treatment.

The outcome

This situation could have been avoided if the practice and associate had made comprehensive arrangements for the completion of courses of treatment before his departure. This would include a written agreement setting out who would provide the treatment, in what circumstances, and at whose expense.

Even without an agreement, both dental professionals should have been prepared to set aside their differences in the best interests of the patient, even if it meant sharing the cost. A compromise solution would have avoided inconveniencing the patient and retained her goodwill.

Finally, the case highlights the importance of effective succession planning so that there is more than one person trained and qualified to provide treatment which is listed at the practice.


This article was correct at publication on 19/04/2018. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

John Makin

Head of the DDU

John Makin BDS PgDL PgCDE FHEA is head of the DDU. He qualified in Manchester in 1983 and has worked as a general dental practitioner in Lancashire and Devon before joining the DDU as a dento-legal adviser. He was involved with foundation training for many years as both a trainer and VT adviser/training programme director with the Manchester and Exeter DFT schemes. 

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