Dental professionals are increasingly accepting part-time positions, and for a variety of reasons. These may be due to necessity; combining multiple part-time posts can be advantageous in areas where competition for jobs is high, or in portfolio careers where colleagues have a number of professional interests. And of course personal and family circumstances can often dictate that full-time working is not an option.
Of course, while there are positive aspects to the flexibility that part-time working can bring (such as the introduction of specialist skills available to patients in-house), there are a number of pitfalls which can give rise to difficulties, some of which we see at the DDU on a regular basis.
Examples include patients who are dissatisfied that they were not made aware of the limited availability of a particular clinician at the outset of treatment, or that they were charged to see a colleague for urgent treatment which they would have expected to have been included within the treatment being provided by their regular clinician.
Planning for part-time
The very nature of part-time working means that there can be significant gaps in one's availability, which may impact on patient care. Careful planning and team working are essential to ensure that the risks arising from this are mitigated.
Before starting any such arrangement and to make sure that patients are not disadvantaged, the practice owner and clinician (whether the latter is self-employed or employed) should put together an agreed protocol for matters such as apportionment of treatment fees for work carried out by others, or the availability of urgent appointments. These should be reflected in documents such as associate agreements and contracts of employment as appropriate.
It is essential that clear and careful arrangements are put in place to ensure that care is available from a colleague when the treating clinician is away from the practice.
Clinical records should always give the narrative of the course of treatment - presentation, diagnosis, special tests, discussions including treatment options and a clear treatment plan. Any colleague either seeing the patient mid-treatment or taking over an incomplete course of treatment should be clear as to what has been agreed.
Incomplete or unclear records can cause a variety of problems for a clinician seeing a colleague's patient. As well as having the potential to increase the risk of errors such as erroneous extractions, it is embarrassing for all parties where it is apparent that the proposed course of action is unclear.
The very nature of current practice is such that there are numerous demands and pressures upon clinicians, and keeping all of these plates spinning can be even more difficult for colleagues working in multiple practices.
Good organisation and team communication are therefore the key to risk reduction. Examples of this include but are not limited to:
- comprehensive and up-to-date records
- Making sure that administration (such as patient referrals and the sending and receipt of laboratory work) is always up-to-date
- 'handover meetings'
- clear information for patients on availability, alternative arrangements on non-working days
- agreed protocols in respect of fees
- clear delegation to other team members where appropriate (eg, checking the arrival of an item of laboratory work for the next day)
- making contact details available for when you are elsewhere, if urgent contact is necessary in patients best interests.
In summary, while part-time working can have a number of benefits to clinicians, practices and patients alike, it is important to carefully plan and organise. This will help to make sure there is continuity of care for patients and that nothing 'falls through the gaps' during periods of unavailability.
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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