Eh? What do you mean I can’t be seen?

With direct access at the forefront of many discussions at the moment, I thought I would take the opportunity to just show how sometimes the current law can be so detrimental to the patient and to a business. The following is an account of an incident that occurred in practice today.

Mr S had booked an appointment back in August with the hygienist for today (05/10/11) and his examination on 02/11/11. The patient had last been seen by the GDP in July 2010 who had clearly stated in the recall 12/12 visits, the patient had booked this way due to work commitments and other commitments in our appointment books.

The receptionist who booked the appointment had unfortunately forgotten to check the date of his last dental examination and had not noticed that he was now outside his 12-month recall period.
The GDC has quite clearly stated that a hygienist must have a valid prescription (or referral, let us play with semantics here) and that the absolute is the recall date to the dentist for the ‘full mouth examination'.

This presented a dilemma but had been noticed by one of the other receptionists as she was checking daylists (a very astute lady!). She had attempted to make contact with the patient on two occasions to discuss this with him but to no avail and had made temporary notes on the computer system so that it could be brought to his attention when attending.

It must be made clear here that numerous staff work on reception, a situation that has been brought about by various staff having children and returning on a part-time basis.

Let me tell you more about the patient, Mr S. A 35-year-old professional who has had very little conservative work carried out, is fit and well with no known medical history and his last treatment (in 2010) was tooth whitening.

He simply wanted to see the hygienist for a scale and polish (he has no known periodontal problems). He sees the hygienist yearly for a little bit of maintenance and advice to reduce staining and calculus build up. I'm sure you get the picture.

He arrived at the practice for his appointment and the receptionist failed to notice the temporary note on his record. He sat in the waiting area but, in the meantime, the hygienist had gone to reception to discuss the fact that he needed an examination with the dentist before he could be seen.

There was an attempt to get the patient booked in with a GDP but unfortunately, none were available. This created a problem; someone was going to have to tell the patient that he could not be seen. Remember, the patient has got his check-up booked a few weeks' away and it could be assumed that he will certainly turn up for that as he is a long-standing patient with a very good attendance record.

It was now going to be up to someone to explain to the patient he cannot be seen! The patient was asked to go to reception and the situation was explained to him. Unfortunately, because of the law, he would not be able to be seen until he has had an examination with the dentist. The patient was somewhat upset, it transpired that he had phoned the practice to check his appointment and was told that it was fine. Indeed, the patient's wife had even called in just to check that it was still OK. So what went wrong here?

Take note
Well, the first thing that can be gleaned is that the various communications with the patient had not been recorded in the notes. It is good practice to make a note of EVERY communication with patients and in this instance, the receptionist who had spoken to patient or the other one who had spoken to Mr S's wife had failed to record this. It is obvious that there was a failure in communication here.

The hygienist had to bring the patient into the surgery to explain the situation and offer profuse apologies. An explanation was given and the patient expressed disbelief that he could not be seen for a scale and polish. The GDC guidance was shown to the patient who had to concede that this was indeed the case. He found it bizarre that he could not be seen and was a little upset that despite the communication with the practice no one had identified this at an earlier stage.

The practice lost out on an appointment here, the patient is a little dissatisfied and a gesture of goodwill will have to be made given the lack of communication of the team. But it does raise the question: What harm would the patient have come to?