How to end your professional relationship with a patient because trust has broken down

The DDU receives many calls from practices asking how to manage aggrieved patients. Many issues can be resolved swiftly by the practice but occasionally, dental professionals say they have little choice but to end their professional relationship with a patient because trust has broken down. 

Taking the decision to no longer treat a patient is often a last resort, after attempts to resolve an issue have failed. But it is important that it is handled sensitively to avoid the patient making further complaints or even taking their grievance to the General Dental Council (GDC), the Ombudsman or the media.

It’s over

The GDC has, for the first time, included specific guidance on ending your professional relationship with a patient in its Standards for the Dental Team. Paragraph 1.7.8 states:

‘In rare circumstances, the trust between you and a patient may break down, and you may find it necessary to end the professional relationship. You should not stop providing a service to a patient solely because of a complaint the patient has made about you or your team. 

‘Before you end a professional relationship with a patient, you must be satisfied that your decision is fair and you must be able to justify your decision. You should write to the patient to tell them your decision and your reasons for it. You should take steps to ensure that arrangements are made promptly for the continuing care of the patient.’

If a patient’s behaviour gives cause for concern, the DDU advice to dental professionals is to discuss this with the patient to try to determine the reason behind it. If the patient refuses a meeting or this approach is unproductive, you can write to the patient, advising them that they risk being removed from the list if their behaviour continues.   

Of course, if a patient has been abusive or violent towards a member of staff, it may be necessary to consider withdrawing care straight away. We strongly recommend that practices have a clear policy in place setting out how abusive and threatening behaviour from patients will be treated and explaining that violence will be reported to the police.

Things to consider

If you are considering ending the dentist/patient relationship, you should consider the following points:

  • Try to remain objective and don’t allow personal feelings to colour your judgement
  • Don’t remove a patient solely because they have complained
  • Document any steps you have taken to warn the patient about their behaviour
  • If ending the relationship, be prepared to provide the patient with a reason for your decision (although this may not be appropriate if the patient has been violent)
  • Ensure the process complies with your existing contractual obligations, eg giving appropriate notice, notifying your Local Area Team or NHS England/Health Board
  • Remember, ending a professional relationship with a patient does not usually justify refusing to continue treating their family as well.

Ending a professional relationship can lead to a complaint, so you may wish to get advice from your dental defence organisation before finalising your decision. 

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