Is there a dental indemnity crisis?

dental indemnityThe rising cost of dental indemnity is unsustainable, Neel Kothari argues.

There are a few things that I really don’t understand – the first is how the footballer Neymar is worth £200 million, the second is why no-one ever vets Donald Trump’s tweets and finally how dental indemnity costs are calculated.

As a general dentist I’ve always accepted the principle of indemnity as a means of protecting patients, but in more recent times costs have escalated to the point where some dentists are now questioning whether they can afford to carry on working.

What’s worse is that we have no way of calculating how our costs are itemised, how much they will rise next year, or whether they will significantly increase if we are ever unlucky enough to actually use their services.

Why is this happening?

Quite simply, litigation has skyrocketed, but rather than costs being passed onto those most at risk, the rising costs have been crudely apportioned across the profession, with some clinicians with decades of experience seeing thousands of pounds being added to their fees, despite having a clean record.

In my view this shows a failure to appropriately risk assess members.

Interestingly, risk assessing clinicians may actually help make the profession safer and improve standards for patients.

In 2015 the highest number of UDAs claimed  by a single clinician (without assistance) was 24,425.

Given that most feel that it’s impossible for a single-handed clinician to ethically complete >8,000 UDAs, this raises the awkward question, are dodgy dentists paying enough?

And are good clinicians being penalised?

For me this bears a striking resemblance to how good patients who require small items of care are being asked to fund the NHS dental service and pay for those who present with rampant dental disease.

What is the impact for clinicians?

A general dentist who prefers not to be named contacted Dentistry magazine to tell us his story after his fees rose from around £4,000 in 2016 to well over £14,000 this year, after contacting his indemnifier on a matter unrelated to his own clinical practice.

The shocked clinician told us: ‘I understand that indemnity costs have to rise with increased litigation, but I was astounded at the fee that was debited from my account.

‘Although the indemnity society advised that they had attempted to contact me, I didn’t receive any correspondence.

‘What’s worse is that payment is considered acceptance of a year-long policy.’

The dentist also informed us of the difficulty he had in attempting to change suppliers, telling us: ‘I was offered a full refund, but due to needing a “letter of good standing”, which takes around 15 days, this will leave me with a gap in my indemnity, meaning I cannot practice.

‘I feel like they have me over a barrel.’

What are other dentists saying?

Anecdotally, I am hearing reports from multiple sources that some of the main dental indemnifiers are desperately trying to hang on to their members, with some reporting being offered discounts when informing them of their wish to leave.

As yet it’s still unclear how much further indemnifiers are prepared to raise rates (or how much more dentists can afford to pay), but if even a fraction of the stories I am hearing turn out to be true then it would seem that the dental indemnity sector is already in crisis.

Comments (8)

I work in the prison service and I get solicitors letters from patients probably once every couple of months. Unfortunately there is no easy way to deal with these types of letters! My indemnity is constantly informed of claims made against me from the type of patients I see looking for a “quick buck”.

This is not due to clinical negligence or being a “dodgy dentist”.

I whole heartedly believe in indemnity and protection for the patient but
I don’t think vetoing / risk assessing members is the answer.

I agree something does need to be done as costs are rising, however, just because I choose to work in the prison service – does that mean, as I am more susceptible to solicitors claims, that I should be charged more?!

Yes! Your multiple claims and their associated costs are adding to everyone else’s annual indemnity fees. Prison dentistry is well known for this so if you choose to take that career path, you should bear the additional costs of higher indemnity

Your article does not consider the following:

1) A claim being made against you does not mean you are high risk
2) Making a mistake and costing your insurer money does not mean you are at risk of incurring future claims
3) Research suggests apologising to patients when mistakes are made significantly reduces the chances of them making a claim in the first place.
4) All MDOs defend the vast majority of claims successfully, ergo clinicians aren’t messing up as much as patients seem to claim

If a patient makes a claim that has no merit, but still costs my MDO in legal fees with GMC/GDC, is it fair my premium goes up? No. If I’m with an MDO claim free for 5 years then make a mistake, should I suddenly be deemed high risk and see my premium skyrocket? I don’t believe so.

The purpose of ‘pooling’ risk is that 99% of us are perfectly fine clinicians, and unlike car insurers that will try squeeze money out of you if someone else is at fault in a crash, mutuals understand most claims are bogus but there’s often still legal fees.

Indemnity fees are getting high but the increases are gradual, if someone went from 4000 to 14000 in one year, they’ve had a risk assessment and were deemed higher risk, which is exactly what you propose in your article. I can’t honestly believe a clinician of average risk has a 10,000 increase to indemnity fees for no reason. That person will know why their premium has skyrocketed and just doesn’t want to accept it.

I agree. I switched providers 2 years ago because costs were getting out of hand, and once again they’very risen dramatically, even though I’ve never made a claim or had any action taken against me. My car insurance drops every year since I don’t make any claims; why isn’t it the same for dental indemnity? Why am I being penalised for all the dodgy dentists out there?

The worst of it is that I only work 12 hours a week as a dentist but my indemnity costs well over a month’s earnings from the job. This is NOT sustainable.
So I will be quitting the dental profession at the end of this year and taking the script doctor job that a Hollywood agency offered me instead. The pay is far more lucrative and I’m pretty sure I don’t need to be indemnified to edit screenplays.

Well done DDU for driving me out of the profession.

Litigation has increased due to the fact the very famous dental layers that I shall not name but it doesn’t take a lot to work it out are allowed to publish and embarrass dentists for material gain hoping that more patients will complain and see patients winning large amounts of cash .
The law society governing body should have tight restrictions on what they can do proffessionaly to tout for Bussiness .

Dear Neel Kothari

Can you recommend a sensible dental indemnity provider
I am a part time principal working 10 hours per week or less doing a little additional implant work.
Kind regards
Nilesh Patel

I recently did my MSc in implantology and found that my provider, DPL, which normally charge me £4000 for full-time equivalent general dentistry, put their cover up to £5000 for implants under 6 hours per week. The stick wicket was anything involving sinus work skyrocketed to £14000. This seems to be where the big risk comes in. Interestingly I shopped around and being part of the BUPA group (formerly Oasis), they have a bespoke product with the Lockton companies group, which came in under £2500 for GDP work excl sinus cover. Lockton is apparently also keen to also do a bespoke product for BUPA outsiders at reasonable rates.

Then again, they don’t have a long track record and I can’t quite gather if they provide unlimited cover which DPL claim they do.

Lockton group again claims that they do not provide only discretionary cover like DPL.

I can’t help but wonder

a)if the older indemnity like MDU and DPL providers maybe have a great backlog of liability which they have to cover in their fees and we keep on paying for and
b)whether MDU/DPL is actually worth the pennies and they will do the right thing by you and show loyalty to their client of 20 years and not bump their fee up to £20 000 after one claim.

We seem to have a lot of choices nowadays, but not enough guidance on what standard indemnity provision should be, nevermind the cost. If the GDC is our standard regulating body there should certainly be a standard guidance for indemnity cover? Could anyone advise?

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