Staff asking Ms O to provide information on COVID-19 vaccination status
11. Ms O complains about a call she received from the Practice’s receptionist in March 2021. She says the call was about an upcoming appointment. She says the conversation went as follows: · the receptionist asked if she had received any COVID-19 vaccination · Ms O told the receptionist ‘that’s between me and my doctor’ · the receptionist replied she would put Ms O ‘into a category’
12. By the accounts of both the Practice and Ms O, the call did not end agreeably. The Practice wrote to say Ms O was ‘difficult and aggressive on the phone’ during the call.
13. The dentist subsequently cancelled Ms O’s appointment, saying that she had: ‘made one of [her] members of staff feel uncomfortable, whilst trying to carry out their job. We have to strictly adhere to the guidance from NHS England in order to operate a safe and efficient service. … The questions you were being asked are currently part of our standard procedure and should not cause concern or offense to anyone. This is also the second time members of staff have commented on your attitude and behaviour towards them.’
14. Ms O complains that the Practice has discriminated against her by questioning her vaccination status and telling her she would be ‘put into a category’.
15. We looked at the relevant national guidance for dental practices during the COVID-19 pandemic. Public Health England published ‘COVID-19: infection prevention and control dental appendix’ in October 2020, which states:
‘1. Key messages for dental services Patients will fall into either low, medium or high risk COVID-19 pathways. Patients must be screened, triaged (and when available tested) prior to treatment.’
16. We also looked at the Practice’s own policy that was in place in March 2021. We can see the Practice had referred to the above Public Health England guidance. The Practice adopted a triage system to put patients into a low, medium, or high-risk pathway. It states: ‘Treatment for high-risk patients should be restricted to urgent care only / kept at separate time and space from patients...
Screening/triaging must be undertaken prior to attending.’
17. The Practice further prepared screening guidance for its staff with a list of information they should check with patients, as follows: · ‘Has the patient had any COVID symptoms in the past 7 days?
· Warned we need to triage day before or appointment may be cancelled · I can confirm I have checked the following: COVID status, Medical history, personal details and informed patient of the practice procedure and mask to be worn · Has patient had COVID vaccine · Anything else patient has disclosed’.
18. Our view is that the Practice was complying with national COVID-19 guideline at the time by taking steps to conduct COVID-19 screening and risk assessment for all patients. It was appropriate to put patients with different risk levels onto different pathways to help manage and reduce the risk of COVID-19 infection. This was for the benefit of the patient’s own health and safety, as well as for the safety of the Practice staff. We consider it was reasonable for the Practice to put patients into different risk categories, according to their medical background and different needs.
19. The Practice included a question about vaccination status on its list. We consider this question to be relevant to COVID-19 risk assessment. According to information from NHS England: ‘Anyone who gets COVID-19 can become seriously ill or have long-term effects (long COVID). The COVID-19 vaccines are the best way to protect yourself and others.
Research has shown the vaccines help: · reduce your risk of getting seriously ill or dying from COVID-19 · reduce your risk of catching or spreading COVID-19 · protect against COVID-19 variants’
20. We understand that Ms O felt this question about her vaccination status was discriminating and invasive. Our view is that the Practice staff were acting in line with local and national COVID-19 guidance at the time, by conducting screening and asking for information relevant to risk assessment. Categorising patients according to COVID-19 risk levels was appropriate under the circumstances.
21. We can see that after this correspondence, the Practice cancelled Ms O’s appointment and sent a letter to ask her to find an alternative dental surgery. The Practice referred to its zero tolerance of unacceptable behaviour policy in this decision. This policy states:
‘… Aggressive behaviour, be it violent or abusive, will not be tolerated and may result in you being removed from the Practice list and, in extreme cases, the Police being contacted.
In order for the Practice to maintain good relations with their patients the Practice would like to ask all its patients to read and take note of the occasional types of behaviour that would be found unacceptable: · using bad language or swearing at practice staff · any physical violence towards any member of the Primary Health Care Team or other patients, such as pushing or shoving · verbal abuse towards the staff in any form including verbally insulting the staff · racial abuse and sexual harassment will not be tolerated within this practice · persistent or unrealistic demands that cause stress to staff will not be accepted.’
22. The General Dental Council (GDC) issued the Standards for the Dental Team in June 2014. This document sets out the standards of conduct for all dental professionals including dental nurses and dentists. This guidance 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.’
23. It appears the Practice wrote promptly to Ms O in March 2021 after the call incident. The actions it took were not due to Ms O’s unhappiness with being asked about her vaccination status but were related to alleged unacceptable behaviour during the call. In this letter it communicated its decision to end its relationship with Ms O and asked her to seek an alternative provider for dental treatment. It explained why it was doing this by referring to two previous occasions where she had displayed unacceptable behaviour.
24. It would seem the Practice did not make the decision to refuse service to Ms O lightly. The Practice has provided strong reasons for taking this course of action.
25. Ms O complained soon afterwards. The Practice then wrote again in April 2021 to respond and said the dentist was ‘happy to provide any of [her] clinical records, with [her] consent, to a future treating Dentist and enclose the NHS number in order to look for dentists in the local area providing NHS treatment.’
26. Our view is that the Practice acted in line with its own unacceptable behaviour policy and the GDC professional standards when making this decision to refuse further service to Ms O. It provided sufficient justification for its decision and communicated that promptly to the patient. It also took the appropriate steps to help Ms O get continuing dental care in the area, by explaining it would transfer her records to the new practice of her choice.
27. Overall, we consider the Practice acted in line with the relevant local and national guidance. We have therefore decided to take no further action on the complaint.