On-call Services

Q.Our practice currently carries out its own on-call during evenings, weekends, bank holidays etc. We are mainly a private practice with around 4500 private patients. Each dentist is on call for their own patients and the dentists cover for each other when they are on holiday etc. We see around 5 patients each week out of hours.

The dentist usually attend the practice and ask the patient to bring a chaperon and in most cases the patients are long standing and well known to the dentist and the practice. However we feel the current situation does have some holes, such as the dentists cleaning up after themselves! 

We are thinking about having one practice mobile phone which a nurse would answer then triage the calls – make the arrangements for the patient to attend the practice by liaising with their dentist – attend the practice to set up, assist then clean down.

I would love to hear from any practices that have a similar system in place to see how they organize it and in particular pay the nurse.

We wish to remaining doing our own on call and the dentists insist on seeing their own patients wherever possible.

A.We have 4 dentists here and approx. 8000 pts – each dentist is on call for a week (on a 4 week rota); we have a pager that the dentist takes home with them and emergency pts phone them. They either offer advice over the phone or come out to the practice to see the pt. No nurses are involved, the dentist works unassisted and tidies up, as best they can afterwards! We probably only see a handful each month, the dentists are happy to see their colleagues pts. We charge for the call-out (smaller amount to Denplan pts and not for children). It has worked here for over 30 years.

It helps if the dentists devise the scheme themselves and are happy with it!

A.We have run a triage system for many years, very often the patient's problem can wait for the next surgery rather than necessitate an emergency call out. If you're seeing 5 patients a week (which seems a lot), is this all at weekends? We keep at least one emergency slot free each day so anyone phoning after hours can be offered an appointment the next morning.

We charge £50 for a call out, plus the cost of treatment, and this is stated very clearly on the answerphone message.

If a call out is necessary then the triage nurse co-ordinates the dentist and patient and then nurses for the appointment.

When I worked in a veterinary practice, we only ever had one vet on call out of hours, at the moment it sounds as though all your dentists are on call unless they're on holiday. Perhaps it might be simpler to have a rota for the dentists as well as the nurses?

You could even have an "emergency clinic" at a set time on a Saturday and/or a Sunday, so any emergencies can all be seen together, which saves on travel etc.

A.This is something we are just setting up now for our private patients.

It is slightly different for us as we are Ortho with an NHS contract, and most of our private patients are adults, with not much cause for emergencies.

We have one mobile phone which will be shared around all the Orthodontists (6 in total), who will be on call with a nurse for a month at a time or on a weekly rota (yet to be decided)

It is also yet to be decided who answers the calls!  Our nurses will be paid for the call on a rota a fixed rate with an additional hourly rate including travel if called in.

A.I can understand the worry if a patient doesn't bring a chaperone, but as long as you advise them to, I can't see we can do anymore really. 

With regards to the dentist having to clear up, we have run an on call service for the last 25+ years, and none of our dentists are too precious to clean up after themselves!!!! I would be very careful about asking nurses to triage as they are then responsible for anything that is told to a patient, and if anything is advised incorrectly or anything is missed the nurse is liable not the dentist, as per our new indemnity rules. It's not a question of the pay it's more the legal side I would be very concerned about. If you were to pursue it the nurse would need pay not only for the time at the surgery but also the time they have to have the phone for calls, and extra as it will be out of contracted hours work. You should have something on their contracts about rates of pay for working outside their normal hours.  

I think you also have to think about if a nurse is down to do the on-call and can't do it, this would mean trying to get someone else to cover or being in the same boat you are now.

I know my email seems negative, but to me just because a dentist doesn't want to clean up after themselves you are opening a large can of worms with potential serious implications for the nurse, you would have to be 100% sure the nurse understand the legal obligation and the potential implications to herself if a patient wasn't happy with something they had said.

May 2015