22 November 2011

Q. I am an associate in a practice and my dental nurse is frequently off sick. The practice owner is reluctant to employ an agency nurse on such occasions and so I must treat patients on my own. How should I deal with this?

To a large extent the problems you have are a contractual matter between you and the practice and therefore very much depend upon the associate agreement that you were provided with when you started work as an associate in the practice. Assuming this is a standard associate agreement then I think that you will find that there is a clause within that agreement that indicates that the practice is required to provide you with the services of a dental nurse on a day to day basis. The only time when this would not be the case is when exceptional circumstances exist (illness, etc).

The General Dental Council’s guidance as set out in Principles of Dental Team Working,quite clearly indicates that all clinicians should work alongside another team member (preferably a registered dental nurse) at all times. This is not necessarily a matter of chaperonage, but in fact relates to the provision of medical emergency care to patients.

If one of your patients was taken ill during a treatment session and perhaps lost consciousness, you might well find yourself facing the dilemma of either looking after the patient or going for help. You could not do both if you were working alone. If a dental nurse was working with you, this would not be the case.

It follows then that if such a situation was to arise you might well have to explain perhaps to the coroner, the courts or the General Dental Council, why a dental nurse was not present with you in the surgery, in accordance with GDC guidance. This would not be easy, particularly if it could be shown that the patient had suffered harm through lack of emergency care.

You should discuss your concerns with the practice owner and practice manager and ask them what action they feel they can take to be of assistance to you. I strongly suspect that your associate agreement contains a contractual obligation (to say nothing of an ethical obligation) on behalf of the practice to try and ensure a good working environment.

If the problem continues or shows no signs of resolving, you may have to consider carefully your position at the practice.

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