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Ask Dental Protection

We receive hundreds of enquires every week, and we publish some of the frequently asked questions on this page. These may not always provide the complete answer in your own situation, and members are invited to contact us for specific advice.
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  • Q
    Can I accept a request for work experience from a school pupil who is interested in a career in dentistry?
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    24 March 2015

    It is not unusual to receive a request for work experience from a school pupil. Observing in a dental practice can enhance the pupil’s understanding of dentistry and can assist them in deciding whether or not dentistry is the career for them. Not only that, but some dental schools prefer applicants to have undertaken some type of relevant work experience.

    So what does a practice owner have to consider before agreeing to such a request?

    Health and safety

    Under health and safety law, a work experience student is considered to be your employee. You treat them no differently to other young people you employ. A young person is defined as anyone under the age of 18.

    As an employer you will already have carried out a risk assessment. Under Health and Safety law you must assess the risks to young people under the age of 18 before they start work experience and tell them what the risks are. Young workers may be particularly at risk from work place hazards because of their lack of awareness of existing potential risks, immaturity or inexperience.

    Health and Safety legislation addresses the protection of young persons at work in detail, and you should consider your obligations in this regard. The Health and Safety Executive guide, Young people and work experience: A brief guide to health and safety for employers, contains helpful information about these obligations.

    Assess the risk

    Before the young person can start work experience, the practice owner must carry out a risk assessment to identify any specific risks which they might face. The assessment must take into account the following:

    • The inexperience and immaturity of young persons.
    • Their lack of awareness of risks to their health and safety.
    • The fitting and layout of the practice and surgery.
    • The nature, degree and duration of any exposure to biological, chemical or physical agents.
    • The form, range, use and handling of work equipment.
    • The way in which processes and activities are organised.
    • Any health and safety training given.

    You should keep a record of the main findings of the risk assessment. This is good practice and it is a legal requirement if you have five or more employees (including young people on work experience). The risk assessment and any control measures taken should be shared with the parents of the work experience student. See the Health and Safety Executive's FAQs for more information.

    Once the young person is ready to commence their work experience it is important that you check that they have undergone and understood training which covers, for example:

    • The hazards and risks in the work place.
    • The control measures put in place to protect their health and safety.
    • A basic introduction to Health and Safety, for example, first aid and fire and evacuation procedures.

    In addition to this you may wish to check that your employer’s liability insurance and public liability insurance cover includes work experience students.

    Confidentiality

    Confidentiality is crucial and a clear induction is of paramount importance, as is the need to check the young person understanding of the subject. Confidentiality extends not only to the patient’s treatment, but also to the fact that someone is a patient of the practice. This might include some of the young person’s peers or teachers!

    Issues of confidentiality also extend to access to the dental records and to the appointment book and you would need to ensure that the student is fully aware of your confidentiality protocols.

    It would certainly be appropriate to check with each individual patient that they are happy to have a work experience student observing their dental treatment, and to emphasise that the patient can change their mind at any time.

    The Working Time Regulations 1998 apply to work experience students and you may wish to consult with the school concerning the hours which they wish the work experience student to attend your dental practice.

    Can I have a go?

    The days of work experience students mixing materials and assisting at the chairside are long gone! It is appropriate to manage the work experience student’s expectations so that they are fully aware of that their experience, whilst being very worthwhile, will be limited to observing.

  • Q
    I have elderly patients who come to me privately but who are eligible to receive free NHS prescriptions. Can I provide them with an NHS prescription?
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    17 March 2015
    An NHS prescription can only be written for a patient who is receiving an NHS course of treatment or treatment of an urgent condition under the NHS. If any of your patients are being treated on a private basis, and they require a prescription-only medicine, this must be prescribed privately, or dispensed at the practice.

     
    It is important when dispensing medication that the appropriate records are kept of what is given and the dosage, etc.

    Dental Protection has produced a risk management module, Drugs and Prescribing, which provides advice on prescribing, and is available to members from Prism, our e-learning learning library.

  • Q
    Do I need to take a new medical history every time I examine a patient?
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    10 March 2015

    The current guidance from the General Dental Council and from the Faculty of General Dental Practice of the Royal College of Surgeons of England is that a patient’s medical history should be checked and updated at every treatment visit.

    In practical terms it is good policy to take a full medical history every time a patient is examined and the use of a medical history form provides an excellent way of recording this information.

    It is important, however, that the patient is not left to complete the medical history form; whoever is carrying out the examination should go through all the questions with the patient to ensure they fully understand them or indeed can actually read.

    Such questioning should obviously be carried out in a manner that ensures patient confidentiality. If a practice wishes to become paperless, the medical history form can be scanned onto the computer. The hard copies should then be be shredded or incinerated.

    When a patient attends for an appointment as part of a course of treatment, it is always worth checking to ensure they have not started on any medication or have suffered any relevant illnesses since their last visit. Some practices encourage patients to volunteer such information by placing a sign in the waiting room requesting patients to inform their dentist of these types of changes.

    Taking a full medical history at each examination can be onerous, but it is certainly worthwhile both to protect the patient and the dentist’s own position. Having a written record of the patient’s medical history, signed by the patient, often affords protection to the dentist – particularly if an allegation is made that he or she had not taken the patient’s medical history into consideration when carrying out treatment, which subsequently resulted in the patient being avoidably harmed.

  • Q
    Why should I explain my infection control procedures to patients?
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    10 February 2015

    Patients are likely to be a lot more aware of infection control issues following the recent publicity surrounding a look back exercise involving 20,000 dental patients in the UK. If the cost of their dental care increases, patients are likely to be more critical in their choice of dental care provider. Choice and quality are two of the most important components of consumerism.

    Patients who have come to appreciate the steps that are being taken by a practice to ensure their safety will be far less likely to move to another practice where it is not immediately obvious that the same standards of infection control apply.

    Many of those patients who move from one practice to another never tell the original practice why they have left. They often have unspoken concerns and dissatisfaction and these can include doubts over infection control and the quality of care generally. A visible infection control policy and a willingness to explain to patients what is being done for their safety, and why, can address concerns and reinforce the patient’s decision to stay with the practice.

    A deliberately high-profile and visible commitment to infection control can also help to justify a patient’s perception of value, especially if they have just agreed to pay privately for their dental care.

    There are many different ways to get the point across – a poster in the waiting room or a page on your website can outline the basic principles. You can also reinforce the message every time you open bagged instruments from the steriliser or a new set of instruments by mentioning that they have just been sterilised. Disposable, single use items can also be pointed out to patients instead.

    It is paradoxical that patients may be questioning standards of cross infection control in dentistry at a time when they are generally higher and safer than ever before.

    Topics of inadequate infection control make good stories and help sell newspapers. Take the initiative and get your own story out there first.

    With the help of the rest of the dental team, share the evidence of your own infection control measures with patients before they even have to ask. Whether it is new gloves or the large quantity of disposable item that are used – each of these topics can be turned to a marketing advantage. 
  • Q
    I am a hygienist with a Diploma in Dental Hygiene and want to print some business cards. Can you advise me please?
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    10 February 2015

    The General Dental Council’s advice indicates that however a clinician is being promoted, either inside or outside of the practice, the wording of that promotional material must be legal, decent, honest and truthful. Business cards would be regarded as promotional material and therefore must comply.

    Assuming that your Diploma in Dental Hygiene has been registered with the GDC, you are entitled to use the shortened version of this diploma on your business cards. Similarly, if you have any additional advanced qualifications (BA, BSc, etc.), these may be included too. However, you need to be careful not to potentially mislead patients by including details of qualifications that are unrelated to dentistry.

    It would also be advisable to indicate that you are a dental hygienist as part of your job title, simply to avoid any misunderstanding.

  • Q
    The practice owner has told me to economise the use of local anaesthetic by using it only in those cases where the patient will be in extreme pain. How can I decide what I should do?
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    13 January 2015

    Most patients have an expectation that their dentistry will either be pain-free or that any pain will be managed effectively. Therefore, the provision of a local anaesthetic for a given procedure will initially involve a discussion with the patient about the nature of the procedure being contemplated and what they may expect.

    This is an issue of consent. As a clinician, you should not impose your views and provide treatment without local anaesthetic simply because you have considered the matter (as requested by the practice owner) and concluded that the procedure will not be painful and does not require local anaesthetic. It is incumbent upon clinicians to respect patient autonomy and an individual’s right to make decisions about their treatment and this would extend to a decision about local anaesthetic.

    In any case, the patient’s medical history initially needs to be checked and updated before considering the type of local anaesthetic to be administered.

    Our advice booklet on consent is available here 
  • Q
    I work for a trust and one of my patients died unexpectedly. Can I assume the barrister for the Trust will represent me at the inquest?
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    08 January 2015
    The barrister will have been instructed by the Trust's solicitors to protect the Trust's own position and its interests. It may be that questions will be asked at the coroner's inquest about the role of the theatre or nursing staff who were responsible for the deceased's care. The barrister will normally be instructed to deal purely with the reputation of the Trust and other members of staff and may not be there to protect your own position particularly if there is a conflict between you and the Trust about the events leading up to the death of the patient.

    In cases like this, Dental Protection’s solicitors have instructed an experienced barrister to work with our solicitors, the dento-legal adviser and the consultant to prepare for the Inquest. The barrister would normally attend the Inquest and look after the interests of the consultant oral and maxillofacial surgeon during the hearing, especially where the consultant’s care of the patient is likely to be subject to detailed investigation by the coroner and/or the deceased’s family.

  • Q
    I have not paid my GDC annual retention fee. Can I still treat patients?
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    05 January 2015

    The Dentists Act requires that the ARF is paid in full on or before 31 December (for dentists) and there are no exceptions. Continuing to practise or to have an interest in the ownership of a practice while unregistered would be the illegal practise of dentistry and/or unlawful involvement in the business of dentistry and could in both respects result in a criminal prosecution and invalidate any professional indemnity held by the dentist in question.

    You will need to stop working and apply to the GDC for the restoration of your original registration . This involves providing a character reference and a health declaration. It is likely that processing an application for restoration will take some time, and you should make appropriate arrangements for the care of your patients in the meantime.

  • Q
    My practice principal and I belong to a different defence organisations. He told me I need to join his organisation because my dental nurse will not have access to indemnity when I'm supervising her. Is that true?
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    02 December 2014

    No, it certainly isn't true. A dental member who is working in general or specialist dental practice could be held to be vicariously liable for the negligent acts and omissions of a dental nurse working under their direction and supervision, even if they are not the actual employer of the dental nurse.

    What makes our approach different from that of other defence organisations is that we offer several categories of membership in which an employer/practice owner can provide access to indemnity for 10 full-time equivalent registered dental nurses or dental technicians employed by them in respect of negligence claims, whether or not they are working with them or directing/supervising them at the time of an adverse incident. We believe this flexible approach is fairer to practice owners, associates and dental nurses alike.

  • Q
    Are there any limitations in the role of a treatment co-ordinator if the individual is not registered with the General Dental Council?
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    01 December 2014

    Some practitioners use the services of a treatment co-ordinator to provide the patient with information about their treatment and to answer their questions, although it would still be for the dentist and treating clinician to obtain consent rather than another member of the team. For obvious reasons, the treatment co-ordinator would not be in a position to provide any clinical advice.

    The role of the co-ordinator can sometimes be helpful in showing patients information about various treatment options which have already been discussed with the dentist. A treatment co-ordinator usually has more time to spend with the patient and some patients are more inclined to ask questions of a treatment co-ordinator than they are to ask questions of the dentist. However, there may be other patients who do not want to discuss any aspects of their possible treatment with anyone other than the dentist.

    If a patient brings a civil claim in negligence, a lack of detailed contemporaneous records of the consent process may mean a claim that could otherwise be defended has to be settled.

    Any practitioner planning to use a treatment co-ordinator will need to work closely with them to ensure there is no potential for miscommunication or misunderstanding and that everyone is aware that the ultimate responsibility for taking the patient appropriately through the consent process lies with the treating practitioner.

    Find out about the benefits of DPL Xtra, our practice rewards programme that takes a team approach to dentistry and offers risk management education for all team members. Practices subscribing to DPL Xtra receive a range of free and discounted risk management material from Dental Protection and leading providers such as Croner and schülke. Since the purpose is to lower your risk, team members in a practice which subscribes to DPL Xtra will receive free or discounted individual membership.