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Professionalism

  • Q
    A patient came to see me about his extensive dental problems. However, he has a strong and unpleasant body odour and I am reluctant to see him again. Can I decline to treat him?
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    14 April 2015

    Ethically you have a duty to ensure that the patient’s interests are put before your own. Certainly in the case of a dental emergency you are likely to be criticised for declining to treat a person on the grounds of their poor personal hygiene.

    There may be an underlying reason why this patient has body odour. It may be related to health issues (including mental health), genetic conditions or some learning difficulty. There is always the risk that a decision to decline treatment could be seen as discriminatory.

    The General Dental Council guidance warns registrants not to discriminate against patients on the grounds of their health. The NHS contract also prohibits discrimination on health grounds. If this is the underlying cause of the body odour, you could be exposed to a challenge both legally and by your regulatory body if you declined to provide treatment.

    However, if the smell is impacting on your ability to treat your patient in their best interests, you might wish to tackle the situation in a different way.

    You could discuss the body odour with your patient so that he has the opportunity to try to address this and seek medical support should this be necessary.

    Although it might be a somewhat difficult conversation, you could explain that the smell was sufficiently intrusive that it was distracting your concentration. Reduced concentration would naturally not be in his interests.

    You should document the discussion so that, should a subsequent challenge arise, you would be in a position to demonstrate you had taken all reasonable steps before considering declining to continue treatment.

  • Q
    A patient insists that a large asymptomatic amalgam restoration is causing medical problems and wants an extraction. Where do I stand legally on this issue?
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    22 October 2014

    Although the nature of this patient’s medical condition is not described, some patients trawl the internet seeking a remedy for what they consider to be an untreatable chronic condition.

    Historically, amalgam has been considered to be a safe restoration although there have been developments of global plans to control mercury pollution that could see amalgam being phased out over the next few years.

    When deciding how to respond, you obviously have to advise her on what is considered current best practice and to offer her treatment which would be considered to be in her best interests.

    There would clearly be a dilemma for the patient if there was no improvement whatsoever in her medical condition after you removed the tooth. Even if you did insist on this patient signing a disclaimer, it would be of little help should she decide to make a claim in negligence against you unless there was a cogent reason for you acceding to her request. You could also be asked to justify the reason for the extraction if an adverse incident occurred when extracting the tooth.

    You may wish to consider obtaining a second opinion from a Specialist in Oral Medicine or Oral Surgery, and if necessary with the patient’s permission, to liaise with her general medical practitioner before carrying out any irreversible treatment. It may also be worth discussing your concerns with this patient on the efficacy of the treatment she suggests and perhaps trying to persuade her to have the amalgam removed (which in itself can be a source of morbidity), and to restore the tooth on a temporary or semi-permanent basis to see whether it does have any effect on her underlying medical condition.

    Further information is available in Dental Protection’s Risk Management Module on Amalgam-free Practice.

  • Q
    Can I post patient information on Facebook or Twitter when I am seeking advice from colleagues on the best way to treat a patient?
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    18 September 2014

    The new guidance specifically states (para 4.2.3) ‘you must not post any information about patients on social networking or blogging sites’ such as Facebook and Twitter. 

  • Q
    Can I provide NHS root treatment and charge the patient the NHS fee and an additional private fee for the rotary files that have to be discarded?
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    07 October 2014
    It would be considered a breach of the NHS Regulations to charge a patient an additional fee to the statutory fee charged for an NHS root treatment. Any dentist charging an additional fee leaves themselves open to disciplinary action from the health body to which they are contracted and a possible referral to the General Dental Council. Both are likely to consider such action to be unethical because patients are being misled and being overcharged for the treatment. 

    Patients are entitled to all care and treatment under the NHS which is clinically necessary and which they are willing to undergo. Dentists working under the NHS must not mislead patients into the availability of treatment under the NHS nor denigrate the quality of treatment which is available.

    The use of rotary files can add a financial burden to the practice and dentists wishing to offer private endodontics as an option using rotary files must be extremely careful that patients are not misled into the quality of treatment available using normal endodontic instruments.

  • Q
    Can I withdraw from treating a patient?
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    02 June 2015

    Sometimes, for a variety of reasons, you may decide you need to withdraw from a patient’s treatment, or suggest they seek further treatment elsewhere. This has the potential to create a problem and it needs to be sensitively managed.

    Try never to lose your temper with a patient. Keep your cool and remain professional at all times, however testing it might be on occasions. If you are finding it difficult to treat the patient safely and to an acceptable standard, consider referring the patient to a suitably experienced colleague.

    You must never part company with a patient in anger. If for any reason you decide you cannot continue treating the patient, make it clear that you are withdrawing from the treatment in the patient’s best interests, not your own. Make the necessary referral arrangements, keep the patient informed and resist the temptation to insert any ‘one liners’ in the correspondence or in the clinical records, or worse still in any direct communication you have with the patient.

    Never give the impression that you are being arrogant, dismissive or petulant when deciding to end your relationship with a ‘challenging’ patient. A few ill-chosen words spoken in the heat of the moment can result in months or years of subsequent repercussions if you end up being sued or facing a complaint to the GDC or other agencies.

  • Q
    Can you tell me if I need to register with the Medicines and Healthcare Products Regulatory Agency (MHRA) if I want to provide patients with Cerec restorations involving CAD/CAM technology?
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    05 February 2016

    The MHRA is an executive agency of the Department of Health that, amongst other responsibilities, it is responsible for ensuring that medical devices in the UK meet the applicable standards of safety, quality and efficacy. The agency also regulates medicines, and blood components for transfusion

    All “custom made devices” are subject to Medical Devices Directive (MDD) regulations, and that includes any device specifically made in accordance with a duly qualified medical or dental practitioner’s written prescription with specific design characteristics and intended for the sole use of a particular patient whether NHS or private.

    The Medical Devices Directive requires that manufacturers of any dental device classed as a “custom made device”, such as a Cerec restoration, must register with the MHRA, providing them with a description of the devices concerned and the business address.

    A registration form can be downloaded from www.mhra.gov.uk

    The General Dental Council requires each registrant to be responsible for finding out about laws and regulations which affect their work premises, equipment and business.

    When producing Cerec restorations you must comply with the MDD regulations and as the prescriber of a “custom made device” it is important to ensure that the patient is made aware that they can request the statement of manufacture and to ensure that the document is made available to the patient if it is requested. Non-compliance with such an obligation is regarded as a criminal offence.

  • Q
    Could a male hygienist be vulnerable to accusations of a sexual nature from females unless there is a dental nurse or a chaperone present?
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    17 July 2014

    The simple answer is ‘yes’, although the need for another person present is not necessarily related to the chaperone issue. As a male or female DCP, you do not know the sexuality of the patient sitting in the chair, and therefore there is perhaps as much as a problem for a female hygienist or therapist as there is for a male. Thankfully allegations of a sexual nature are extremely rare, but are certainly not unknown.

    It is much more likely that a clinician could find themselves dealing with a medical emergency while treating a patient. In that situation a clinician working alone is faced with an impossible dilemma – do you provide emergency CPR or do you call for help? You certainly will not be in a position to do both, particularly if the surgery is some way from the reception area, as is often the case for hygienists and therapists.

  • Q
    Does a dental hygienist have to work with a dental nurse in the surgery at all times?
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    19 September 2014

    Standard 6.2 simply says; you must be appropriately supported when treating patients. The word ‘must’ indicates that this is an absolute requirement rather than a suggestion. But this clarity is diluted by the use of the word ‘appropriate’ which introduces an element of judgement and creates a degree of ambiguity. Although ‘appropriate support’ is not defined in the guidance, there are four very good reasons why it might be sensible for a dental hygienist to be supported by a dental nurse when treating patients:

    • Response to a medical emergency
    • Managing infection control
    • Chaperonage
    • Chair side assistance with patient care and note-taking

    Clearly there are cost implications associated with the employment of additional manpower in any business and the GDC recognises (in a personal communication about interpretation) that although the permanent support of a dental nurse might be desirable, if only to make the treatment session run more efficiently, situations will arise where the patient can be safely treated by a hygienist without chair side support but where assistance can readily be summoned in an emergency.

    Standard 6.2.2 says: You should work with another appropriately trained member of the dental team at all times when treating patients in a dental setting.

    • By adopting the use of the word ‘should’, this indicates that the duty does not apply in all circumstances. When deciding whether the duty should apply (there is reference to the circumstances in the guidance), it is necessary to consider the other standards in the guidance in order to decide whether or not the hygienist can work on the patient without a dental nurse in a specific set of circumstances. Patient safety is paramount amongst these. Standard 6.2.1 requires that registrants must not provide treatment if they feel that the circumstances make it unsafe for patients

    If the hygienist feels trained, competent and confident to treat patients in the absence of a dental nurse and that the absence of a dental nurse would not put the patient at risk, and would be able to justify the decision if challenged, then that would be acceptable. Many factors could affect this assessment – not least, the specific patient involved, the nature of the treatment being provided, and so on. It would be important to be able to show that these factors had been properly taken into account. Naturally, there would have to be another competent person available in the practice to deal with a medical emergency.

    It is for the clinician treating the patient to undertake the risk assessment and to decide what would be in the best interests of the individual patient.

    Standard 1.7 reminds us that the patient’s interests must come before those of any, colleague, business or organisation. Clearly any attempt to justify a clinical decision based on financial considerations alone would be a breach of this standard.

    • The use of the phrase ‘work with’ is not specifically defined in the guidance and as such it could reasonably be interpreted that in some situations a hygienist could ‘work with’ a dental nurse, even if the nurse was not continuously present in the surgery at all times. But such an interpretation should not be distorted to imply that a dental nurse would never need to be physically present in the treatment room/surgery.
  • Q
    How can I ensure the patients’ interests when I am working in a busy practice which offers a monthly bonus when we achieve the productivity target set by the owners?
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    18 September 2014

    This standard puts the interests of the patient as paramount when any decision is made about treatment or decisions about referrals. The GDC and the public will expect that any conflict will need to be resolved in favour of the patient.

  • Q
    How should I respond to a negative comment about me that has appeared on the NHS Choices website?
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    18 August 2015

    An adverse comment placed on a website, be it NHS Choices or the practice’s own website can be upsetting, especially as it sits in the public domain for anyone to see.

    With regard to an adverse post left on NHS Choices, the website does have the advantage of allowing the practice to post a response. Whilst there is no requirement to respond to posts on this website and indeed it would be inappropriate to respond to a complaint in this way, it is advisable that a practice responds to such posts with a simple acknowledgment of the comments made and an invitation to the patient to make contact with a named person to discuss their concerns directly. This reassures both the patient who made the post and any other patients, potential patients and any others reading it that the practice takes patient feedback seriously and is keen to learn from patient experiences and to improve the service they offer. A suggested response is:

    Dear [name],
    I am sorry to read your comments posted on the website on [date] and to learn that you are unhappy with the service you received from the practice.

    We value patient feedback and welcome the opportunity to investigate and respond to any concerns. I would invite you to contact [named person] so we can fully investigate your concerns.

    I look forward to hearing from you.
    Yours sincerely

    Many practices have protocols for routinely reviewing posts left on NHS Choices and see them as an opportunity to improve services. Some practitioners also wish to thank those who have left positive feedback.

    A similar approach could be taken to comments placed on practice owned websites which have facilities for this, and sites such as Facebook. Practitioners could also consider inviting satisfied patients to leave positive reviews. These may be helpful in themselves and can also have the effect of balancing out and indeed outweighing any negative comments.

  • Q
    How would I be supported at the GDC if I needed to whistleblow to them about something I have seen?
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    18 August 2016

    The GDC Standards guidance at 8.2.2 confirms that you should not have to prove your concern for it to be investigated and that the fact that you raised the concern should not be held against you as long as you were justified in raising the concern.

    Nevertheless, it can be extremely hard to whistleblow, even in the most obvious of circumstances. It is understandable that there may be a genuine fear and risk that you, as the whistleblower, will subsequently be scrutinised yourself, particularly if the case against the first clinician cannot be proved.

    The Public Interest Disclosure Act 1998 (PIDA) gives protection to registrants who raise genuine concerns about potentially illegal or dangerous practices in the workplace.

    PIDA applies to all employed dental professionals working within the NHS or the private sector, and to self-employed dental professionals contracted to provide NHS services.

    Concerns you raise with the GDC, or with any other professional regulatory organisation, will be protected under PIDA if the concerns are about:

    • crime
    • someone breaking a legal obligation
    • a miscarriage of justice
    • danger to health and safety or the environment;
    • or a cover-up of any of the above

    This protection applies as long as you:

    • are acting in good faith
    • honestly and reasonably believe that the information and any allegation in it are substantially true
    • are not raising concerns mainly for the purpose of personal gain, and
    • have taken steps to raise concerns first with the employing or contracting authority (unless you reasonably believe that you would be victimised if you did so, or you reasonably believe a cover-up is likely or the matter is very serious

    You do not have to prove your concerns, as long as you make them in good faith.

    The GDC prefers that, when you report concerns, you give your name. This is because it is harder to investigate concerns if people cannot ask follow-up questions. It is also easier for you to get protection under PIDA if you raise your concerns openly. If you are concerned about revealing your name when raising a concern, give your name but ask that it is not revealed more widely without your consent.

    If you are anxious that there may be related professional issues that mean that you may find yourself vulnerable to criticism during an investigation, discuss the matter with one of our dentolegal advsiers.

  • Q
    I am a hygienist in an entirely private practice and I have concerns about the health of my principal. Where can I obtain advice and personal support for the issues involved before I notify my concerns to the GDC?
    +
    18 August 2016

    These situations are always difficult for all concerned. It can seem counterintuitive to take steps that may cause your practice to close, affecting your own livelihood. Health issues are challenging for all concerned - the best advice is to talk to one of our experienced advisory team who can listen to your concerns and help you balance your professional obligations with your own personal interests. If there is another dentist in the practice it might be helpful to talk to them as they may be able to seek practical support from their Local Dental Committee and perhaps the local PASS (Practitioner Advice and Support Scheme).

    In any case, where concerns are to be raised outside the practice, you would be wise to think about the following points to ensure you are not vulnerable to criticism during any ensuing investigation:

    • What is the real background to this episode, Is there a 'back story' that has not (yet) been disclosed, and about which you may be unaware?
    • Is there anything in my relationship with this person/the practice that might support an allegation that this concern was raised to gain a competitive advantage?
    • Could a reasonable and neutral observer detect any personal motive associated with raising your concerns?
    • Is there any objective evidence available to support and justify the concerns?
  • Q
    I am an experienced sedation practitioner. What do I need to consider following the introduction of the IACSD Standards document published in April 2015?
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    17 August 2016

    It is every General Dental Council registrant’s duty to ensure they are competent and have received adequate training for the tasks they are to perform. The GDC expects registrants to follow appropriate guidelines, in this case the Report of the Intercollegiate Advisory Committee for Sedation in Dentistry (IACSD) entitled Standards for Conscious Sedation and the Provision of Dental Care 2015

    • You should take the time necessary to really understand the new standards and how you will implement them in your provision of sedation services. In particular you need to consider whether you and your sedation nurses comply with the standards in terms of you being regarded as suitable as a sedation practitioner. This may mean exploring the transitional arrangements section.
    • You and your team will need to demonstrate either ILS training or a course which trains the essential components of ILS relevant to sedation dentistry. This training needs to be relevant to the age of the patients you will be treating. If you treat children under the age of 12, compliance with the equivalent to PILS would be expected.
    • You will need to provide sedation cases on a regular basis. No minimum limit is set but you need to consider whether you complete enough cases to maintain your skills and be able to comply with the standards.
    • Your nurse does not need to hold the NEBDN certificate but will be expected to demonstrate adequate training and experience
    • You need to complete regular audits of your sedation activity to demonstrate your commitment to improving the service you offer. As yet there are no "off the peg audits" to use, and you would be expected to tailor yours to your particular style of practice.

    It may be helpful to bear in mind the Standards have already undergone several modifications without notice so please ensure that you keep updated of any changes.

    If you require further advice, please contact us

  • Q
    I am fully abled and usually consider myself level-headed but the guidance says that I must only work within my mental and physical capabilities. What does this mean?
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    19 September 2014

    Throughout a professional career there will inevitably be times of personal stress which may, for example, involve financial difficulties, relationship or family concerns (bereavement, marital breakdown) that could have an impact or bearing on day to day decision making and in the short term on mental wellbeing. Such factors may, albeit subconsciously distract a registrant from the challenges of patient care.

    Paragraph 7.2.3 stipulates ‘You must only work within your mental and physical capabilities’ and these capabilities will vary at times for us all. Hence there is now an imperative to self-assess and not to work with patients if you are particularly stressed or physically unwell.

    The guidance reminds me that I need to update and develop my professional knowledge and skills throughout my working life. Am I right in thinking that the GDC is going to change the CPD arrangements that currently apply?

    The GDC intend to increase the verifiable CPD requirements for each registrant group to be ready for the introduction of Revalidation but to do so this will require a change in the law called a Section 60 order. There is currently no indication as to when this will take place.

    Dental Protection responded to the GDC’s consultation of CPD and our response document gives further information on what is being proposed.

  • Q
    I am under pressure to make an in-house referral to our implantologist and if I do, I receive a referral fee from the owners.
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    18 September 2014

    Within this principle, standards 1.7.1 and 1.7.5 clearly explain that all referrals must be made in the best interests of the patient. Any financial transactions must be transparent and able to withstand independent scrutiny, without any hint of a decision being influenced by a financial benefit to the practice or referring dentist at the risk of harm to the patient. This is crucial where the practitioner has any concerns about the training or competence of the in-house implant dentist (for example) and is not permitted to refer out of house by the owner. Such a situation would be contrary to the best interests of the patient (see question above.)

    The same logic would apply to any in-house fee paid for a private referral to a hygienist.

  • Q
    I employ an associate who regularly leaves his patient in the surgery with the dental nurse whilst he goes outside to get fresh air or something to eat. Is this professional behaviour?
    +
    26 September 2014

    It is not uncommon for some dentists to administer local anaesthetic to a patient and then send them into the waiting room (where they may not be supervised or observed) whilst waiting for the local anaesthetic to take effect. Similarly some dentists work between two surgeries and may leave the patient in the chair either alone or with a dental nurse.

    There are a couple of potential problems which could arise as a result of this type of practice. From a clinical point of view, any patient may have an immediate or delayed reaction to the local anaesthetic and it is obviously important that the dentist is alerted and that if the patient is accompanied by a dental nurse, the nurse is able to at least start to deal with an adverse clinical scenario.

    The other issue is whether the dental nurse’s position could possibly be compromised because there was not a third party to act as a chaperone. The General Dental Council’s guidance advises dentists that a third party should normally be present when carrying out treatment.

    The main concern is why this dentist appears to be acting in this way on a reasonably regular basis. From a practice management point of view you may wish to set protocols within your practice to ensure patients are provided with a high standard of service and care and you therefore may wish to advise your associate that you would wish him to sit with the patient unless there were other acceptable reasons for leaving the surgery. You may need to take further advice if he fails to comply with your wishes.

    Should a patient develop an adverse reaction while the dentist was not present, the dentist would have to provide a cogent reason why he or she believed it was in the patient’s best interests to leave them with the dental nurse. The training and experience of the dental nurse will also have a bearing on any decision made by the dentist. If a dental nurse feels the patient could be at risk because of their own particular level of experience, it is very responsible of them to have brought this to your attention.

  • Q
    I fitted a set of dentures which the patient says are unsatisfactory, but he will not return the dentures so I can examine them.
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    14 July 2015
    I fitted a set of dentures which the patient says are hideous and demands that I refund his money. However, he will not return the dentures so I can examine them, saying they belong to him. I am happy to refund the money but would like my work returned.

    Generally speaking, the ownership of any item of dental treatment passes to the patient at the time the appliance is fitted. This is, however, not always at the same time as the treatment is completed.

    It follows that during the various stages of denture construction, the denture itself still belongs to the clinician. Once it is fitted, however, the patient then owns that denture, irrespective of whether or not a fee has been paid.

    If the patient is unhappy with the dentures and the clinician decides to refund the fees, there is no absolute right to demand the denture should be returned in lieu of the refunded fee.

    A patient who is unhappy with a denture for whatever reason would probably argue that the denture was not ‘fit for purpose’ as defined under contract law. As such the patient may ask for either a replacement item or their money back. On the basis that any replacement is unlikely to satisfy the patient (particularly if they have high expectations), the best option may be to refund the money.

    It is a simple matter to suggest to the patient that if they return the denture to the practice a full refund will be made. Most patients are happy to return the dentures as they are apparently of little use.

    However, if the patient insists they wish to keep the denture, a demand for its return could create an obstacle to the resolution of the patient's complaint. From a pragmatic perspective, whilst you may wish to ask for the dentures to be returned, if the patient remains unwilling to do so you may wish to refund the fees in any event.

  • Q
    I have a Master’s degree in implant dentistry and a special interest in endodontics. Can I include this information on the practice website and professional stationery?
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    18 August 2016

    The information used in promotional material must be legal, decent, honest and truthful. The content must not mislead patients and other members of the public in any way, or suggest any degree of pre-eminence over other members of the profession.

    You are perfectly entitled to include the qualification associated with your Master’s degree on your practice stationery, but for obvious reasons you do need to make sure it is accurate. Generally speaking, each degree that is awarded will have a shortened version that the relevant graduates are permitted to use after their name. You may like to contact the course organisers to be sure you are using the appropriate version. Any variations on that shortened version could be regarded as misleading, and therefore lead to a complaint against you.

    Web pages will be scrutinised both by patients and members of the dental profession. The General Dental Council receives a considerable number of complaints every year in relation to website content. Generally speaking, those complaints arise from poorly chosen wording that could lead the reader to think that the dentist’s name is included on one of the GDC’s Specialist Registers when in fact this is not the case. You should ensure that the website complies with the criteria set out in the GDC document Ethical Advertising Guidance.

  • Q
    I have had a CQC inspection and I am not happy with the report I have received from them. Am I able to challenge this?
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    03 February 2016

    After each inspection the Care Quality Commission (CQC) produces a report.  This is a legal obligation under Section 61 (3) of the Health and Social Care Act 2008.  The report focuses on their findings and whether a provider is meeting the regulations and is structured to reflect the five key questions that CQC asks; are the services safe, effective, caring, responsive and well-led?  The report will also set out any evidence about breaches of the regulations.

    CQC send the draft report to the provider for comment in relation to factual accuracy.  There is a deadline for providing comments or challenging the report and it is important to meet it. 

    The report is normally emailed to the registered provider (or nominated individual and the registered manager).  If those people are likely to be absent at the time this report is expected, alternative arrangements should be made for accessing the CQC communication in a timely fashion.

    It is important to understand the grounds upon which a challenge can be made and whether CQC have followed their own guidance and reported accurately, as well as acted proportionately and obtained evidence to support their statements.  It is also important to provide documentary evidence to support any challenge you wish to make.  If you feel that the report is factually incorrect and the inspector does not agree with your challenge then you are able to escalate your concerns within CQC to the national professional adviser for dentistry.

    Take care not to confuse factual inaccuracies with any errors that you have made within the practice or gaps which you have in your systems as those would normally be addressed in your action plan.

    You have one chance to affect change within the draft report particularly if incorrect, imprecise, unreasonable, unsupported or misleading statements have been made.  This enables CQC to make appropriate changes to your report prior to finalising it. The process of altering the document also assists CQC to standardise their methodology across their workforce. 

    Access further advice about CQC

  • Q
    I have not paid my GDC annual retention fee. Can I still treat patients?
    +
    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
    I understand that I must now inform the GDC immediately if I have been subject to the fitness to practise (FTP) procedures of another healthcare regulator, either in the United Kingdom or abroad. What other healthcare regulators does this mean?
    +
    19 September 2014

    The list would include any other national Dental Council or Board that acts as a professional regulator and the General Medical Council. This list would not include CQC as they do not investigate FTP issues.

  • Q
    I undertake visits as part of my job and wondered if it's necessary to carry the same emergency drugs that I keep in the surgery?
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    19 August 2014

    Would I need to do this if I was visiting a nursing home with its own supply of emergency drugs?

    When carrying out home visits for patients, you should make every effort to ensure that the patient will not be disadvantaged by having treatment carried out in an environment which is not a normal dental practice.

    Consequently, you should always carry emergency drugs and oxygen, etc. If visiting a nursing home that has its own drugs and portable oxygen, it would be reasonable to accept that situation but always to ensure the drugs are in date and adequate for emergency purposes.

  • Q
    Is it enough to ask a patient if they have seen our price list on the website or in the waiting room before starting treatment and to bill them at the end?
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    18 September 2014

    By displaying a price list in the practice and on the website, patients can gain some idea about the cost of the initial examination. Indeed it is a good idea to tell all patients if the price list has been updated and to offer them a printed copy or indicate where it can be viewed.

    The GDC says that a simple price-list must be displayed and that it must list basic items of treatment including a consultation, a single-surface filling, an extraction, radiographs (bitewing or panoral) and treatment provided by the hygienist. For items which may vary in cost, a ‘from - to’ price range can be shown.

    Patients should be encouraged to review the price list before seeing the dentist. Although they can read the prices of an x-ray or other items of treatment they will not necessarily know how many x-rays and what sort of films will be required, or indeed what other treatments might be clinically necessary. Clarification of the cost needs to be done before starting the treatment in order to avoid misunderstandings about the cost of treatment and the nature of the contract (private or NHS) under which it will be provided.

  • Q
    I've been told that every dental practice must appoint a first-aider. Is that correct, and what happens if the first-aider has time off? Is it illegal to continue working?
    +
    17 August 2016

    The Health and Safety (First Aid) Regulations 1981 require all business premises to provide adequate and appropriate equipment, facilities and personnel to enable first aid to be given to employees if they are injured or become ill at work. There is a separate requirement in any dental setting in the UK to ensure that appropriate CPR and medical emergency training has been undertaken by all registered dental professionals as well as other practice staff. The GDC recommends that registrants should undertake training about medical emergencies every year.

    In order to comply with the Regulations, the practice must first be assessed as to whether it is a low, medium or high risk environment. A dental practice would probably be assessed as medium risk, bearing in mind the training associated with the roles of the employees.

    The minimum first-aid provision on any work site is:

    • A suitably stocked first aid box
    • An appointed person to take charge of first aid arrangements

    An appointed person is someone who is chosen to:

    • Take charge when someone is injured or falls ill, including calling an ambulance if required
    • Look after the first aid equipment, e.g. re-stocking the first aid box

    However, this role is separate, and over and above, to the requirement for all the staff to participate in regular training for medical emergencies including CPR. 

    For dental practices assessed as medium risk and employing fewer than 20 people there should be a minimum of one appointed person. If there are more than 20, or the practice is assessed as hazardous, then a first-aider should be appointed.

    A first-aider is someone who has undergone a training course in administering first aid at work and holds a current first aid at work certificate, and will need to participate in regular training for medical emergencies including CPR.

    These requirements in terms of risk and numbers of employees are suggestions only and not definitive legal requirements. It would be desirable in any event for at least one practice member to have first-aider training, but the qualified first-aider does not need to be on the premises at all times and there is no recommendation to have one for a business with fewer than 20 employees.

    Further details are on the HSE website 
  • Q
    My colleague says there is no requirement to undertake CPD every year and is prepared to do it all within the last six months of her five-year cycle. Can you reassure me on this subject?
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    18 November 2014

    The General Dental Council’s requirement is that registrants undertake a set amount of CPD within a five-year period and therefore if that registrant wishes to undertake all of that CPD in the last six months, then he or she is perfectly entitled to do this. That is not to say, however, that such an approach would be wise as this is an awful lot of CPD in a very short period of time. Simply trying to find courses that cover the core subjects within this brief window of opportunity might well be difficult. 

    Undertaking CPD in this way is not within the spirit of the GDC’s advice. Some patients might be alarmed if they knew the treating clinician held this view and was likely to be somewhat out of date at a given point in time.

    The role of the hygienist has changed significantly over the last few years and is likely to do so again. Your hygienist colleague is likely to be a long way behind the times and the provision of her treatment might well suffer accordingly.

  • Q
    My name has been removed from the register for non-payment of my annual retention fee. I've requested a restoration form; is it okay to continue working?
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    28 October 2014

    I've received a letter from the GDC advising that my name has been removed from the register for non-payment of my annual retention fee. I have been working without realising that my registration had lapsed and I have now requested a restoration form – is it okay to continue working in the meantime?

    It is imperative that until your name has been restored to the Dentists Register you do not carry out either the practise of dentistry or the business of dentistry. 

    In addition to this, you need to be aware that while your name is not included in the Dentists Register, you cannot be indemnified. However, should a claim arise in relation to the advice and treatment you provided during the time when you were practising without being registered, you may apply to Dental Protection for assistance (needing approval from the Board of Directors).

    In the meantime you should ensure you have made the appropriate arrangements for the care of your patients. It is also important that you take all steps to have your name restored to the Dentists Register as soon as possible. This is not an automatic process and the application form requires you to enclose a letter setting out the reason why you were working as a dentist during the time you were not registered with the GDC. You should contact Dental Protection for assistance in relation to this.

    Being unaware of lapsed registration is no excuse in the eyes of the GDC and the Law. The longer a dentist has been practising unregistered, the less likely the GDC is to take a favourable view. Past experience has shown that a dentist who has had previous periods of non-registration is more likely to experience difficulties in having their name restored to the Register.

  • Q
    Standard 9.1.2 says that I must not make disparaging remarks about another member of the dental team. What is meant by this?
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    19 September 2014

    If you are disparaging about someone or something, or make disparaging comments about them, you are effectively undermining their credibility by expressing a poor opinion about them.

    This Standards guidance is designed to raise the awareness of professionalism in the dental team and any remark designed to undermine the patient’s confidence in another member of the dental team (in your practice or elsewhere) will be seen as reducing the standing of the profession in the patient’s eyes, and liable to criticism.

    This standard links with 1.3.1 (acting with honesty and integrity) and 1.3.2 (not bringing the profession into disrepute)

    A disparaging remark might refer to an individual’s demeanor or attitude at work or it might refer to the quality of dental care the patient has received prior to seeing you. In these circumstances you need to be mindful of 1.7.1 (put patient’s interests first at all times).

    When describing a patient’s current condition, particularly at a new patient consultation, whether you are a dentist or DCP, you must ensure that any remarks explaining the condition of their dental tissues are neutral, accurate, factual and dispassionate.

    It would be helpful to document in the records, or in a letter to the patient enclosing a treatment plan, a concise summary of the current condition of the mouth in layman’s language for the patient. In particular, it is often helpful to note the questions the patient might have asked you, and an indication of your response.

  • Q
    We are making a Facebook page for the practice. Are there any specific dos and don’ts that I need to be aware of?
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    27 August 2014

    Given the popularity of Facebook and its usefulness in the promotion of business, many dentists have been somewhat cautious in promoting themselves in this way, perhaps through fear of breaching the General Dental Council’s guidance.

    In reality, however, a Facebook page is no different to any web-based advertisement other than the fact that access to the page can be restricted. The contents of the Facebook page must conform to the GDC’s guidance and that of the Advertising Standards Authority; they must be legal, decent, honest and truthful. The contents of the page should not make any statements that cannot be substantiated, or would be regarded as misleading.

    It is quite possible to indicate to any patient who wishes to subscribe to the friends list that their name will be displayed on the website and will be visible to other members of the public. Their consent to this disclosure can then be obtained.

    For obvious reasons no other personal information should be displayed and certainly no indication of any treatment that has been provided for a patient unless they have provided their specific written consent.

    If a practice is considering whether a Facebook page is appropriate, it may wish to give thought to whether it will be possible for a ‘patient’ to use the Facebook page to post adverse comments that can be seen by other friends.

    Some disgruntled patients are seeking to use the internet as a forum to post their complaints. Thus if a practice is seeking positive reviews in this way, it may also receive negative comments. The practice may wish to consider how easy it would be to remove such comments. 

    With a little care, therefore, the use of a Facebook page to promote the practice should not necessarily cause the GDC any undue concern.

  • Q
    What is the best way to deal with a situation in which you believe a colleague’s work is below standard?
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    19 September 2014

    Deciding what to do when you have concerns about a colleague’s behaviour is always uncomfortable. Your duty to raise any concerns you have, however, overrides any personal and professional loyalty.

    The guidance makes it clear that the safety of patients must come first at all times. This means that any dental professional who has concerns that a colleague may not be fit to practise must take prompt and appropriate action. You should explain your concerns clearly and honestly to an appropriate person from your contracting body or employer.

    Salaried employee
    If you are working as an employed dental professional, any specific local procedures should be followed (your contract may well define them). You should expect that your employer will promote and support a culture of openness and that you should be made aware of the local processes to follow. Your employer must support you if you need to raise a concern and take your concerns seriously, creating a culture where you should not fear reprisal.

    In such circumstances it would also be prudent to seek advice from Dental Protection about how to raise your concerns, to ensure that your own position is protected. Make sure that you keep a record of your concern and the steps you have taken to try to remedy the situation.

    Self-employed
    For those who are self-employed, if the dental professional is not appropriately receptive to constructive criticism or is not able to improve performance to a level that removes any risk to patients, paragraph 8.2.5 of the GDC’s guidance makes it clear that you must act on your concerns promptly.

    If local procedures have not resolved the problems, or the person to whom you would normally report your concerns is part of the reason you are concerned, you should refer your concern to the GDC.

    If you need to contact the GDC for this reason, it would be wise to contact Dental Protection and speak to a dento-legal adviser about how to take the matter further. To facilitate that conversation it would be helpful to have available a record of your concerns and the steps you have already taken to try to remedy matters.

    Although the decision to raise concerns is entirely personal and is not one that any other clinician can make for you, it is best to speak with one of our dento-legal advisers and ask for their guidance. Every case will be different and there is no one answer that will fit every occasion. If there are related professional issues that you think could leave you vulnerable to criticism during an investigation, Dental Protection will know how best to assist and support you. Doing nothing, however, in a situation where you have concerns about patient safety is not an option. Failing to act in such circumstances may put your own registration at risk.

    In summary, if in doubt, always raise a concern. Try to raise concerns locally first. If you have already done that, and no action has been taken, you must act on your concerns promptly. You should not be asked to prove your concerns although you might need to explain your decision.

  • Q
    What should I do if a patient asks to record their consultation with me?
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    03 February 2016

    It is becoming common for patients to ask to record discussions about their dental treatment using a mobile phone. Dental Protection is also aware of cases where the patient has made a covert recording without telling the dentist. In a recent case in the USA, a clinician was sued after a patient’s mobile phone recorded him making unprofessional comments about the patient whilst he was under anaesthesia.

    It is common courtesy that somebody wishing to make a recording should ask permission. If you feel uncomfortable at the prospect then you should express that discomfort and tell the patient that you would prefer your conversation not to be recorded.

    If you would prefer not to be recorded, but the patient is insistent, it would be inadvisable for you to refuse to proceed with a consultation simply because the patient wishes to record it. A patient may have their own reasons for wishing to record a consultation and it would be worth exploring this further with them. Reasons could relate to the complexity of the consultation, the significance of the diagnosis, the patient’s memory, or the patient’s potential dissatisfaction. A little careful questioning could be helpful in discovering the patient’s thought process. Often patients simply wish to record consultations to ensure that they do not forget important information and/or because they want to share it with a friend or relative. There may be other ways of communicating this information (for example, by writing down the relevant information, or recording a summary of the relevant points at the end).

    If your consultation is recorded, it would be sensible to ask for a copy so that it can be placed in the patient’s notes to form a permanent record. Medical records already incorporate a variety of formats, including text messages and emails to and from patients, and recordings could become part of this mix.

    Secret recordings

    Technology makes it increasingly easy for patients to secretly record conversations. Most mobile phones and smartphones have record functions which can easily be activated without the dentist or dental nurse realising. Even hand-held games consoles can record conversations.

    A patient does not require your permission to record a consultation. The content of the recording is confidential to the patient, not the dentist so the patient can do what they wish with it. This could include disclosing it to third parties, or even posting the recording on the internet. So what does this mean for dentists?

    The content of the recording is confidential to the patient, not the dentist so the patient can do what they wish with it.

    Protection

    Smartphone use in the dental surgery should not affect the way you deliver treatment. Dentists and hygienists should always behave in a responsible and professional manner when working with a patient and consequently, any recording will provide concrete evidence of that. Such a record would inevitably be more complete than a traditional note and Dental Protection’s experience is that detailed record keeping is an invaluable tool in protecting the dental team against unsubstantiated complaints or legal action.

    A recording would potentially provide even more detail to demonstrate the professional management of your patients. There should be no reason therefore why you should have anything to fear from such a recording.

    Whilst you may understandably feel that being recorded may impair the professional relationship, this may well simply be a matter of adapting to current cultural and societal norms where it is becoming commonplace for the public to record and publish on the internet all sorts of pictures, recordings, etc, relating to their private lives.

    The future?

    Technological advances will undoubtedly bring further changes and it may well be that in 20 years’ time, recording of consultations, with copies being held by both doctor and patient, will be commonplace.

  • Q
    Where can I find out about creating a personal development plan (PDP) that will improve my practice?
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    19 September 2014

    The GP’s Guide to Personal Development by Amar Rughani (Radcliffe Publishing, 2001) is available from Amazon. This text offers a simple guide to the process of formulating a PDP, with exercises and advice on how to write and develop a PDP. It shows the reader how to demonstrate that they have engaged in appropriate educational activity, essential for revalidation. Some postgraduate deaneries are also able to provide advice about formulating a PDP.

    The Royal College of Surgeons also has guidance and templates on PDPs as well as other organisations such as the former Deaneries.