The GDC standards for the dental profession were introduced on the 30th September 2013. A set of standards and guidelines was issued to every GDC registrant.

The standards are there to offer guidance for members of the dental profession on conduct, performance and ethics.

They also inform patients and the public about what they can expect from the members of the profession in relation to their treatment.

One of the key purposes of the standards is to provide clear outcomes against which ‘fitness to practice’ cases can be judged, and for which the profession can be held accountable.

It should be noted that although issued to the dental profession, the standards are there to protect the patient!

The standards can be accessed on the GDC website (www.gdc-uk.org) by both patients and the members of the dental profession.

Regulation

The GDC is one of 11 health and social care regulatory bodies in the UK (website details for the others can be found at the end of the article). It is responsible for:

• Registering qualifications for the dental profession;
• Setting and enforcing standards of dental practice and conduct;
• Protecting the public from illegal practice;
• Assuring the quality of dental education;
• Ensuring professionals keep their knowledge and skills up-to-date;
• Investigating and acting upon complaints received about fitness to practice;
• Helping patients and the dental profession to resolve complaints about private dentistry through the dental complaints service.

All regulatory bodies are accountable to the Professional Standards Authority (PSA), which is directly answerable to the Privy Council. Since the release of the Francis reports (www.midstaffspublicinquiry.com ), the PSA has actively enforced changes to regulation of people working with patients and vulnerable people, in order to protect them from malpractice, mistreatment and victimisation.

This has resulted in many of the regulators adopting changes to their standards, with the GDC being at the forefront of this process.

Methodology

The GDC formed a Task and Finish group from Council members comprising of dental professionals, lay members and the executive team to review, and if necessary re-structure and re-format, the existing guidance that had been in place for a number of years.

The group were tasked with establishing whether the standards:

• were fit for purpose; 
• were relevant to the profession;
• were up-to-date; 
• provided protection for the patient. 

The group were determined that any alterations must include and be focused on patient expectations as to how dental professionals could and should meet their oral and personal needs.

Each standard is broken down into four categories:

• Principles – the core ethical principles of practice;
• Patient Expectations – what patients can expect from the dental team;
• Standards – what registrants must do to ensure patient expectations are met;
• Guidance – how registrants must meet the standards.

All categories are focused on objectives that are clear, transparent and specific. They are to help patients to understand their rights and to help dental professionals to understand their responsibilities.

The outcome of the review was the development of nine principles:

1. Put patients’ interests first.

2. Communicate effectively with patients.

3. Obtain valid consent.

4. Maintain and protect patients’ information.

5. Have a clear and effective complaints procedure.

6. Work with colleagues in a way that is in patients’ best interests.

7. Maintain, develop and work within your professional knowledge and skills.

8. Raise concerns if patients are at risk.

9. Make sure your personal behaviour maintains patients’ confidence in you and the dental profession.

These principles are fundamental to your day-to-day working practices within a dental environment. The guidance emphasises must and should to help differentiate between what is compulsory and what you are expected to do to the best of your ability given the circumstances.

Due to the complexity of certain subjects it was felt that additional guidance giving more detailed information on the following topics would clarify areas liable to misconception and misinterpretation:

• Advertising;
• Prescribing medicines;
• Indemnity;
• Social Media;
• Commissioning and manufacturing of dental appliances;
• Child protection and vulnerable adults;
• Reporting criminal proceedings;
• Scope of practice.

Information on all of the above can be downloaded from the GDC website, along with a presentation, including case studies, on the GDC’s standards for the dental team. The standards can also be downloaded in a poster format which is to be displayed in the waiting area for patients to access. This shows good practice in the working environment (www.gdc.org.uk).

Training

It would be very easy to glance through the Standards, feel that you are working within their boundaries, and then leave them on a shelf and not look at them again. But that would not be acting in a very professional manner, nor providing good practice to your patients and peers.

A useful way to become familiar with the standards, and also to obtain relevant Continuing Professional Development (CPD), is to hold training sessions within your working environment. These can be both informative and can provide a good team-building exercise.

Below, you will find a range of scenarios which could be used or adapted to test and improve your knowledge base. For each scenario you need to ask these specific questions:

• Which standard does this area relate to?
• What do the guidance notes specify about the related problems?
• How should the issue/problem be dealt with?
• Who should be involved in helping resolve the problem/situation?
• What could/would happen if it is not resolved?

Scenarios

1. A member of staff frequently returns from their lunch break smelling of alcohol. Although their work is not affected, they can sometimes be quite offhand with other members of staff.

2. A patient has issued a complaint regarding their treatment. They requested that a cavity be filled with a white filling material, but the dentist has inserted an amalgam filling.

3. A qualified dental nurse at a partner practice has informed you that she is carrying out teeth-bleaching for some private patients.

4. A new dental nurse who has just been employed by your practice has confided in you that although she has been qualified for three years, she has not carried out any continuing professional development.

5. Following a tiring day at work, you get home and find that a colleague has posted a comment on Twitter which states that you have been rude to a patient that day, and that you have not cleared the surgery adequately at the end of the session.

Workshop Template (example)

Name...........................................   Role.................................................

A member of staff frequently returns from their lunch break smelling of alcohol. Although their work is not affected, they can sometimes be quite offhand with other members of staff.

Which standard does this area relate to?

What do the guidance notes specify about the related problems?

How should the issue/problem be dealt with?

Who should be involved in helping resolve the problem/situation?

What could/would happen if it is not resolved?

Date:....................................................

Conclusion

If you have found these scenarios helpful, why not try and develop some of your own that relate to treatments carried out in your working environment and to different members of staff. If you add aims and objectives, and devise a small feedback form for your colleagues to complete, both they and you can claim verifiable CPD.

An example is:

Aim

To update members of staff on the new GDC standards and enable them to familiarise themselves with the standards, in order to ensure that everyone understands and implements good practice.

Objectives

1. To set a series of scenarios for staff to work with.

2. To discuss and interpret areas of concern or misunderstanding.

3. To reinforce the importance of patient protection.

Feedback

Did you find the scenario relevant to your working environment?

Do you feel that you are now more familiar with the standards?

Has this helped you think more about the patient journey?

Will this session change any of your working practices?

If yes, please give an example:

Remember that training should be fun as well as educational, so be open with discussion, talk about the different roles and expectations, and enjoy the learning!

The other health and social care regulatory bodies are:

General Medical Council (GMC) – www.gmc-uk.org

Nursing and Midwifery Council (NMC) – www.nmc-uk.org

Health and Care Professionals Council (HCPC) – www.hcpc-uk.org

General Optical Council (GOC) – www.optical.org

General Pharmaceutical Council (GPhC) – www.pharmacyregulation.org

General Osteopathic Council (GOsC) – www.osteopathy.org.uk

Including:

Care Council Wales (CCW) – www.ccwales.org.uk

Northern Ireland Social Care Council (NISCC) – www.niscc.info

Author: Janet Goodwin BA(Hons), RDN, LCGI

The Care Quality Commission (CQC) is an independent body that provides information and regulates the quality and availability of health and social care services in England.

The CQC regulates not only dentists but also hospitals, GPs, ambulances, mental health services, care homes and care in people’s own homes, and services for people restricted under the Mental Health Act.

The aim of the CQC is to ensure that patients receive better care and that standards of quality and safety are met. They also encourage ongoing improvements.

Since December 2014, the CQC has been testing a new approach to the inspection of dental practices, using specially trained inspectors accompanied by dental advisors. The reports focus on whether services provided are safe, effective, caring, responsive and well-led. The CQC have announced that they will be rating services and they will highlight where care is outstanding, good, in need of improvement, or inadequate. This rating system does not apply to dental care services in 2015/16, as they are only inspecting 10 per cent of England’s 10,000 dental practices. The focus will be on those that are a ‘cause of concern’, as dental practices present a lower risk to patients than other environments. However the CQC will be seeking views on whether to provide ratings after 2016.

From April 2015, the CQC has withdrawn its outcomes and replaced them with eleven fundamental standards. However nothing appears to have dropped from the previous outcomes. The significant change is the depth of the inspections. Previously, inspectors would have looked into around five of the eleven outcomes. In future, they will look into all eleven, and will examine them in more detail. This means you can expect the inspectors to spend an entire day carrying out the inspection.

The fundamental standards as mentioned above are:

• Care and treatment must be appropriate and reflect service users’ needs and preferences.
• Service users must be treated with dignity and respect.
• Care and treatment must only be provided with consent.
• Care and treatment must only be provided in a safe way.
• Service users must be protected from abuse and improper treatment.
• Service users’ nutritional and hydration needs must be met.
• All premises and equipment used must be clean, secure, suitable and used properly.
• Complaints must be appropriately investigated and appropriate action taken in response.
• Systems and processes must be established to ensure compliance with fundamental standards.
• Sufficient numbers of suitably qualified, competent, skilled and experienced staff must be deployed.
• Persons employed must be of a good character, have the necessary qualifications, skills and experience, and be able to perform the work for which they are employed (‘fit and proper persons’ requirement).
• Registered persons must be open and transparent with service users about their care and treatment.

The CQC also have a new approach to inspecting dental practices. Their guide to this process is called What to expect when we inspect, and explains what you can expect to happen from eight weeks before the inspection right up to the day of your inspection. It states that:

6-8 weeks before the inspection - CQC will telephone your NHS area team and send them a letter to request information they have about the dental practices to be inspected, such as assessments undertaken, complaints, risks or issues received, and any investigations undertaken.

4 weeks before the inspection - CQC will send an information request to your local Healthwatch requesting information they may hold about the quality of care provided. This will include evidence of good quality care as well as concerns.

2 weeks before the inspection -  The CQC inspector will call you to introduce themselves, discuss the new approach and talk through the agenda for the inspection visit. You will receive a letter from the CQC to confirm the date of your inspection and request a copy of your statement of purpose, information on complaints/compliments and staff details. They will also send out some comment cards for your patients to complete and posters to advertise the inspection.

The CQC recommends that primary care dental practices read about the new approach to regulating and inspecting on their website at: http://www.cqc.org.uk/freshstartdental.

On the day of the inspection - The CQC inspector will use a combination of interviews with staff and patients, and reviews of information the practice has such as policies, procedures and data. They will also collect all comment cards completed by your patients and will require to see a range of documentation, including:

• Equipment maintenance certificates (autoclave, X-ray equipment, lasers, compressors, fire equipment etc.);
• Radiation protection file (this needs to be up-to-date - speak to your RPA for more information);
• Selection of audits and action plans;
• Infection control – policies, procedures and records;
• Staff recruitment – policies, procedures and staff files;
• Staff training records – safeguarding, IRMER, vulnerable adults, CPR, CPD, meetings etc.;
• Patient satisfaction survey and findings.

At the end of the inspection the CQC inspector will hold a feedback session with you to share their initial thoughts about what they had found. Following the inspection they will draft an inspection report. You will have the opportunity to challenge any inaccuracies at this stage. They will then publish the final report on the website.

The CQC is always changing and evolving in order to improve the services we offer to our patients. Whilst most of the recent changes apply mainly to other health sectors, it is very important that we exceed the standards expected from us to ensure our patients receive the best standard of care. Details of outcomes, fundamental standards, policies, expectations, guidelines and much more can be found on the CQC website. It may be worth bringing in an external person to prepare you for the CQC inspection, especially if you are new to management and the CQC, or if you require help with preparation.

There may be times in your working life when you need to raise a concern with your manager. This could be over something minor or something major, but it is important that all staff members feel they are able to approach their manager to discuss the best course of action and resolve the issue without feeling afraid.

Always remember that your manager is there to ensure your workplace runs smoothly, to organise staff and to iron out any issues there may be.

Raising a concern about a dentist

There are certain situations in which you may feel out of your depth, and that you feel unable to handle on your own. You may therefore need to involve your manager. An example of this could be where a dentist you work with is having problems at home and is using a mobile phone whilst treating patients. In a scenario like this, it would be a good idea to approach your manager as nurses don't always have the authority to enforce rules. The best way to inform your manager would be to inform him/her of the issue on a private basis and if possible offer a solution that you feel may help.

An example of how to inform your manager would be:

Nurse:  The dentist is having problems at home and he is using his mobile phone whilst treating patients. I didn't think it was an issue at first but a few patients have mentioned this issue to reception and have stated that they felt uncared-for. I'm concerned that one of these complaints may escalate and I'm also concerned that his lack of concentration may have an effect on his dentistry. I was anxious about mentioning this as I do not want him to get into any trouble, but I felt I needed to say something in his best interests.

Manager: I appreciate you bringing this to my attention; I will speak to the dentist concerned.

This shows that you have identified the issue and involved the correct person (your manager) – and that the outcome is in the best interests of the dentist.

Systems

In my experience, it is a great idea to work together as a team and introduce a system that works well for you all, as every workplace is different. A system we have in place at my current practice is what we call a courtesy system. It can seem a bit contrived, but it has worked nearly every time for us. The courtesy system uses the following key:

Red – Problem

Orange – How it makes you feel

Green – Solution

An example of how the courtesy system works is:

Nurse 1: You keep taking instruments from my room and I have to keep asking for them back. This makes me feel frustrated as I feel I am doing you a favour. Instead of returning them, you are hoarding them in your surgery all day, and I have to run around to find them, which makes us run behind. I don't mind you borrowing my instruments as long as they are sterilised and then returned.

Nurse 2: I am sorry if I have caused any upset; because I am busy myself I forget to bring them through to your surgery. I will make a conscious effort to ensure I return them to you after use in future.

Nurse 1: Thank you - I appreciate it. I don't mean to moan, but it can be frustrating. I am glad we have sorted this issue.

The aim of the courtesy system is to keep the problem between the relevant members of staff without involving others. It informs them of what the issue is, how it makes you feel and how it can be resolved. The first question I ask when a member of staff approaches me with an issue about another individual is: “Have you used the courtesy system?”. This does not work for all scenarios, but it is a good system to have in place.

Raising a concern about being unhappy in the workplace

There may be a point in your career where you feel unhappy and may need to raise a concern with your manager or ask them for some advice. The best way to raise a personal concern is to inform your manager that you would like to talk, or arrange a meeting and inform him/her about what is bothering you in the workplace. Managers tend to have experience and have probably dealt with a situation similar to yours in the past. They have the authority to make arrangements to ensure that you are happy within the workplace and that the issue is resolved. Remember that whatever is discussed with your manager remains confidential.

There are many reasons to approach your manager, including annual leave requests, equipment malfunctions, complaints, issues in the workplace and many more. It is important that everyone in the workplace builds a good working relationship with their manager to ensure a healthy workplace. It is also important to remember that your manager has more than likely worked their way up to their role. This means that what you want to speak to them about is probably something they have encountered before. They are there to make the workplace better, so if you have any concerns, be sure to raise them in the right way. If your manager is unable to resolve the issue him/herself, they will always have external contacts who can help you if necessary.

R.Gibbons

Risk assessments are not an option, they are a legal requirement under the Health and Safety at Work Act 1974. Employers have a duty of care to protect the people they employ as well as service users and business subcontractors. The Act gives general responsibility to employers, employees, the self-employed and manufacturers and suppliers.

Risk management is a standardised process to reduce injuries, errors, faults and accidents and at the same time improve quality. It is defined as a systematic process whereby risk is identified and analysed. This enables the establishment of practice policies and procedures that can be implemented in order to control the risks that have been established as ‘likely’ to happen. It has been established that 10% of patient or staff incidents that do occur in the workplace, of these half of them are preventable. All incidents that occur must be investigated and learned from to prevent similar incidents from happening in the future. This will improve the quality of care the practice provides to patients, staff and visitors.

There are many types of risk that we have to learn to control within dental practices and dental laboratories, but the number of hazards present within a dental surgery is very low nowadays due to regulations and enforcement of good practice by government authorities such as the Health and Safety Executive (HSE). We can control the hazards that do exist through high standards of infection control and decontamination of all instruments, services and equipment.

Dental patients and health care workers can be exposed to pathogenic microorganisms such as: HBV, HCV, Herpes Simplex Virus Types 1 and 2, HIV, Mycobacterium tuberculosis, staphylococci, streptococci, and other viruses and bacteria that colonise or infect the oral cavity and respiratory tract. These organisms can be transmitted in dental settings through direct contact with blood, saliva, or other patient materials or through indirect contact with contaminated objects (e.g. instruments, equipment, or surfaces). They can enter the body through the eyes, nose, or mouth in the form of droplets (e.g. aerosols or splatter) from an infected person coughing, sneezing, spitting or even talking.  Airborne microorganisms can remain suspended in the air for long periods of time.

Due to the risks that we work with on a daily basis we have to ensure that we reduce the possibility of cross-contamination and/or cross-infection by following good practice guidelines such as Standard Precautions. This was initially put into practice by the Centers for Disease Control and Prevention, based in Atlanta, USA. In 2003, the British Dental Association (BDA) brought the Standard Precautions guidance up to date and made it relevant to current dental practice. It covers:

• The use of personal protective equipment (PPE);
• Effective hand-washing;
• Safe disposal of sharps;
• Safe disposal of clinical waste;
• Effective hard surface decontamination;
• Effective decontamination and sterilisation of contaminated items;
• Use of zoning techniques to prevent contamination of items that cannot be sterilised;
• Safe storage of sterilised items.

The BDA advises that implementing safe and realistic infection control procedures requires the full participation of the whole dental team. They state that every practice must have a comprehensive written infection control policy which identifies the infection control procedures to be followed.

These procedures should be regularly monitored during clinical sessions and routinely audited. All healthcare workers in the dental team must understand and practise these procedures. The BDA recommends that regular discussions at practice meetings should be carried out.

A thorough medical history must be obtained for each patient at their very first visit to a practice. It must be updated yearly for annual attenders, but for those patients who attend more regularly the medical history must be updated at the start of each new visit.

The medical history and examination may not identify asymptomatic carriers of infectious disease, and therefore standard precautions must always be adopted. This means that the same infection control procedures must be used for all patients routinely and systematically.

In view of the information that I have researched, I have established that all necessary risk assessments for each work activity must be implemented and carried out and then reviewed annually. In this way, a map of the safety of work premises is created. This helps to ensure safe control of the working environment and hopefully prevents any accidents or injuries - most accidents are the result of human error.

Conducting this research has also highlighted for me the fact that all team members must be educated in practice procedures and policies on risk management. These are living documents and must be reviewed after any incidents have taken place to ensure constant improvement in safety in the workplace.

Sharon Holmes