Scope of Practice

I should add that some of these children have not seen a dentist for several years either because they have a history of DNAs or they have slipped through the recall net.

Hi, thank you for your reply.
Childsmile are pretty vague on their guidelines for Childsmile Practice appointments as they simply state that "this will be delivered by an appropriate member of the dental team." which could involve Dentists, Therapists, Hygienists, Nurses or Dental Health Support Workers leaving it as flexible as possible for individual practices. They rely on the GDC Scope of Practice as the benchmark for each DCP group.

The Scope of Practice does not allow treatment planning by Dental Nurses and it feels a bit like we are being expected to carry out full oral health assessments in the absence of a Dentist with being asked to select an appropriate recall period for children and if necessary to recall them back to ourselves for further appointments.

I think you're right, I need to speak to our indemnity company. We are covered by the NHS as employees but I can contact the indemnity agents directly. Thank you.

I also note that under Direct Access that I can refuse to see patients under these circumstances as it is not compulsory. My role should purely be to advise/ educate and apply fluoride varnish if necessary but should not be a substitute for regular dental examinations (although we can also recommend that patients can register with external local independent practices)so will need to fully clarify my legal position before agreeing to see these patients.

Thanks again for your reply

The first thing I would do is contact your indemnity provider...you should have your own indemnity as an extended duty nurse or if it is provided by your work you should know who it is with and be able to discuss this with them.

If it is Childsmile you are working under then have a look at the procedures / guidelines within that programme too for their statements.

It certainly sounds like you are working beyond your scope of practice which is not a good thing.

Hope this sort of helps

Hi all,

Just wondering if we have other Oral Health Ed Certificated nurses here who work as oral health educators/ extended duty dental nurses in practice?
I work for an NHS board at Bd4 (standard Dental Nurse banding in the NHS approx. 19,000 to 23,000pa) and have been stuck at the top of the band for the last 6 years due to the 1% pay cap in the NHS.

I have not had a chair side role for the past 15 years but have been involved in community oral health promotion and education - all at Bd4 and have been involved in clinical prevention clinics for the past 2 years. I am additionally quallified as an EDDN in Fluoride Varnish Application.

The issue myself and a couple of colleagues are coming up against is that our service is over subscribed and short of Dentists. We are now being expected to continue seeing paediatric patients as part of an established programme (Childsmile)under the Direct Access rules in the absence of regular dental examinations. However this seems to fly in the face of the Clinical Effectiveness Programme which states all children under 16 should have a dental examination every 12months max.
We all know that as Dental Nurses, we are not allowed to diagnose or treatment plan yet it seems that we are being asked to make clinical decisions on patients alongside giving preventive advice.
I am concerned that we are being asked to make judgements beyond our scope of practice and that this is way above our paygrade.

My main concern is that I'm being expected to assess children as dentally fit and set a recall period of 3mths/ 6mths/ 12mths when I am not carrying out full oral examinations beyond risk assessing for fluoride varnish applications. What happens if a child then presents at a local emergency dept with an abscess or worse with sepsis because I have missed something as we are not xraying or probing for sticky fissures, etc.
How does this affect my indemnity and registration?

Has anyone else come across this kind of expectation in their role? Any advice or am I just being over cautious? TIA