Section 2: Professional Practice
Chapter 8: Professional practice requirements and CPD
- What are the GDC principles of dental practice?
- What are the Standards for Professional Practice?
- What are my obligations regarding equal opportunity?
- What are my responsibilities to the patient to ensure they understand what their treatment involves?
- What are my responsibilities regarding patient confidentiality?
- What are my responsibilities to other members of the team?
- What should I do if I feel that the patients are not being treated correctly?
- What indemnity insurance do I need to have?
- What happens if I am not covered?
- What should I do if a claim is made against me?
- Why is this important for practice?
- What are my obligations regarding CPD?
- How can I gain my CPD?
- Should my employer provide my CPD?
- What further training can I do to further my career?
- Should my practice principal keep my GDC registration certificate?
- Should my employer employ qualified nurses who are not registered?
It is not sufficient for you to just qualify to call yourself or work as a ‘Dental Nurse’. Since July 2008 it has been illegal to work as a ‘Dental Nurse’ unless you are registered with the General Dental Council (GDC) and must be renewed annually. If you work as, or call yourself a ‘Dental Nurse’ and are not registered, you are breaking the law and could be prosecuted, as could any dentist who employs you.
What are the GDC principles of dental practice?
The GDC sets out six principles within the Standards for Dental Professionals (2008). These are:
- Putting patient’s interests first and act to protect them.
- Respect patient’s dignity and choices.
- Protect the confidentiality of patient’s information.
- Co-operate with other members of the dental team and other healthcare colleagues in the interests of patients.
- Maintain your professional knowledge and competence.
- Be trustworthy.
This main booklet is supported by other guidance documents which should be used as principles to work by, not rules to be governed by. These principles are outlined in a booklet which each registrant should have know and understand.
The GDC also produced a series of booklets in 2008 which give guidance for registrants in various aspects such as:
- Patient confidentiality
- Team working.
- Complaints handling.
- Raising concerns.
- Management responsibility.
What are the Standards for Dental Professionals?
It is every registrant’s responsibility to keep up to date with both the Standards for Dental Professionals (2008) and the Scope of Practice for Dental Nurses (2008) as issued by the GDC. These are the standards which were devised for all Dental Care Professionals (DCP). They are the standards that must be adhered to in order to maintain your professional status and your registration. The standards are what you will be judged against if a patient makes a complaint against you and these are the standards you will have to defend your actions against. Some of the main clauses from the Standards for Dental Professionals (GDC 2008) are discussed next.
1.3. Work within your knowledge, professional competence and physical abilities; refer patients for a second opinion for further advice.
This means that you should not take on any duties for which you have not been trained and which you feel uncomfortable about completing. See also Chapter 3 for discussion on Scope of Practice for Dental Nurse.
5.4. Find out about laws and regulations which affect your work, premises, equipment and business and follow them.
As a registered dental care professional, your registration will be in jeopardy if you break the law and put your patients at risk. The GDC provide advice and guidance about professional conduct. Advice can be found on their website. If you get into trouble with the police for even the most minor indiscretion, the fact will be reported to the GDC who may or may not take action against you. This includes motoring offences, cautions etc.
6.1. Justify the trust that your patients the public and your colleagues have in you, by always acting honestly and fairly.
As a registered professional you are duty bound to act at all times in an honest and fair way. Doing otherwise will not only put your registration at risk but could also put you at risk of criminal proceedings.
6.3. Maintain appropriate standards of personal behaviour in all walks of life so that patients have confidence in you and the public have confidence in the dental profession.
This means that should you do anything which puts either your own or the dental professional’s reputation at risk you could be removed from the register of DCP. This includes any circumstances in which the police become involved i.e. public order, drunkenness, motoring offences. Then the GDC will be informed and you could be asked to explain yourself in front of the disciplinary committee.
Remember: If your name is removed from the register you cannot legally work as a dental nurse.
The Standards for Dental Professionals (2008) also gives guidelines on the treatment of patients under general anaesthetics or conscious sedation. There is a post qualification certificate available in conscious sedation. To find out more information about this course, contact the National Examination Board for Dental Nurses (NEBDN), in Fleetwood. They can provide a list of course providers, costs and course prospectus. You should refuse to assist a dentist in this type of treatment if you don’t hold this certificate. A one day information session is not sufficient for working safely with patients undergoing this type of treatment.
What are my obligations regarding equal opportunity?
2.3. Treat patients fairly and in line with the law. Promote equal opportunities for all patients, do not discriminate against patients or groups of patients because of their sex, age, race, ethnic origin, nationality, special needs or disability, sexuality, health, lifestyle, beliefs or other relevant consideration.
The biggest impact this could have on your working practice is if you routinely take extra precautions when treating a patient who has a known infection or is a carrier of a blood borne infection. All patients attending for treatment must be treated equally. In terms of infection control and decontamination, all procedures must be the same to ensure the prevention of cross contamination and infection.
What are my responsibilities to the patient to ensure they understand what their treatment involves?
2.4 Listen to patients and give them the information they need, in a way they can use, so that they can make decisions.
This means that you should ensure that patients understand completely what they are being told. The information you give needs to be in a form that they can understand. This means not using jargon or technical terms. The patient must be fully aware of the treatment that is proposed and, where necessary, the full cost of the treatment. The patient must be able to make an informed decision and give consent from a basis of understanding.
What are my responsibilities regarding patient confidentiality?
3.1. Treat information about patients as confidential and only use it for the purposes for which it is given.
This means that any information disclosed should not be discussed outside the working environment i.e. on the bus, in public areas of the practice or clinic, in a lift etc.
3.2. Prevent information from being accidentally revealed and prevent unauthorised access by keeping information secure at all times.
This means not leaving patient notes lying around where other people can read them and ensuring that any electronic records are kept secure. This is also true of disclosing information to people on the telephone i.e. someone calling to see if a patient has attended for an appointment or enquiring about the treatment carried out. You cannot be sure who you are speaking to on the telephone or who may be listening. They may not be the person they say they are.
What are my responsibilities to other members of the team?
4.1. Co-operate with other team members and colleagues and respect their role in caring for patients.
Working in any type of dental institution has to be a team effort. No one person can do all the jobs involved. An efficient practice is one where every staff member knows their roles and responsibilities. This will lead to the patient receiving the best possible treatment in the best possible environment.
4.3. Communicate effectively and share your knowledge and skills with other team members and colleagues as necessary in the interests of patients.
‘A team is only as strong as its weakest member’, is a well known saying and is particularly pertinent to dental teams. Most practice teams will include a trainee, either a nurse or a vocational trainee dentist, who may be the weakest member of the team as they lack knowledge and expertise. It is the responsibility of all the qualified team members to pass on their knowledge and skills and communicate to other members of the team so that everyone fully understands their role.
What should I do if I feel that the patients are not being treated correctly?
1.7. If you believe that patients might be at risk because of your health, behaviour or professional performance or that of a colleague or because of any aspect of the clinical environment, you should take action.
This means that if someone you work with puts the wellbeing of patients at risk you must report it to the GDC. If you do not, and knowingly work in an unsafe way because of the actions of colleagues, then you will also be liable. This relates to anyone you work with: dentist, nursing colleague, hygienist, receptionist etc.
You have a responsibility to report any other registered professional who does not fully comply with the standards required of their professional registration. This has huge implications for not only you but also for every registered professional that you work with.
If you report a dentist, you could well have your employment terminated and find it difficult to obtain further employment. This provides you with a dilemma. If you do report the person, you could be out of work. But if you don’t and a patient makes a complaint against the practice, you could be brought before the GDC Disciplinary Committee or Fitness to Practice Committees. It is for this reason that it is imperative that you have personal indemnity insurance and do not rely on a policy taken out by the practice owner which covers all staff. A policy that covers the whole practice may not provide sufficient protection to provide assistance in such an instance.
Since registration, all registered professionals are responsible for their actions and can be brought to account to the GDC. If your defence is that you knew things were not being done in a correct manner but were in fear of losing your job if you reported it, this argument will not protect you from possibly losing your registration and therefore, your job.
This is a difficult action to take and there are organisations that you can turn to for help and advice such as the Colleagues Defence Organisation, Professional Organisation or the GDC. Remember you may not want to ‘whistle blow’ on a colleague but would they worry about doing the same to you in a similar incident?
What indemnity insurance do I need?
1.6. Make sure your patients are able to claim any compensation that they may be entitled to by making sure you are protected against claims at all times, including past periods of practice.
Since the advent of compulsory registration in 2008, it has become possible for registered dental nurses to be sued by patients if they feel that they have not been treated correctly. Registered dental nurses are now responsible for their own actions and could be reported to the GDC who will take action either via the Disciplinary Committee or the Fitness to Practice Committee. Defending yourself in either hearing could cost many thousands of pounds and you would need the services of a barrister to represent you.