The changes have also strengthened clinical governance (see p. 8), and have happened as part of the government’s response to a number of official inquiries into doctors who have harmed their patients. One example is the Shipman Inquiry, which investigated the conduct of Dr Harold Shipman from Manchester, who was imprisoned in 2000 for 15 murders, but is alleged to have killed 218 patients.

The national health service (NHS)

The NHS is the name commonly used to refer to the UK’s publicly funded healthcare system, which was set up in 1948. It is now called by different names in different parts of the UK:

• In England, the ‘National Health Service’ is responsible to UK Government

• In Ireland, ‘Health and Care Northern Ireland’ is responsible to the Northern Ireland Executive

• In Scotland, ‘NHS Scotland’ is responsible to the Scottish Government

• In Wales, ‘NHS Wales’ is responsible to the Welsh Assembly.

However, a person who lives in one part of the UK can receive treatment under the relevant NHS in another UK country without being discriminated against.

Structure of the NHS

The NHS is divided into two sections: primary and secondary care.

• Primary care – this is the most common ‘front-line’ service, that is, it is the first point of contact with the NHS for most people. Primary care is delivered by a wide range of healthcare professionals such as doctors, dentists, pharmacists and optometrists. It also includes NHS Direct and walk-in centres. The government bodies in charge of primary care are the primary care trusts (PCTs). These not only provide some primary and community services but PCTs also commission them from other providers. They are involved in commissioning secondary care (see below). PCTs control 80% of the NHS budget as well as overseeing general medical (GPs) and dental practitioners.

• Secondary care (also known as acute healthcare) can be either elective care or emergency care. Elective care means specialist medical care or surgery that has been planned in advance and it usually follows referral from a primary or community health professional. Emergency care is unplanned care, for example following a car accident. The bodies in charge of providing secondary care in the UK include foundation NHS trusts, acute NHS trusts, mental health NHS trusts and NHS ambulance services trusts. The NHS care trusts provide both health and social care.

The strategic health authorities (SHAs) oversee the work of PCTs and other NHS trusts in a particular region and provide the link between the Department of Health and the NHS at the local level.

Several healthcare-related government agencies (e.g. National Institute for Health and Clinical Excellence (NICE) and the National Patient Safety Agency (NPSA)) also come under the umbrella of the NHS.

Term to Learn

NICE: the UK government agency that is responsible for deciding which treatments or investigations are required most commonly and are the most cost-effective (http://www.nice.org.uk).

Find Out More

What is the mission of the NPSA (http://www.npsa.nhs.uk)?

Dental nurses’ scope of practice

The material in this section is largely adapted from the GDC’s ‘Scope of Practice’ publication, which states that:

The scope of your practice is a way of describing what you are trained and competent to do. It describes the areas in which you have the knowledge, skills and experience to practise safely and effectively in the best interests of patients.

Your scope of practice is likely to change over the course of your career. Some registrants will expand their scope by developing new skills, while some may narrow their scope but deepen their knowledge of a particular area by choosing more specialised practice.

You should only carry out a task or type of treatment or make decisions about a patient’s care if you are sure that you have the necessary skills.

You should only ask someone else to carry out a task or type of treatment or make decisions about a patient’s care if you are confident that they have the necessary skills.

Scope of Dental Nurse Practice on Qualification

Roles permissible:

• Preparing and maintaining the clinical environment, including the equipment

• Carrying out infection control procedures to prevent physical, chemical and microbiological contamination in the surgery or laboratory

• Recording dental charting carried out by other appropriate registrants

• Preparing, mixing and handling dental materials

• Providing chairside support to the operator during treatment

• Keeping full and accurate patient records

• Preparing equipment, materials and patients for dental radiography

• Processing and mounting dental radiographs

• Monitoring, supporting and reassuring patients

• Giving appropriate advice to patients

• Supporting the patient and their colleagues if there is a medical emergency

• Making appropriate referrals to other health professionals.

Roles that are excluded: dental nurses do not undertake any of the skill areas described in Chapter 15, as these are within the roles of the dental technician, clinical dental technician, dental hygienist, dental therapist, orthodontic therapist or dentist.

Terms to Learn

Charting: filling in the dental record sheet (called a chart) for a patient, e.g. recording which teeth are present, missing or decayed (see Chapter 7).

Mounting: the procedure of correctly displaying dental radiographs for the clinician to see. For example, ensuring the radiograph is the correct side up and the correct side is facing the clinician.

GDC Guidance on the Various Areas of Dental Nurse Roles in ‘Scope of Practice’

Additional Skills that a Dental Nurse Could Develop during Their Career

With additional training, dental nurses may also be involved in expanded duties such as:

• Providing oral health education and oral health promotion

• Assisting in the treatment of patients under conscious sedation

• Assisting in the treatment of patients with special needs

• Intra-oral photography

• Shade taking

• Placing rubber dam

• Measuring and recording plaque indices (see Chapter 7)

• Pouring, casting and trimming study models

• Removing sutures after the wound has been checked by a clinician

• Applying fluoride varnish as part of a programme that is overseen by a consultant in dental public health or registered specialist in dental public health

• Constructing occlusal registration rims and special trays

• Repairing the acrylic component of removable appliances

• Tracing cephalograms.

Term to Learn

Intra/extra-oral: inside/outside the mouth.

Identify and Learn

Identify a shade guide, special tray, occlusal registration rim, cephalogram, topical anaesthetic and vacuum-formed retainers in your workplace.

Dental nurse training and qualifications

Several different routes lead to a qualification in dental nursing. This is because a route that may be suitable for some may be less suitable for others. Dental nurse training providers in England, Wales and Northern Ireland are listed in Table 3.1.1. For details about the Scottish Vocational Qualification (SVQ) in Oral Healthcare: Dental Nursing Level 3, contact the Scottish Qualifications Authority (see p. 78 for contact details).

TABLE 3.1.1 Accessing Dental Nurse Training (England, Wales and Northern Ireland)

Qualification	Awarding Body	Details of Study and Examinations Available from
The National Certificate – Dental Nursing	National Examining Board for Dental Nurses (NEBDN)	NEBDN (http://www.nebdn.org/)
The City & Guilds Level 3 NVQ in Dental Nursing (England and Wales)	NEBDN/City & Guilds Care, Health & Community	NEBDN
	NEBDN/City & Guilds Care, Health & Community	City & Guilds (http://www.cityandguilds.com/uk-home.html)
The City & Guilds Level 3 Award in Dental Nursing (VRQ) (England and Wales)	NEBDN/City & Guilds Care, Health & Community	NEBDN
	NEBDN/City & Guilds Care, Health & Community	City & Guilds
The Certificate of Higher Education in Dental Nursing	Cardiff University*	School of Postgraduate Medical and Dental Education (see p. 78 for contact details)School of Professionals Complementary to Dentistry
	Portsmouth Dental Academy (scl.admissions@port.ac.uk)	School of Professionals Complementary to Dentistry
Foundation Degree in Dental Nursing	University of Northampton (study@northampton.ac.uk)

* This programme has received provisional approval from the GDC Education Committee. Full GDC approval of new programmes is not granted until the first batch of students has completed their studies and examinations or assessments and the programme has been inspected by the GDC. Potential applicants should contact the provider for further information about the programme.

Pre-registration Certificates

Appropriate pre-registration certificates are offered by:

• National Examination Board for Dental Nurses (NEBDN)

• City & Guilds of London Institute (City & Guilds).

The national examination board for dental nurses

The National Certificate of the NEBDN (see p. 78 for contact details) provides a mix of theoretical learning and practical teaching and experience. It can be undertaken at a dental hospital or at a college of further education.

• Dental hospitals usually provide full and part-time courses.

• Colleges of further education usually provide part-time courses (mainly evening or day release).

• Full-time courses are usually work-related, and the theoretical and clinical teaching programme is combined with clinical placements in the hospital specialist departments.

• Part-time courses usually involve employment as an unqualified dental nurse in a general dental practice or equivalent in order to gain the practical experience, and attendance at part-time evening or day release classes. You will need to attend an accredited training centre to train as a dental nurse, which will cover you until registration.

The NEBDN stipulates that 24 months of verified chairside assisting (assisting a dentist or other clinician during treatment of a patient) is necessary before the qualification can be awarded. However, the national examination can be taken before these 24 months are completed.

The NEBDN syllabus has 15 sections. In addition to theoretical study, you need to complete a ‘Record of Experience’ in the workplace. This provides a measure of your application of skills during routine dental procedures as outlined in the syllabus. The procedures are divided into five units. For each unit, you must demonstrate competence in a prescribed number of clinical activities and provide additional evidence recorded on a ‘Practical Record Sheet’, which is signed and dated by a witness who holds a GDC-registerable dental qualification. You must also complete a report (case study) of no fewer than 1000 words and no more than 1500 words on one treatment session which involves provision of a fixed or removable appliance or a surgical or restorative procedure.

The national examination is held twice each year – on the third Saturday in May and November – and comprises:

• A practical test

• An oral examination (viva voce)

• Two-hour written paper, consisting of:

Four essay-type questions

Multiple-choice questions

Short-answer questions

A diagram to label with related questions

A dental chart (see Chapter 7) to complete.

The city & guilds of london institute

Vocational qualifications reflect the skills, knowledge and understanding an individual possesses in relation to a specific area of work. National Vocational Qualifications (NVQs) and Vocationally Related Qualifications (VRQs) are workplace-based. The NEBDN provides the dental expertise whereas City & Guilds is the awarding body.

The ‘City & Guilds’ is the main UK examining and accreditation body for vocational training. Dental nursing is also recognised as a vocational qualification.

Dental Nursing NVQ (No 3231)

You can undertake NVQs at dental hospitals and at further colleges of education. NVQs are made up of different units of competence. A portfolio of evidence is completed in the workplace, which is assessed and verified before you sit an independent assessment. The Dental Nursing NVQ (No 3231) is a Level 3 qualification and is aimed at dental nurses working in general dental practices, community dental services, dental and general hospitals, armed services, who are providing direct chairside work, patient care and support during a range of dental treatments.

To gain the full NVQ, you must complete a total of 11 mandatory units as follows:

‘Ensure your own actions reduce the risk to health and safety

Reflect on and develop your practice

Provide basic life support

Prepare and maintain environments, instruments, and equipment for clinical dental procedures

Offer information and support to individuals on the protection of their oral health

Provide chairside support during the assessment of patients’ oral health

Contribute to the production of dental radiographs

Provide chairside support during the prevention and control of periodontal disease and caries, and the restoration of cavities

Provide chairside support during the provision of fixed and removable appliances

Provide chairside support during non-surgical endodontic treatment

Provide chairside support during the extraction of teeth and minor surgery.’

(City & Guilds website, http://www.cityandguilds.com/20031.html)

Dental Nursing VRQ (Vocational No 7393)

VRQ in Dental Nursing (Vocational No 7393) is another Level 3 qualification aiming to develop the knowledge required for full-time employment and/or career progression in dentistry. For full details see the City & Guilds website (http://www.cityandguilds.com/20028.html).

Dental nurse registration

Registration

The first step after qualifying as a dental nurse is to register with the GDC. The National Certificate, or the NVQ and VRQ, are required for entry in the GDC Register. GDC registration must be renewed annually.

Key Point

It is good practice to complete the appropriate paperwork beforehand so that you can send it to the Registrar at the GDC immediately on qualification.

After GDC Registration

As a registered dental professional, you must be familiar with and understand:

• Current standards and principles of dental care, and apply them at work, using your judgement in the light of the principles

• Relevant guidelines from related organisations and sources of evidence that support current standards.

As a dental nurse, you must ensure your knowledge and skills are up to date, and apply them ethically. You must also be prepared to justify your actions to the GDC. If an unsatisfactory account of the behaviour or practice is given (in line with the principles), the dental nurse’s GDC registration may be at risk. In other words, a dental nurse is responsible and accountable to themselves, their colleagues, their patients and the GDC, and for continuing development of knowledge and skills. Besides the compulsory (mandatory) training, such as basic life support and infection control, which all members of the dental team are required to undergo, you will be expected to participate in continual professional development (CPD) to maintain your status on the GDC register.

Continued Professional Development

The GDC states that:

In line with the clinicians’ CPD scheme, we recommend that [Dental Care Professionals] DCPs involved in the care of patients should undertake Continual Professional Development in legal and ethical issues and complaints handling.

Compulsory CPD maintains public confidence in the Dentists and Dental Care Professionals Registers by showing that clinicians and registered dental care professionals keep up to date so that they can give their patients a good standard of care.

Compulsory CPD means that dental nurses must complete and record 150 hours of CPD every five years, of which a third (50 hours) should be verifiable (Box 3.1.1). Most providers of CPD will issue a certificate for proof of attendance at the verifiable CPD event, but it is wise to check there will be CPD credits before deciding to participate in the CPD. Some CPD must be on mandatory (essential) core subjects, which are the same as for clinicians:

• Medical emergencies (10 hours per five-year cycle)

• Disinfection and decontamination (5 hours per five-year cycle)

• Radiography and radiation protection (5 hours per five-year cycle).

BOX 3.1.1 Verifiable CPD

Verifiable CPD is defined as that which has:

• Concise educational aims and objectives

• A clear purpose or goal

• Quality controls

• Documentary proof of participation.