CHAPTER 3 Law and Ethics
3.1 Regulation of dental nursing in the UK, scope of practice, training and qualifications
The GDC is the organisation that regulates all dental professionals training and working in the UK. Dental professionals include dentists and all dental care professionals. The dental care professionals are:
The registers include the names of all the dentists and dental care professionals who are registered to practise in the UK, regardless of whether they work in the National Health Service (NHS), private practice or any other form of practice. Thus all dental nurses must be registered with the GDC’s Dental Care Professionals Register. Those who are registered are called registrants.
All dental nurses should have a copy of the Standards for Dental Professionals booklets as well as the additional supporting documents. You can download them from the GDC website (www.gdc-uk.org/Current+registrant/Standards+for+Dental+Professionals/).
Another, independent, regulatory body that dental nurses need to be aware about is called the Care Quality Commission (CQC) in England and the Care Commission in Scotland. The aim of the CQC is ‘to ensure better care for everyone in hospital, in a care home and at home’. Thus the CQC ensures the safety and quality of the care provided to patients through various assessment, monitoring and inspection procedures, and this includes dental professionals.
In April 2010, CQC introduced a registration system for all providers of health and social care which was introduced gradually across the care sector with the aim of incorporating primary care services that provide dentistry (NHS and private sector) by 1 April 2011. Thus, in addition to standards set by GDC, it is mandatory for dental practices to register with CQC and comply with its Essential Standards of Quality and Safety (standards that outline the ideal outcome patients should experience when using a service). Each practice will need to be able to demonstrate compliance with the regulations in the following areas:
The Dentists Act in the UK was passed in 1984. The title ‘dental nurse’ is now protected by law through an amendment to the Dentists Act, known as Statutory Instruments 2005 No. 2011, Health Care and Associated Professions: Dentists.
If an individual is not registered with the GDC and uses the title ‘dental nurse’, or any other title that misleadingly implies that the person is a dental nurse, they can be prosecuted in court. This will also put at risk the registration of the dentist who is employing them.
In recent years, the UK law has undergone several changes to enhance public and professional confidence in the delivery of healthcare. That is, the law now aims to ensure that all health professionals continue to earn the trust that patients place in them by:
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.
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.
The NHS has to run as cost effectively as possible so as to avoid wasting precious resources, while delivering the best possible care to all patients irrespective of where they live in the UK. (Difference in care in different parts of the UK has been termed ‘postcode rationing’.) The organisations that are responsible for ensuring this are:
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.
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.
Additional skills with additional training and only on prescription (see below for details of training)
Taking radiographs to the prescription of a clinician (but see Chapter 14; certificate in dental radiography is required)
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).
|Qualification||Awarding Body||Details of Study and Examinations Available from|
|The National Certificate – Dental Nursing||National Examining Board for Dental Nurses (NEBDN)||NEBDN (www.nebdn.org/)|
|The City & Guilds Level 3 NVQ in Dental Nursing (England and Wales)||NEBDN/City & Guilds Care, Health & Community||NEBDN|
|City & Guilds (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|
|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 (email@example.com)||School of Professionals Complementary to Dentistry|
|Foundation Degree in Dental Nursing||University of Northampton (firstname.lastname@example.org)|
* 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.
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.
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.
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.
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.
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 (www.cityandguilds.com/20028.html).
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.
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.
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:
BOX 3.1.1 Verifiable CPD
If there is any evidence of poor practice by a dental nurse, according to healthcare regulation, the GDC is required to undertake an investigation which will include processes to test any specific doubt that a registrant remains fit to be on the register, that is, fit to practise. These processes are called the ‘fitness to practise system’.