Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5523_Библиотеки_им_академика_М_И_Перельмана.pdf
12 • Professionalism, Law and Ethics
307
n
four elected from the professions complementary to dentistry (PCDs) elected by registered PCDs (note: in September 2005, in line with new legislation, the GDC agreed to
use the term ‘Dental Care Professionals’ instead of PCDs)
n
four associate members, who have no voting rights;
these are the four Chief Dental Officers for England, Scotland, Wales and Northern Ireland.
In 2009, in line with government plans for health care
regulation, the membership of the GDC and the way that
membership was appointed changed. The new GDC was
smaller, comprising:
n
eight dentists
n
four DCPs
n
12 lay people.
This meant that from 2009, the GDC no longer had a majority of dentists in its membership. Following national advertisements, all members of the GDC are now appointed by the
government’s Appointments Commission within the parameters set down by the GDC. The purpose of this change was to
remove any perception by the public that professional members of the GDC, and of other health care regulatory bodies, are
representing those who elected them, rather than being purely
responsible for the effective regulation of that profession.
In 2013, a new Council convened. The Council is now
formed of 12 members: six appointed registrant and six
appointed lay members.
REGISTRATION WITH THE GDC
In the United Kingdom, only dental surgeons registered
with the GDC are entitled to practise dentistry. Graduates
and licentiates in dentistry of universities and Royal Surgical Colleges of the United Kingdom may be registered on
completion of the appropriate application and payment of
the prescribed registration fee. The universities and royal
colleges in the United Kingdom provide the GDC with lists
of their dental graduates or licentiates. Registration has to
be renewed annually as long as a dentist wishes to practise
in the United Kingdom. The annual renewal process includes three actions: making an Indemnity Declaration;
payment of the Annual Retention Fee (ARF); making a
Continuing Professional Development (CPD) statement.
Prior to the U.K. withdrawal from the European Union
(Brexit) holders of an appropriate European Dental Diploma
who were nationals of member states of the European Union
(EU) were also entitled to register, as were Icelandic and Norwegian graduates, since Norway and Iceland are members of
the European Economic Association (EEA), as are dentists
who qualified in Switzerland. Any European dentist applying
for registration required documentary evidence of:
n
identity
n
academic attainment
n
a knowledge of the English language which, in the interest
of themselves and their patients, is necessary for the
provision of dental services
n
good standing
n
good health.
Disqualification from practice in any EU/EEA member state
is most likely to bar a dentist from registering with the GDC.
Up to 2001, dentists holding a primary dental diploma
from certain overseas universities that the GDC had visited
to check educational standards could also be fully registered with the GDC and are still able to continue to be registered. These universities are in Commonwealth or former
Commonwealth countries where dental education is similar to that in the United Kingdom. No other qualifications
were automatically accepted by the GDC for full registration
and therefore the right of undertaking independent dental
practice in the United Kingdom.
There are several ways by which dentists with qualifications that do not fit into the above categories can register
with the GDC.
Temporary Registration
Temporary registration is available to allow such dentists to
teach, do research work or obtain postgraduate instruction in certain approved hospital, dental school or other
approved institution posts for a limited period. Temporary
registration only lasts for the period of a particular post or
employment and may be renewed by application up to a
maximum of 5 years.
Dentists with temporary registration can only practise
dentistry under the supervision of a named, fully registered
dentist of consultant status in the United Kingdom.
International Qualifying Examination
The International Qualifying Examination (IQE) replaced
the Statutory Examination in 2001. At the same time, the
GDC ceased to recognise the primary dental diplomas from
certain universities overseas. From 2001, all dental surgeons who do not have a primary dental qualification
gained through a dental school or Royal Surgical College in
the United Kingdom, the EU or the EEA had to sit the IQE.
The IQE closed to new applicants in 2007.
Overseas Registration Examination
In 2007, the Overseas Registration Examination (ORE) became the new statutory examination to permit overseas
dental graduates to apply for admission to the Dentist’s
Register, it replaced the IQE.
Additionally, since October 2011, before applying to sit
the ORE, prospective candidates need to demonstrate that
their dental course and qualification is comparable to EU
training and assessment requirements. A statement to this
effect has to be obtained from the UK National Recognition
Information Centre (UK NARIC). This organisation has been
set up by the UK government to check comparability of all
professional qualifications. Other EU countries have set up
similar organisations. A NARIC Statement of Comparability
has to be submitted with the application to sit the ORE. Prospective candidates must also demonstrate that their clinical
experience satisfies the requirements set (a set number of
hours is required of personal treatment of patients in the
dental chair) and English language requirements are met.
The ORE is comprised of two parts:
Part 1 consists of two, 3-hour written papers, comprising short
answers, which are undertaken on a computer, to test the
candidates’ application of knowledge in clinical practice:
Paper A: this covers clinically applied dental science and
clinically applied human disease.
308
Master Dentistry
Paper B: this covers aspects of clinical dentistry, including
law and ethics and health and safety.
Part 2: the purpose of this part is to test candidates’ ability
to demonstrate clinical skills safely and consists of four
elements:
1. three practical exercises on a dental manikin in
3 hours
2. an Objective Structured Clinical Examination (OSCE)
3. a diagnosis and treatment planning exercise
4. an examination in medical emergencies, including
cardiopulmonary resuscitation using a manikin.
Up to four attempts each are allowed for Part 1 and Part
2 of the ORE. Also, Part 2 has to be passed within 5 years of
the first attempt at Part 1 of this examination.
Additionally, to register with the GDC, candidates will
need, as part of the application process, to provide evidence
of good standing.
To be able to work in National Health Service (NHS)
primary care dental services, those who have passed the
ORE have been expected to show equivalence to dental
foundation training (DFT).
There are various local rules and legislation governing
dentists moving to a new country. It is beyond the scope of
this book to cover all eventualities, and the reader is recommended to engage with border and immigration services
and the professional regulator to determine the requirements, e.g. in the United Kingdom, the GDC and the UK
Visas and Immigration.
Licence in Dental Surgery
The Licence in Dental Surgery (LDS) examination is open to
applications from qualified dentists and is awarded by the
Royal College of Surgeons of England (RCS Eng). Again,
there are criteria which must be satisfied when applying to
sit this examination. Successful candidates are eligible to
apply for GDC registration.
The LDS is comprised of two parts:
Part 1 consists of two, 3-hour written papers comprising
short answers, to test the candidates’ application of
knowledge in clinical practice:
Paper A: this covers clinically applied human disease and
clinically applied dental science.
Paper B: this covers elements of clinical dentistry, including
health and safety, law and ethics.
Part 2: the purpose of this part is to test candidates’ ability
to practise clinical skills safely and consists of three
elements:
1. an Objective Structured Clinical Examination
2. an operative test on a dental manikin
3. an unseen case examination including diagnosis,
treatment planning and clinical reasoning.
Up to four attempts each are allowed for Part 1 and Part
2 of the LDS. Also, Part 2 has to be passed within 5 years of
the first attempt at Part 1 of this examination.
Continuing Professional Development
CPD includes professional development through learning,
training or other activities, which maintain and further
develop an individual’s practice or intended practice. It is
the duty of all dental professionals to keep their knowledge
and skills up-to-date. It is also a requirement for all dentists
and DCPs in order to remain registered with the GDC. The
GDC made CPD compulsory for dentists on 1 January 2002;
since then, there have been different schemes and requirements, and these have included the need for concise and
appropriate educational aims and objectives, in addition to
a quality control mechanism. Compulsory CPD for DCPs
was introduced in 2008.
The 5-year CPD cycle was phased in over a period of 3 years
depending on the date of first registration with the GDC:
n
First registered between 1990 and 2001, 5-year cycle
started on 1 January 2002.
n
First registered between 1980 and 1989, 1 January
2003.
n
First registered before 1979, 1 January 2004.
These first 5-year cycles therefore ended on 31 December
in 2006, 2007 and 2008, respectively.
Dentists whose first registration date is on or after 1 January
2002 commence their 5-year cycle on 1 January of the
year following their first registration. Also, dentists applying to rejoin the register will have to show that they have
met CPD requirements prior to being readmitted to the
Dentists Register.
The current legislation governing CPD requirements for
Dentists and Dental Care Professionals is the General Dental
Council (Continuing Professional Development) (Dentists
and Dental Care Professionals) Rules Order of Council 2017,
which came into force on 1 January 2018. The enhanced
Continuing Professional Development (eCPD) scheme
started in January 2018 for dentists and August 2018 for
DCPs. The scheme has a number of features and includes:
n
A requirement for a Personal Development Plan (PDP).
n
A minimum number of verifiable hours of eCPD for each
registrant group (these should be evenly spread over a
5-year cycle).
n
A requirement to declare the number of hours completed in an annual declaration to the GDC.
n
A requirement to plan CPD activities according to the
field of practice of the individual dental professional.
n
The GDC has set development outcomes, and CPD should
also be aligned to these. Full descriptors of the development outcomes can be found on the GDC website, but
briefly these include:
A. Communication with patients and the dental team.
This includes aspects of obtaining consent, managing complaints and raising concerns
B. Patient management, management of the dental team
and management of self-leadership as appropriate
C. Maintenance and development of knowledge and
skill;
D. Maintenance of skills, behaviours and attitudes which
put patients’ interests first and maintain patient confidence.
The GDC website also holds a list of highly recommended
topics for CPD, for which they recommend certain levels of
engagement (number of hours) based on field of practice:
n
Medical emergencies;
n
Disinfection and decontamination; and
n
Radiography and radiation protection.
12 • Professionalism, Law and Ethics
309
They also recommend CPD in the following areas:
n
Legal and ethical issues;
n
Complaints handling;
n
Oral cancer: early detection;
n
Safeguarding children and young people; and
n
Safeguarding vulnerable adults.
The 2018 Enhanced CPD scheme requires dentists to
complete a minimum of 100 hours of verifiable CPD per
5-year cycle and to ensure hours are spread evenly over the
cycle, at least 10 hours must have been completed during
any 2-year time period.
For DCPs under the 2018 Enhanced CPD scheme, completion of a minimum of 50 hours of verifiable CPD is
required for dental nurses and dental technicians during
the 5-year cycle. A minimum of 75 hours verifiable CPD per
cycle is required for dental therapists, dental hygienists,
orthodontic therapists and clinical dental technicians.
Again, at least 10 hours must be completed during any
2-year period.
A written record of CPD must be kept by each registrant,
together with documentary evidence (e.g. certificates from
the CPD provider). Details of what CPD records must include
are available on the GDC website.
A CPD declaration is made annually by each registrant.
The ‘annual CPD statement’ includes: the number of hours
of CPD which have been completed; a declaration that a
CPD record has been kept; a declaration that a PDP is in
place; a declaration that the CPD is relevant to the current
or intended field or practice, and that the statement is full
and accurate.
Periodic checks are carried out by the GDC, and they can
randomly select registrants to check CPD records.
The previous GDC CPD scheme ran from 2008 to 2017
and included a combination of both verifiable and nonverifiable requirements. Transitional arrangements exist
until 2022 for certain registrants, depending on where they
are in the 5-year cycle.
Personal Development Planning
A PDP provides an opportunity to identify areas for further
development, record development objectives and encourage
life-long learning. It also aids development of a strategy to
achieve the goals set.
Following a learning or development activity, the participant should take time to consider what they have learnt,
whether their learning objective from their PDP has been
met and how they may benefit from their learning, and possibly how others may benefit (e.g. the team they work with).
Personal development plans are not static and may need
to be revised following reflection, or if learning needs alter
or if the individual’s field of practice changes.
GDC requirements are for a PDP that must include the
CPD which is planned during the registrant’s 5-year cycle
(this must be relevant to field of practice).
Reflective Practice
Reflection is important in development, and reflective practice aims to allow individual practitioners to assess their
professional experiences, recognise positives and where improvements could be made. Identification of opportunities
to improve may guide personal development planning and
learning. Reflection may be individual, but multi-disciplinary
and team reflection can be important for development and
improved practice.
In June 2019, a joint statement of support on the benefits of becoming a reflective practitioner was made by the
Chief Executives of the United Kingdom’s statutory regulators of health and care professionals. This included the
General Dental Council. Whilst approaches of reflective
practice from each regulator may vary, this statement
demonstrates the importance and value placed on reflection in learning and development.
Professional Standards Authority
The government originally set up the Council for the Regulation of Healthcare Professionals (CHRP) in April 2003,
and it consisted of 10 lay members and nine members
nominated by health care professions regulators, including
a GDC nominee. In the Health and Social Care Act (2008),
the name of the council was changed to the Council for the
Regulation of Healthcare Excellence (CHRE). The Council for
Healthcare Regulatory Excellence (CHRE) was renamed
under the Health and Social Care Act 2012 and became the
Professional Standards Authority (PSA).
The PSA is independent and accountable to the UK parliament. It oversees nine regulators who ‘register’ health
and care professionals; one of these is the General Dental
Council. The PSA encourages co-operation and greater
consistency in the work of health care regulators and promotes good practice. One of the PSA’s powers is to review
decisions of a health care regulator about practitioners’
‘fitness to practise’ and appeal to the appropriate court of
law against a decision where it considers that such a decision has been over-lenient.
The PSA board consists of eight members; none of
whom are health or care professionals. The board set the
strategic directions and are responsible for determining
overall policies. The PSA has adopted the approach of
right touch regulation, which includes ensuring understanding of a situation and proportionate regulation. Further information about the Professional Standards Authority and right touch regulation is available on their
website (www.professionalstandards.org.uk).
12.3 Titles and Descriptions
LEARNING OBJECTIVES
You should:
• understand what dental specialties are available
• know the scope and limitations of the tasks that Dental
Care Professionals undertake.
DENTISTS
Registration with the GDC allows the use of the titles
Dentist, Dental Practitioner or Dental Surgeon. Also, since
November 1995, the GDC has accepted the use of the courtesy title Doctor, provided that it is not used in a way to
suggest that the user is anything other than a dentist. The
services offered must be clear and must not imply that the
user is a medical doctor.
310
Master Dentistry
Before 1998, no other title was permitted, but the GDC is
now empowered to set up and maintain specialist lists of
practitioners who can show they have received sufficient
postgraduate training to be considered specialists in a particular field. Practitioners on these lists are permitted to use
the appropriate titles (e.g. ‘Specialist in Endodontics’).
Entry to the lists is determined by European and GDC
regulations. There are two methods of entry to these
specialist lists:
1. At the end of the appropriate time in a recognised train-
ing post, the appropriate postgraduate diploma and an
assessment by the Specialist Advisory Committee for the
specialty.
2. By virtue of current specialist practice and previous
training. Consideration of equivalents is known as medi-
ated entry. There was also a pathway open for 2 years
following the establishment of each individual specialist
list, this was referred to as transitional arrangements.
There are currently 13 specialist lists. These are:
Dental and Maxillofacial Radiology
Dental Public Health
Endodontics
Oral and Maxillofacial Pathology
Restorative Dentistry
Oral Medicine
Oral Microbiology
Oral Surgery
Orthodontics
Paediatric Dentistry
Periodontics
Prosthodontics
Special Care Dentistry
The specialty of restorative dentistry involves training
in endodontics, periodontics and prosthodontics; it therefore involves a longer training period than that required
for specialisation in only one of the other three recognised
restorative specialties.
In 2019, the GDC began quality assuring specialty training and education programmes in the United Kingdom.
Specialty curricula are developed by the Special Advisory
Committees (SACs) for a given specialty, for example, the
Specialist Advisory Committee for Special Care Dentistry.
Curricula are then approved by the GDC. There is a reference guide for postgraduate training in the United Kingdom, The Dental Gold Guide, which is produced by the UK
Committee of Postgraduate Dental Deans and Directors
(COPDENDs). The Dental Gold Guide sets out a framework
for the operational management of postgraduate specialty
training. In addition to outlining roles and responsibilities
of the organisations involved in specialty training, the guide
outlines stages in undertaking a training programme and
how trainees progress through a programme. The guide can
be downloaded from the COPDEND website (www.copdend.
org). For medical postgraduate training in the United
Kingdom, the Gold Guide is the reference guide, and this is
produced by the Conference of Postgraduate Medical Deans
of the United Kingdom (COPMeD). This guide, which is
regularly updated, is available on the COPMeD website
(www.copmed.org.uk).
The GDC is currently reviewing aspects of specialty listing and training; this includes specialty curricula and assessments and the mediated entry process to specialist lists.
Mediated entry and equivalents of specialty training are
currently under a comprehensive review. There is considerable flux around entry to the specialist lists in the United
Kingdom, and a number of stakeholders are currently involved, including the GDC, the SACs and Health Education
England (HEE).
Since the GDC originally established specialist lists, the
specialties included have altered. The original 13 specialist
lists established by the GDC were:
END OF TRANSITIONAL
SPECIALTY
Dental and maxillofacial
ENTRY PERIOD
31 May 2002
radiology
Dental public health 15 April 2000
Endodontics 31 May 2000
Oral medicine 30 June 2001
Oral microbiology 31 May 2002
Oral pathology 31 May 2002
Oral surgery 15 April 2000
Orthodontics 30 June 2000
Paediatric dentistry 30 June 2000
Periodontics 31 May 2000
Prosthodontics 31 May 2000
Restorative dentistry 15 April 2000
Surgical dentistry 31 May 2000
Surgical dentistry was confined to dento-alveolar
surgery, whereas oral surgery encompassed surgery to surrounding structures and the treatment of maxillofacial
injuries. At the December 2005 meeting, the GDC decided
to merge the surgical dentistry list into the oral surgery list.
Current surgical dentistry trainees and future trainees were
then expected to train to the oral surgery core competences.
Those previously admitted to the surgical dentistry list were
reminded that the professional duty is to practise only
within the limits of their competence. This change brought
the United Kingdom in line with the situation in the EU
and in many other countries. This merger took place in
April 2007.
In 2008, the GDC added another specialty, ‘Special Care
Dentistry’, again with a 2-year transitional period for those
already competent in that specialty.
Maxillofacial surgery is considered to be a medical specialty by the EU, and maxillofacial surgeons are registered
with the GMC.
DENTAL CARE PROFESSIONALS (FORMERLY PROFESSIONS COMPLEMENTARY TO DENTISTRY)
Since 1956, the GDC has been responsible for maintaining
a register of dental hygienists and dental therapists. The
2005 amendments to the Dentists Act of 1984 allowed for
the registration of other groups of dental care workers. In
12 • Professionalism, Law and Ethics
311
2005, the title Professions Complementary to Dentistry was
changed to Dental Care Professionals. Several new classes of
DCPs were eligible for registration, and ‘grand parenting’
arrangements were agreed for dental nurses and dental
technicians, but only for the first 2 years of this register.
The GDC Dental Care Professionals’ Register opened in
July 2006 and is separate from the Dentists Register. Registration for dental nurses and dental technicians became
compulsory in July 2008. Also, it became illegal for a nonregistered person to use any of the recognised DCP titles as
they are protected by law. For two of the new classes of
DCPs, clinical dental technicians and orthodontic therapists, registration has been compulsory since this register
opened.
The GDC Scope of Practice document can be found on the
GDC website and describes the skills and abilities each DCP
registrant group should have. The GDC makes it clear that
registrants should ensure they have the necessary skills, are
appropriately trained, competent and indemnified for the
patient care they deliver. The Scope of Practice document
also includes the additional skills a registrant may develop
if they have attended appropriate additional training and in
some cases undertaken appropriate assessment. The following descriptors of dental care professionals are based on the
GDC’s Scope of Practice document; the reader is recommended to refer to the GDC documentation to appreciate
the full scope of practice of each registrant group.
Dental Hygienists
This group of dental professionals help patients to maintain
their oral health by promoting good oral health practice.
They also work by preventing and treating periodontal disease. Among a range of other skills, dental hygienists use
indices to screen and monitor periodontal disease, undertake supragingival and subgingival scaling and root surface
debridement and also apply certain prophylactic materials
to the surface of teeth. They provide advice on preventive
oral care and smoking cessation. Hygienists who qualified
prior to 1992 and who administer local anaesthetic infiltration analgesia must have attended a course and received a
certificate in administration of local infiltration analgesia,
or hold the Diploma of Dental Therapy.
Dental Therapists
Among a range of other skills in the scope of the dental
hygienist, dental therapists undertake direct restorations on
primary and secondary teeth, can carry out pulpotomies
on primary teeth and extract primary teeth. Before 2002,
dental therapists were only allowed to work in the community dental service or in the hospital service, but now they
also work in general dental practice.
Dental Nurses
Dental nurses provide clinical and other support to registrants and patients. This includes, amongst other roles,
preparation of the clinical environment, chairside support
to other registrants during treatment and monitoring, support and reassurance to patients. Following appropriate
additional instruction, additional skills dental nurses could
develop include further skills in oral health promotion and
oral health education. Additional skills carried out on
prescription from, or under direction of, another registrant
could include taking radiographs, removing sutures after
the wound has been checked by a dentist or taking impressions to the prescription of a dentist.
Orthodontic Therapists
Orthodontic therapists are permitted to carry out certain
parts of orthodontic treatment under prescription from a
dentist. Their roles can include taking impressions, inserting removable orthodontic appliances, fitting orthodontic
headgear, separators and orthodontic bands, placement of
direct bonded orthodontic attachments and the ligation
and removal of archwires previously fitted by a dentist and
the removal of orthodontic bands and excess cement.
Dental Technicians
This group of dental professionals make dental devices to
the prescription of a dentist or clinical dental technician.
They are also able to repair dentures direct to members of
the public. In addition to the construction of appliances,
they can take tooth shades of patients for the construction
of prostheses.
Clinical Dental Technicians
This registered group of dental professionals, who are also
qualified dental technicians, provide complete dentures direct to patients, and other dental devices on prescription
from a dentist. Clinical dental technicians can refer patients
to a dentist if they are concerned about a patient’s oral
health, or if they need a treatment plan. Patients who have
implants or natural teeth must be seen by a dentist before a
clinical dental technician can do any treatment.
Maxillofacial prosthetists and technologists were originally included in the GDC’s list of PCDs, but as much of
their work is non-dental, the Institute of Maxillofacial Prosthetists and Technologists, on the recommendation of the
Department of Health, has elected to be registered with the
Health Professions Council rather than the GDC.
Direct Access
In the United Kingdom, since 2013, the GDC has allowed
certain DCP’s to provide a range of services directly to the
general public without the need for a referral or a prescription from a registered dentist.
Before undertaking direct access, registered DCPs must:
n
be appropriately trained, competent and indemnified for
any tasks they undertake
n
continue to work within their scope of practice regardless
of this change in status
n
follow the GDC’s Standards for the Dental Team
n
DCPs do not have to offer direct access and should not be
made to offer it.
Dental Hygienists and Dental Therapists can carry out
their full scope of practice without prescription or having to
see a dentist first if they are confident that they have the
skills and competences required. They are not permitted to
directly undertake tooth whitening or botulism toxin treatment and are not able to prescribe local anaesthesia. Those
who were trained and registered prior to 2002 may require
‘top-up’ training.
Dental Nurses can participate in preventative programmes
without the patient(s) having to see a dentist first.
312
Master Dentistry
Orthodontic Therapists can carry out Index of Orthodontic Treatment Need (IOTN) screening, but the majority
of their work remains under the prescription of a dentist.
Clinical Dental Technicians can continue to provide and
maintain full dentures for patients. Other work must have a
prescription from a dentist.
Dental Technicians, apart from denture repairs, continue
to carry out work only on the prescription of a dentist.
12.4 Requirements for the Practice of Dentistry
LEARNING OBJECTIVES
You should:
• understand how the GDC carries out its regulatory
tasks and how disciplinary matters are dealt with
• understand the educational and indemnity require-
ments of being a member of a profession.
REGULATION BY THE GENERAL DENTAL COUNCIL
It is the GDC’s duty to maintain the Dentists Register and
the Dental Care Professionals Register. The Registrar and
Chief Executive of the GDC is responsible for ensuring the
accuracy of these registers. The Registrar must remove the
name of any dentist or DCP who fails to satisfy requirements for ongoing registration. A name can only be restored to the register by formal application and the payment
of a restoration fee in addition to the annual retention fee.
Evidence of CPD may also be required, depending on how
long someone has been off the register. Further information may also be required depending on circumstances; this
may include a Certificate of Current Professional Status
(CCPS) and/or demonstration of English language knowledge. There are mechanisms to appeal erasure from the list;
these depend on the reason for removal. Further information is available on the GDC website.
Education
The Dentists Act (1984) gives the GDC the responsibility to
supervise all stages of dental education, postgraduate as
well as undergraduate. The GDC quality assures new and
existing programmes which lead to registration. The GDC
determines minimum standards and sends an inspection
panel to dental schools and other training establishments to
check on standards of teaching and of examination of students. It has the power to recommend that the recognition
of a dental qualification by the GDC is withdrawn should
the council consider that the training or examination no
longer secures sufficient knowledge and skill to practise
dentistry.
The 2005 Amendment Order requires the GDC to determine the appropriate standard of proficiency required and to
specify the content and standard of education and training
required for the registration of DCPs.
The GDC document Preparing for Practice: Dental Team
Learning Outcomes for Registration (2015 revised edition)
presents the learning outcomes which an individual must
be able to demonstrate at the end of a period of training for
each of the professions registered by the GDC.
The outcomes are presented by profession (dentist, dental
therapist, dental hygienist, dental nurse, orthodontic therapist, clinical dental technician and dental technician) in a
domain structure, with varying content and numbers of
outcomes for each group. The four domains included are:
n
clinical
n
communication
n
professionalism
n
management and leadership.
Quality assurance processes for education and training
programmes leading to registration with the GDC are
outlined in the GDC Quality Assurance Guidance for Educa-
tion Providers document. A further document, Standards
for Education, outlines the standards required by providers
of UK dental GDC accredited training programmes. Standards for Education highlights three areas of requirements:
patient protection; quality evaluation and review of the
programme; and student assessment.
Education providers of qualifications that lead to registration as a dentist with the GDC must hold dental authority status; this is a legal status granted by the Privy
Council. Standards for Education forms the basis of the
quality assurance processes and monitoring/inspection
of programmes leading to registration. If the required
level is achieved, programmes that lead to registration as
a dentist are found ‘sufficient’ and programmes leading to
DCP registration are ‘approved’ (the terminology is dictated by the Dentists Act 1984).
A number of resources are available for students on the
GDC website. These are aimed at supporting understanding
and how standards may be applied in specific situations. An
example of this is the resources on student professionalism,
which include guidance and case studies.
As discussed in the previous section, in 2019, the GDC
became responsible for quality assurance of specialty
education. The Standards for Specialty Education document
contains the standards and requirements for programme
and examination providers. Requirements are presented
under the areas of: patient protection (programme providers only); quality evaluation and review of the programme
and specialty trainee assessment. Specialty curricula are
currently under review and new curricula are expected to
be implemented in 2022.
Conduct
The GDC also has a duty to remove from the Dentists
Register or the Dental Care Professionals Register any member who is shown to have behaved in a manner unsuitable
for continued registration. The GDC has regularly issued
written advice on the standards required by the professions
it regulates; further information is available on the GDC
website.
At all times, the dentist’s and dental care professional’s
conduct must be of the high standard that the public and
the profession expect. The dentist’s first priority is a responsibility to patients. If a dentist’s conduct falls below this high
standard, the GDC has the power to suspend or remove the
dentist’s name from the register. Conviction for a criminal
12 • Professionalism, Law and Ethics
313
offence or serious professional misconduct can be grounds
for refusal of admission, erasure or suspension from the
register. Conduct or behaviour prior to qualification is also
considered by the GDC; therefore, this power also applies to
students. Any dentist or DCP who is found guilty of serious
professional misconduct in another country may not be
entitled to register with the GDC.
Serious professional misconduct by a dentist cannot be
precisely defined. However, it is considered to be conduct by
a dentist that falls short of the standards of conduct expected among dentists, and that this should be a serious
omission/commission. Specifically, the GDC has to decide
upon a dentist’s Fitness to Practise (FtP) if a concern is
raised. In the case of DCPs, the GDC uses the more general
term of ‘misconduct’ for matters that may be investigated
and be subject to disciplinary action. Also, any criminal
conviction in the United Kingdom of a person on a GDC
register is automatically forwarded to the council by the
police, who may also inform the GDC of formal cautions
and other matters of concern. Standards for the Dental Team
also requires registrants to report any criminal proceedings
or regulatory findings made against them, anywhere in the
world, directly to the GDC.
When Concerns Are Raised
In addition to criminal convictions, a patient, a member
of the public, another dentist or a DCP may raise a concern to the GDC. If serious concerns are raised about a
dental professional’s ability, health or behaviour to the
GDC, they can look into these if there is a suggestion
these could lead to significant harm to patients, the
general public or colleagues and/or undermine public
confidence in the profession.
The GDC has a responsibility to investigate when concerns
are raised regarding possible impaired fitness to practise of a
registrant.
Until 2004, disciplinary hearings were conducted by
various committees made up of GDC members. The GDC
started discussing major reforms in 2000 to update its
functions and membership to make the organisation fit and
appropriate for the 21st century. One of the reforms was to
set up an independent Fitness to Practise Panel made up of
people who are not members of the council. A pool from
which the membership of the disciplinary committees
would be formed thus allowed the council to concentrate on
strategy, such as setting standards, and also ensuring that
there was no risk of compromising the integrity and impartiality of conduct hearings. This pool consists of dental
professionals (dentists and dental care professionals) and
lay members.
Panel members are initially appointed for 5 years and
have been given appropriate training for their task. As has
always been the case, appropriate legal advice is always
available for all conduct hearings.
Fitness to Practise Investigations
Outlined below are stages and committees which can
be involved if concerns are raised to the GDC. The details
have the potential to change over time, and these processes
are related to the United Kingdom; however, they are likely
to be mirrored by regulators/organisations around the
world. For location-specific information and specific detail,
the reader should access information directly from the
relevant regulator.
Initial Assessment of Concern or Received Information
When concerns are raised to the GDC, they undergo an
initial assessment by the Initial Assessment Decision Group
(IADG); this consideration uses the Initial Assessment Test
(IAT). The group considers whether, in principle, the concern would be a fitness to practise issue if it were proven
true and also the risk involved which informs the urgency
of any investigation. If a more urgent process is indicated,
this is the Interim Orders Committee (IOC).
There are specific circumstances when IADG may refer
low-level concerns which do not give rise to a fitness to
practise concern, to the NHS. There are categories within
which concerns referred to the NHS must fit.
Investigating Committee
The Investigating Committee (IC) considers if allegations
should be referred to a Practice Committee for a full inquiry.
Meetings of this committee, which is made up of trained
members drawn from an independently appointed pool, are
held in private. This committee can:
n
close the case should no further action be needed
n
adjourn the case for further information
n
issue a letter of advice
n
issue a letter of warning to the registrant, which, if
appropriate, may be published on the GDC’s website, or
n
refer the case to a Practice Committee for a full inquiry
and, if necessary, refer the case immediately to the Interim Orders Committee to consider if action is required
before a full inquiry by a practice committee.
The remaining committees are drawn from the FtP Panel.
The Interim Orders Committee
At any stage in the investigation, a case may be referred to
this committee. This committee has the power when necessary to protect the public, the public interest or the registrant themselves pending the outcome of the case. It does
not investigate allegations or conduct a fact-finding exercise.
If necessary, this committee can:
n
suspend a registrant for up to 18 months, with 6-monthly
reviews
n
impose conditions on a registrant for up to 18 months,
with 6-monthly reviews
n
decide that no order is necessary.
The Practice Committees
There are three Practice Committees whose role is to determine whether a registrant’s fitness to practise is impaired and, if so, what action has to be taken to protect
patients. Also, these committees have the direct power to
impose interim suspension, or conditions limiting the field
of practice, if it is considered that immediate action to
protect the public is needed pending the final outcome of
a particular case. If one of these committees considers it
appropriate, it can refer a case directly to another practice
committee.
314
Master Dentistry
These committees are:
the professional conduct committee. This committee inves-
tigates cases involving conduct issues. It has the power to:
n
conclude a case without further action if it is considered
that fitness to practise is not impaired
n
issue a reprimand
n
impose conditions on the registrant for up to 3 years,
for example, prohibiting a registrant from working in a
particular field of practice, to take immediate effect if
required
n
suspend a registrant for up to 12 months, with or without a review. Again, with immediate effect if required
n
erase a registrant from the register, which recently became
for a compulsory minimum of 5 years.
n
refer the case back to case examiners, the Investigating
Committee or to the Interim Orders Committee or one of
the other practice committees.
After July 2006, any new case reported to the GDC that
is assessed by the Professional Conduct Committee is no
longer judged as being guilty or not guilty of serious profes-
sional misconduct but whether or not their fitness to practise
is impaired. Also under these rules, the committee can sanc-
tion a suspension with review, which gives the committee the
power to recall the suspended registrant before the end of
the period of suspension to check whether or not the suspended person is fit to be returned to the register.
the professional performance committee (ppc). This com-
mittee deals with cases where it appears that a registrant’s
performance may be deficient, and that deficiency would
mean an impairment to fitness to practise.
This committee can impose conditions or suspend registration in the same way as the Professional Conduct Committee.
the health committee. The Investigating Committee refers
cases to this committee where it appears that fitness to practise is due to a health condition. This committee can impose
the same sanctions as the other practice committees, including referral back to case examiners, the Investigating Committee or other practice committees. It cannot, however,
erase a dentist from the register if it determines that fitness
to practise is impaired solely as a result of adverse physical
or mental health.
The GDC, on their website, have learning points from the
fitness to practise process, including the types of issues represented. Examples include the types of clinical treatment
concerns, conduct concerns and consent concerns which
have led to cases being opened for further investigation.
Advertising
Guidance on advertising has been issued by the GDC,
which took effect from 30 September 2013. This incorporates important recommendations in the Code of Ethics for
Dentists in the EU. The GDC clearly states that whenever
the name of a registrant appears on any form of advertising, it remains the responsibility of that individual dental
professional to ensure the accuracy of their personal information appearing.
It states specifically that:
n
if mentioned on a website as providing dental care as a
dental professional, his or her professional qualification(s)
and the country where it was obtained is stated
n
clear language that patients will understand is used
n
all claims made are backed up with facts
n
ambiguous statements are avoided
n
no statements of claims are made that could create an
unjustified expectation of achievable results
n
only dentists on a GDC specialist list can refer to themselves as a ‘specialist in …’
n
dentists not on a specialist list should not use specialist
titles such as Endodontist, Orthodontist, etc.
n
dentists who limit their practice completely or mainly to
a particular form of treatment should use terms such
as ‘practice limited to . . . ’; ‘experienced in . . . ’ or ‘special
interest in . . . ’.
All information and publicity regarding dental services
should meet the following criteria:
n
Be legal, decent, honest and truthful.
n
State whether the practice is NHS, mixed or wholly
private.
n
Information should be balanced, factual and in a language
that patients understand to help them make informed
choices about their treatment.
n
Products should only be recommended if they are the
best way to meet patients’ needs.
Websites
In addition to the above, websites should include:
n
the name and geographic address of the dental practice/
service
n
full contact details of the practice/service, including
telephone number and email address
n
the GDC’s full contact details or a link to the GDC website
n
details of the practice’s complaints procedure, and details of who patients may contact if they are not satisfied
with the response from the practice
n
the date when the website was last updated.
Websites should be regularly updated to accurately reflect
the current personnel and the services offered. No comparative information comparing the skills or the qualifications of
one dental professional with another should ever be displayed.
Listing memberships of professional associations and societies,
or honorary degrees, can be misleading and imply additional
skills. It would be sensible for registrants to consider this information and how it may mislead patients or be criticised as
misleading patients, and ensure current guidance is followed.
OTHER REQUIREMENTS FOR THE PRACTICE OF DENTISTRY
Following qualification, a dental surgeon is immediately
eligible for full registration with the GDC. Before commencing the practice of dentistry, however, there are several requirements or recommendations that should be carried out
in addition to registering with the GDC.
n
the registrant must ensure information is current and
accurate
n
his or her GDC registration number is included
Professional Indemnity
Dentists have always been advised to have professional indemnity (insurance) cover in the unfortunate occurrence
12 • Professionalism, Law and Ethics
315
that they are sued for damages or their actions are investigated by a statutory body. However, since November 2015,
the GDC has made proof of sufficient indemnity cover a
requirement of being on the Register. This was in further
clarification of the Amendment Order 2005 (of the Dentists
Act 1984), which made adequate and appropriate insurance (professional indemnity) compulsory for retention on
the Dentists or the Dental Care Professionals Registers.
Until 2019, there were three organisations in the United
Kingdom that provide indemnity for dentists and doctors.
These are mutual organisations, which mean that the organisation belongs to the members and all profits made by
these organisations have to go to the benefit of the members
(unlike a limited company where owners or shareholders
reap the benefit of any profits). These organisations are:
n
the Dental Defence Union (a subsidiary of the Medical
Defence Union)
n
Dental Protection (a subsidiary of the Medical Protection Society)
n
the Medical and Dental Defence Union of Scotland.
These non-profit making (mutual) organisations provide
members with indemnity against any legal action brought
by patients; advice and assistance on medicolegal matters;
legal representation at courts, tribunals or professional
committee hearings on disciplinary matters and general
advice on professional conduct.
Hospital trusts and health authorities as employers of
salaried practitioners have corporate indemnity should a
patient sue the organisation or individual employees. However, this cover does not include representation of a practitioner at tribunals or disciplinary hearings of any sort.
Therefore, it is advisable to belong to one of the professional
protection organisations; these organisations offer lower
rates of subscription for those practitioners who have indemnity from their employers.
In 2019, the British Dental Association set up its own indemnity scheme restricted to British Dental Association
(BDA) members who practice in the United Kingdom (excluding those practising in the Isle of Man or the Channel
Islands). This is a hybrid scheme, where advice, assistance
and case management is provided by an expert team of senior BDA members, whilst legal representation and financial
indemnity is provided by a major UK insurance company.
The indemnity cover with all the above organisations is
‘occurrence based,’ which means that the policy has to be
active when an unfortunate incident or treatment occurred. This is important as patients have the automatic
right to claim in court for up to 3 years after they were
aware of any damage or negligence from treatment. Also,
in extenuating circumstances, the courts may extend this
3-year limit.
Professional indemnity is also available on the commercial market, but this normally has a maximum limit of
indemnity and only provides cover within the time of the
insurance contract (i.e. a ‘claims made’ contract, so that it
may be necessary to continue to have the insurance for
several years after retirement!). Therefore it is important to
carefully check the contract of your insurance to ensure
continuing cover. This is an important factor, which is
recognised and covered by the professional protection
organisations, as there may be a delay of several years
between an incident occurring and a patient bringing an
action for damages, and is referred to as ‘Incurred But Not
Reported’ (IBNR). Also, it is unlikely that advice on medicolegal matters, legal representation at tribunals or professional committee hearings on disciplinary matters, or
general advice on professional conduct would be available
with commercial insurance cover.
Whoever you choose to obtain professional indemnity
from, the premium that will be charged will depend on the
scope of your practice.
The First Steps
For many years, there was nothing to prevent a dental surgeon on qualification and initial registration from setting
up in single-handed private practice, but the benefit of a
period of a supervised practice cannot be overemphasised.
The majority of UK dental graduates undertake a year of
Dental Foundation Training (DFT) in general practice on
qualifying. Foundation training, previously known as Vocational Training (VT), is under the supervision of Regional
Postgraduate Dental Deans and provides a very good introduction to the practice and business of dentistry. Successful
completion of Dental Foundation Training allows entry to
the NHS Performers List in England and Wales and Health
Boards in Scotland and Northern Ireland.
Recruitment to Dental Foundation Training in England,
Wales and Northern Ireland is by a national recruitment
process, and recruitment to Scottish schemes is currently
managed separately. National recruitment involves competitive assessment, and at the time of writing included
online Situational Judgement Testing (SJT) and face-to-face
assessment stations. The Dental Foundation Training Curricu-
lum, which includes a competency framework and detail of
assessment, can be found on the COPDEND website (www.
copdend.org).
Continuing Education
There are several important aspects to postgraduate training
and education.
Further information and detail of postgraduate and
specialty training can be found on the specialty training
section of the NHS Health Education England website
(www.hee.nhs.uk), on the postgraduate training section
of the COPDEND website (www.copdend.org) and the den-
tal faculty sections of the Royal Surgical Colleges.
Dental Core Training (DCT)
This is a recognised, standalone period of training with a
number of exit points. It occurs after DFT and prior to entry
to specialty training. There are DCT 1, 2 and 3 posts, each
with competitive entry. Trainees will have clinical and
educational supervisors, the level of skills and attributes
develops through the training years. Further information
about DCT recruitment and the curriculum can be found
on the COPDEND website.
Specialist Training
There is a national recruitment and benchmarking process
for places on specialty training programmes. The benchmarking process ensures that individuals who gain entry to
specialty training have demonstrated an appropriate level
of knowledge, clinical skills and experience. On successful
316
Master Dentistry
completion of the appropriate period of higher professional
training and obtaining any required postgraduate qualifications, a certificate of completion of specialist training
(CCST) will be issued, and that dentist will then be eligible
to apply to join a specialist list held by the GDC.
General Dental Practice
There is no formalised postgraduate equivalent training in
general dental practice, but general practitioners can undertake further study to sit for various diplomas awarded by
the Royal Surgical Colleges.
The Royal Surgical Colleges are associated with numerous
opportunities for postgraduate development. An example of
recognition of additional training is through the award of
Fellowships and Memberships of the various Colleges. In
addition to examinations and assessments, the Colleges
offer learning through events and courses and support in
personal development.
Continuing Professional Education
It is essential that dental surgeons, or members of any other
profession, continue to update their knowledge and expertise throughout the whole of their professional practising
life. Learning more about dentistry should continue until at
least retirement to provide the best for one’s patients.
As detailed previously, continuing professional education/
development is now a prerequisite to remaining registered
with the GDC.
Professional Organisations and Societies
It is not compulsory to join any organisation or society connected with dentistry, but all dentists practising in the
United Kingdom are recommended to join the BDA. The
BDA is the official negotiating body with the government on
matters concerning general dental practice and the community dental service. It also contracts with the British
Medical Association to negotiate on behalf of the hospital
dental service and clinical academic staff.
Advice on all aspects of dental practice is available to
members from the BDA, and it has a large library available to
members. The BDA publishes many advice booklets, which
are regularly updated, as well as giving individual advice on
request. The British Dental Journal is published on behalf of
the BDA and contains scientific papers and useful review articles. Also in the BDJ Portfolio of publications is the BDJ In
Practice, published monthly, which updates members on
developments and issues affecting dental practices including
legal and ethical matters pertaining to all aspects of dentistry. As it is a registered trade union, the BDA can assist
members who have problems relating to their employment.
There are also many specialist dental societies, and it is
worthwhile joining those related to any special interest.
Dental surgeons undergoing higher professional training
are strongly recommended to join the appropriate specialist
society or societies pertaining to their specialty.
successfully in the patient’s best interest, as well as having the
necessary equipment and materials available to complete
the task.
Referrals
If a dental surgeon does not feel competent to complete a
particular treatment for their patient, or if the patient requests a second opinion, then that patient should be referred
to a colleague or specialist. Referrals can be made by multiple
routes of communication including paper-based or electronic
means, but in cases of acute emergency or life-threatening
conditions, telephone referral can be acceptable.
All correspondence of referral should contain:
n
the patient’s full contact details and appropriate demographic information
n
the reason for the referral
n
whether the patient is referred for:
n
an opinion only
n
a special investigation only, e.g. advanced imaging
n
treatment of a specific condition
n
complete and continuing treatment.
n
the patient’s medical history
n
details of any relevant treatment already carried out
n
whether the patient has requested NHS or private
treatment.
There are specific criteria for referrals for general anaes-
thesia and sedation, which are described later in this chapter.
It would be considered best practice for the person receiving the referral to focus treatment and advice to that
requested by the referrer. It could be considered negligent
to not offer comment on observations made during a consultation. It would be expected that the person receiving
the referral should inform the referring practitioner of
their decision, observations made and any proposed treatment, by written correspondence. In the case of a referral
for an investigation, rather than treatment, a comprehensive report of that investigation would be expected to be
sent to the referring dentist.
On completion, a letter of information should be sent to
the referrer, with a copy to any other party relevant to the
patient’s care (e.g. the patient’s general medical practitioner),
and offered to the patient.
12.5 Records and Documentation
LEARNING OBJECTIVES
You should:
• realise the importance of neat contemporaneous
records detailing all aspects of patient care
• have a clear understanding of informed consent prior
to undertaking any treatment
• be aware of the importance of a chaperone.
Ability and Experience
Ability and experience are essential matters of self-regulation
throughout one’s professional life, not just at the beginning.
Prior to undertaking any particular item of treatment for
a patient, a dental surgeon must be certain that (s)he has
both the ability and the experience to complete the treatment
RECORDS
The patient’s records do not just consist of clinical notes but
also include radiographs, referral letters and replies, study
models, occlusal recordings, photographs, dental laboratory