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An NHS prescription can only be written for a patient who is receiving an NHS course of treatment or treatment of an urgent condition under the NHS. If any of your patients are being treated on a private basis, and they require a prescription-only medicine, this must be prescribed privately, or dispensed at the practice.

 
It is important when dispensing medication that the appropriate records are kept of what is given and the dosage, etc.

Dental Protection has produced a risk management module, Drugs and Prescribing, which provides advice on prescribing, and is available to members from Prism, our e-learning learning library.

The current guidance from the General Dental Council and from the Faculty of General Dental Practice of the Royal College of Surgeons of England is that a patient’s medical history should be checked and updated at every treatment visit.

In practical terms it is good policy to take a full medical history every time a patient is examined and the use of a medical history form provides an excellent way of recording this information.

It is important, however, that the patient is not left to complete the medical history form; whoever is carrying out the examination should go through all the questions with the patient to ensure they fully understand them or indeed can actually read.

Such questioning should obviously be carried out in a manner that ensures patient confidentiality. If a practice wishes to become paperless, the medical history form can be scanned onto the computer. The hard copies should then be be shredded or incinerated.

When a patient attends for an appointment as part of a course of treatment, it is always worth checking to ensure they have not started on any medication or have suffered any relevant illnesses since their last visit. Some practices encourage patients to volunteer such information by placing a sign in the waiting room requesting patients to inform their dentist of these types of changes.

Taking a full medical history at each examination can be onerous, but it is certainly worthwhile both to protect the patient and the dentist’s own position. Having a written record of the patient’s medical history, signed by the patient, often affords protection to the dentist – particularly if an allegation is made that he or she had not taken the patient’s medical history into consideration when carrying out treatment, which subsequently resulted in the patient being avoidably harmed.

Most patients have an expectation that their dentistry will either be pain-free or that any pain will be managed effectively. Therefore, the provision of a local anaesthetic for a given procedure will initially involve a discussion with the patient about the nature of the procedure being contemplated and what they may expect.

This is an issue of consent. As a clinician, you should not impose your views and provide treatment without local anaesthetic simply because you have considered the matter (as requested by the practice owner) and concluded that the procedure will not be painful and does not require local anaesthetic. It is incumbent upon clinicians to respect patient autonomy and an individual’s right to make decisions about their treatment and this would extend to a decision about local anaesthetic.

In any case, the patient’s medical history initially needs to be checked and updated before considering the type of local anaesthetic to be administered.

The barrister will have been instructed by the Trust's solicitors to protect the Trust's own position and its interests. It may be that questions will be asked at the coroner's inquest about the role of the theatre or nursing staff who were responsible for the deceased's care. The barrister will normally be instructed to deal purely with the reputation of the Trust and other members of staff and may not be there to protect your own position particularly if there is a conflict between you and the Trust about the events leading up to the death of the patient.

In cases like this, Dental Protection’s solicitors have instructed an experienced barrister to work with our solicitors, the dento-legal adviser and the consultant to prepare for the Inquest. The barrister would normally attend the Inquest and look after the interests of the consultant oral and maxillofacial surgeon during the hearing, especially where the consultant’s care of the patient is likely to be subject to detailed investigation by the coroner and/or the deceased’s family.

The Dentists Act requires that the ARF is paid in full on or before 31 December (for dentists) and there are no exceptions. Continuing to practise or to have an interest in the ownership of a practice while unregistered would be the illegal practise of dentistry and/or unlawful involvement in the business of dentistry and could in both respects result in a criminal prosecution and invalidate any professional indemnity held by the dentist in question.

You will need to stop working and apply to the GDC for the restoration of your original registration . This involves providing a character reference and a health declaration. It is likely that processing an application for restoration will take some time, and you should make appropriate arrangements for the care of your patients in the meantime.

No, it certainly isn't true. A dental member, who is working in general or specialist dental practice, could be held to be vicariously liable for the negligent acts and omissions of a dental nurse working under their direction and supervision, even if they are not the actual employer of the dental nurse.

What makes our approach different from that of other defence organisations is that we offer several categories of membership in which an employer/practice owner can provide access to indemnity for registered dental nurses (or dental technicians) employed by them, in respect of negligence claims, whether or not they are working with them or directing/supervising them at the time of an adverse incident. We believe this flexible approach is fairer to practice owners, associates and dental nurses alike.

Indemnity offered through an employer however only extends to claims in negligence and will not provide assistance for any GDC or disciplinary matters, or for the provision of individual written or telephone advice from Dental Protection.

Indemnity, offering the full range of member benefits is available to all registered dental nurses either as direct members (following the payment of the appropriate subscription) or (free of charge) where the practice is part of the Dental Protection Xtra scheme.

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Some practitioners use the services of a treatment co-ordinator to provide the patient with information about their treatment and to answer their questions, although it would still be for the dentist and treating clinician to obtain consent rather than another member of the team. For obvious reasons, the treatment co-ordinator would not be in a position to provide any clinical advice.

The role of the co-ordinator can sometimes be helpful in showing patients information about various treatment options which have already been discussed with the dentist. A treatment co-ordinator usually has more time to spend with the patient and some patients are more inclined to ask questions of a treatment co-ordinator than they are to ask questions of the dentist. However, there may be other patients who do not want to discuss any aspects of their possible treatment with anyone other than the dentist.

If a patient brings a civil claim in negligence, a lack of detailed contemporaneous records of the consent process may mean a claim that could otherwise be defended has to be settled.

Any practitioner planning to use a treatment co-ordinator will need to work closely with them to ensure there is no potential for miscommunication or misunderstanding and that everyone is aware that the ultimate responsibility for taking the patient appropriately through the consent process lies with the treating practitioner.

While it is tempting to capture various intra-oral situations with a handheld mobile camera phone, it is important to appreciate that the making of that image creates a record. This electronic record has the same quality of confidentiality as all other records and should be managed accordingly.

Can you be sure that only the intended recipient will see the image? Unless there is encryption software on the phone, confidential material could be available to anyone who accesses the device especially if it is lost or stolen.

The images, even on high resolution camera phones, may not be sufficient to make a diagnosis and may even lead to misleading advice being given. There is also the issue of storage since as a record it will require the same degree of permanence as other records. It cannot therefore simply be deleted.

The General Dental Council’s requirement is that registrants undertake a set amount of CPD within a five-year period and therefore if that registrant wishes to undertake all of that CPD in the last six months, then he or she is perfectly entitled to do this. That is not to say, however, that such an approach would be wise as this is an awful lot of CPD in a very short period of time. Simply trying to find courses that cover the core subjects within this brief window of opportunity might well be difficult. 

Undertaking CPD in this way is not within the spirit of the GDC’s advice. Some patients might be alarmed if they knew the treating clinician held this view and was likely to be somewhat out of date at a given point in time.

The role of the hygienist has changed significantly over the last few years and is likely to do so again. Your hygienist colleague is likely to be a long way behind the times and the provision of her treatment might well suffer accordingly.

Even if it is within my scope of practice and I have appropriate training what should I do if I don’t feel confident about undertaking a particular treatment for a patient? Would I be vulnerable if I tell the practice owner about my reluctance to provide that treatment?

Principle 7.2.1 of Standards for the Dental Team states that you must only carry out a task or type of treatment if you are appropriately trained, competent and confident, and indemnified. Insertion of the word ‘confident’ is new and is a largely subjective judgement for each individual to make.

The need to feel confident is likely to be particularly relevant to DCP/therapists and new dental graduates who may find they are asked to carry out something which, though falling within their scope of practice and trained to provide, they may lack the confidence to undertake. The introduction of the new wording legitimises the decision to decline to carry out the task. On the other hand it may well be possible to build a degree of confidence if it is possible to provide a mentor or supervisor on site who could assist and advise when needed and to help build confidence and ensure patient safety. This clause may also apply to more experienced clinicians learning a new technique who may also wish to use a mentor or to work with a degree of supervision.

Paragraph 7.2.2 develops the situation further by stating: ‘If you are not confident… you must refer’. There is no choice; this is a ‘must’, not a ‘should’ and dignifies the referral process if the registrant considers they are not confident to carry out a particular treatment. A practice owner would need to recognise that by declining to carry out a particular treatment due to lack of confidence, the clinician is adhering to the GDC Standards document.