Within this principle, standards 1.7.1 and 1.7.5 clearly explain that all referrals must be made in the best interests of the patient. Any financial transactions must be transparent and able to withstand independent scrutiny, without any hint of a decision being influenced by a financial benefit to the practice or referring dentist at the risk of harm to the patient. This is crucial where the practitioner has any concerns about the training or competence of the in-house implant dentist (for example) and is not permitted to refer out of house by the owner. Such a situation would be contrary to the best interests of the patient (see question above.)

The same logic would apply to any in-house fee paid for a private referral to a hygienist.

This standard puts the interests of the patient as paramount when any decision is made about treatment or decisions about referrals. The GDC and the public will expect that any conflict will need to be resolved in favour of the patient.

Looking at this principle together with standards 1.7.2, 1.7.3 and 1.7.4 there appears to be very little room for doubt. Patients must be given a real choice, and a practice cannot hide behind a ‘policy’.

If the practice uses the services of a hygienist, the practice may give the NHS patient an option of seeing the hygienist privately. However, if the patient does not want to have the treatment privately, then under the terms of NHS contract, there is an obligation to provide all necessary treatment on the NHS.

The GDC recognises that patients expect their interests to be put before financial gain and business need. Since the GDC’s function is to protect the patient it is likely to take dim view of those who do not meet patient expectations. ‘You must always put your patient’s interests before any financial, personal or other gain’ 1.7.1

The NHS does accept that patients may choose a private option - for example if in the opinion of the dentist, the treatment is not clinically necessary and the patient is insistent on having this done or simply because the patient preferred to have the treatment provided privately.

If a private charge is to be made for scaling and polishing, the mixing rules must be adhered to - with an FP17 DC form signed to confirm the choice made by the patient. In those circumstances, there is no cause for concern.

It means that when assuming responsibility for the care of a patient, a registrant must be mindful of the impact that any decision taken about oral health may have on the general health of the patient. Taken simply it means that no decision about an individual item or items or treatment can be made without considering the wider implications for the patient.

This standard (1.4) is particularly relevant when patients seek one off cosmetic treatments that have limited or no therapeutic benefits. It also means that when seeing a patient on referral for an item of treatment, an overview of the oral health of the patient should be taken and the treatment plan discussed in that context, rather than in isolation.