Looking to the future when revalidation commences, each registrant is likely to require a Personal Development Plan (PDP). Each learning event and episode of formal training should be anticipated, documented and a reflection on the learning experience kept in the PDP. This provides invaluable evidence of a commitment to lifelong learning.

In the meantime, any in-house training offered to team members needs to be properly documented, with aims and objectives together with the learning outcomes clearly listed. Evidence of attendance should be kept with certification where appropriate (CPR training, for example).

Where practical training is being undertaken, a log should be kept of the number of tasks undertaken in the three following categories:

• Directly observed
• Carried out under close supervision
• Carried out unsupervised, but checked. This checking stage should be documented.

Similarly with any course attended, certification and ideally a reflective record compiled by the participant should be kept.

Standard 6.2 simply says; you must be appropriately supported when treating patients. The word ‘must’ indicates that this is an absolute requirement rather than a suggestion. But this clarity is diluted by the use of the word ‘appropriate’ which introduces an element of judgement and creates a degree of ambiguity. Although ‘appropriate support’ is not defined in the guidance, there are four very good reasons why it might be sensible for a dental hygienist to be supported by a dental nurse when treating patients:

• Response to a medical emergency
• Managing infection control
• Chaperonage
• Chair side assistance with patient care and note-taking

Clearly there are cost implications associated with the employment of additional manpower in any business and the GDC recognises (in a personal communication about interpretation) that although the permanent support of a dental nurse might be desirable, if only to make the treatment session run more efficiently, situations will arise where the patient can be safely treated by a hygienist without chair side support but where assistance can readily be summoned in an emergency.

Standard 6.2.2 says: You should work with another appropriately trained member of the dental team at all times when treating patients in a dental setting.

• By adopting the use of the word ‘should’, this indicates that the duty does not apply in all circumstances. When deciding whether the duty should apply (there is reference to the circumstances in the guidance), it is necessary to consider the other standards in the guidance in order to decide whether or not the hygienist can work on the patient without a dental nurse in a specific set of circumstances. Patient safety is paramount amongst these. Standard 6.2.1 requires that registrants must not provide treatment if they feel that the circumstances make it unsafe for patients

If the hygienist feels trained, competent and confident to treat patients in the absence of a dental nurse and that the absence of a dental nurse would not put the patient at risk, and would be able to justify the decision if challenged, then that would be acceptable. Many factors could affect this assessment – not least, the specific patient involved, the nature of the treatment being provided, and so on. It would be important to be able to show that these factors had been properly taken into account. Naturally, there would have to be another competent person available in the practice to deal with a medical emergency.

It is for the clinician treating the patient to undertake the risk assessment and to decide what would be in the best interests of the individual patient.

Standard 1.7 reminds us that the patient’s interests must come before those of any, colleague, business or organisation. Clearly any attempt to justify a clinical decision based on financial considerations alone would be a breach of this standard.

• The use of the phrase ‘work with’ is not specifically defined in the guidance and as such it could reasonably be interpreted that in some situations a hygienist could ‘work with’ a dental nurse, even if the nurse was not continuously present in the surgery at all times. But such an interpretation should not be distorted to imply that a dental nurse would never need to be physically present in the treatment room/surgery.

The new Standards document requires dental practices to display:

• The GDC’s nine principles
• Details of all registered staff working at the practice, including names, job titles and registration numbers
• A reference to the GDC as the regulator
• A price list, including NHS patient charges (if applicable to the practice) and indicative price lists for private care for, as a minimum, basic items such as consultation, single filling, extraction, radiography, dental hygiene treatments. Items that may vary in cost can be described in a from-to scale
• You are also now required to give clear information on prices in your practice literature and on your website; patients should not have to ask for this information