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Standards for the Dental Team An Introduction

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1 Standards for the Dental Team An Introduction
Standards for the Dental Team An Introduction

2 The Process November 2010 to February 2013
The Process November 2010 to February 2013 Evidence gathered from a wide variety of sources Registrant events held in each of the four countries Two stakeholder events External research companies used for: - patient and public research - registrant research - harder to reach groups research Online consultation The new standards took effect on 30 September They were the result of a concerted programme of work, based on evidence gathering and iterative discussion. Review was done differently to previous reviews of the standards. Started with research asking patients what they expected from their dental professionals. Followed with research with registrants, stakeholders and Fitness to Practise panellists about what they thought patients expected and what worked or didn’t work with the previous standards. Commissioned external research companies to speak to particular groups and asked for feedback during those sessions on the content and language of the new drafts. All the evidence was systematically reviewed and changes were made throughout the process. For patients the most important concerns were communication and transparency with costs. Registrants wanted more prescriptive language so that they know exactly what is expected of them

3 This slide shows what’s important to patients. No particular surprises but now is evidence-based 3 of the circles relate to communication – this is something which came through time and time again

4 Outcome One document for all registrants
Outcome One document for all registrants Supplemented by additional online guidance Renewed focus on patients’ interests More prescriptive language Greater focus on communication, transparency with costs and maintaining an ongoing dialogue with patients What all that led to….. A single book for all registrants – research looked at whether there should be one booklet for all registrants or separate booklets for each registrant category and whilst opinions on that were sometimes divided, it was decided that it was important to have one as it makes it clear you are all part of the same team Design is meant to feel like a handbook to encourage its use and the notes pages at the back are there to encourage active use Additional guidance documents are now online only - allows flexibility and means we can add to them/amend without having to reproduce the whole book Inclusion of patient expectations - principal difference More prescriptive language - Must and should – more about that later Communication now a stand alone principle, reflecting how important it is

5 Format What the new guidance looks like –
At the start of each principle there are a set of patient expectations which set out what patients expect in relation to that particular principle. The content of these patient expectations were taken directly from the research conducted with patients. There then follows a set of standards which registrants must adhere to ensure that the patient expectations are met. Each standard is accompanied by guidance which registrants ‘must’ and ‘should’ follow to meet the standards.

6 Introduction ‘The standards set out what you must do. If you do not meet these standards, you may be removed from our register and not be able to work as a dental professional. The guidance is there to help you meet the standards. You are expected to follow the guidance, to use your professional judgment, demonstrate insight at all times and be able to justify any decision that is not in line with the guidance.’ More prescriptive guidance – registrants said they wanted more prescriptive guidance so that they knew what was expected of them. Many registrants were critical of the previous standards and said the language was too woolly Makes clear that registrants are still expected to use their professional judgment at all times. Also need to demonstrate insight and to justify any decisions that are not in line with the guidance. This is in line with the advice the GDC gives to registrants over the ‘phone.

7 Definitions Must is used where the duty is compulsory.
Definitions Must is used where the duty is compulsory. Should is used where the duty would not apply in all situations and where there are exceptional circumstances outside of your control that could affect whether, or how, you can comply with the guidance. Should is also used when we are providing an explanation of how you will meet the overriding duty. More prescriptive language - must and should used throughout the document and defined in the introduction. ‘Must’ is clear, ‘should’ is used either where the duty may not apply in all circumstances or where the guidance is explaining how a standard might be met.

8 Registrant focus groups welcomed the improved clarity.

9 Introduction continued
Introduction continued ‘Serious or persistent failure to follow the guidance could see you removed from our register and not able to work as a dental professional. If we receive information which brings your fitness to practise into question, such as a complaint or a conviction, we will refer to the standards and the guidance to judge whether you are fit to practise as a dental professional.’ There were also some stakeholders such as trainers and employers who felt that the link between standards and fitness to practise was not clear and that some registrants don’t understand that it’s there - and so the introduction now does that. It is breaches of the standards that can lead to fitness to practise proceedings.

10 1. Put patients’ interests first
1. Put patients’ interests first 2. Communicate effectively with patients 3. Obtain valid consent 4. Maintain and protect patients’ information 5. Have a clear and effective complaints procedure 6. Work with colleagues in a way that serves the interests of patients 7. Maintain, develop and work within your professional knowledge and skills 8. Raise concerns if patients are at risk 9. Make sure your personal behaviour maintains patients’ confidence in you and the dental profession These are now nine principles – it’s important to note that most of them echo the previous Standards – whilst the format has changed and there are some notable additions, the general requirements have remained the same. The new principles are number 2- communicating effectively and number 9 – personal behaviour. As noted, the research established the importance of communication, both with patients and also between the members of the dental team. Patients who thought that their dental professional had communicated well with them were also more trusting of the profession as a whole. New document gives more guidance on how registrants should behave to ensure that they communicate effectively with patients, including a greater emphasis on the need for transparency with costs and treatment options, including the risks and benefits. Some registrants feel it is inappropriate for a regulator to provide guidance on personal behaviour, however there are some registrants who need to be reminded that, particularly with the wide spread use of social media, it is impossible to separate out their personal and professional lives – patients do not make the distinction. More on this later…..

11 Communication now a stand alone principle, reflecting how important it is. This came through time and time again in the patient research This is a really positive quote from a patient – you can tell that she feels very positive about her dentist, but she’s not talking about treatment, she’s talking about communication

12 Within that, patients want to be treated with respect and as individuals. It was clear that sometimes members of the dental team make assumptions – research with patients with particular needs and those belonging to particular groups within the community highlighted this. For example, patients who attend with a carer reported that the team might speak to the carer rather than the patient, which they found frustrating. The lady who provided this quote during a focus group experienced a similar thing in a different way….

13 Principle 1 - Greater emphasis on ‘softer skills’
Principle 1 - Greater emphasis on ‘softer skills’ 1.1 You must listen to your patients. You should take patients’ preferences into account and be sensitive to their individual needs and values. 1.2.3 You must treat patients with kindness and compassion. 1.2.4 You should manage patients’ dental pain and anxiety appropriately. So – much more about Communication. This slide is also a good example of how must and should work – you ‘should’ manage patients’ pain insofar as possible, but you ‘must’ be kind

14 Moving through the principles, another thing that was important to patients was clear information, discussions and a treatment plan

15 Principle 2 -Treatment plans
Principle 2 -Treatment plans 2.3.6 You must give patients a written treatment plan, or plans, before their treatment starts and you should retain a copy in their notes. You should also ask patients to sign the treatment plan. 2.3.8 You must keep the treatment plan and estimated costs under review during treatment. You must inform patients immediately if the treatment plan changes and provide them with an updated version in writing. So while there was guidance before, now it’s a ‘must’.

16 Patients were very clear that they wanted an idea about costs when choosing a practice, as it’s hard to shop around once in the chair. NHS practices are already required to display prices and most respondents agreed that the same should apply to private practices GDC had some initial concerns that this would be impractical for registrants and may be unpopular, BUT….

17 A large majority of registrants also thought that clear prices would improve patient confidence So…

18 Principle 2 - Transparency with costs
Principle 2 - Transparency with costs 2.4.1 You must make sure that a simple price list is clearly displayed in your reception or waiting area. This should include a list of basic items including a consultation, a single surface filling, an extraction, radiographs (bitewing or pan-oral) and treatment provided by the hygienist. For items which may vary in cost, a ‘from – to’ price range can be shown. 2.4.2 You must give clear information on prices in your practice literature and on your websites – patients should not have to ask for this information. Introduced the requirement to display simple price lists which can include a range (a ‘from – to’) element for treatments where costs may vary.

19 Principle 3 - Ongoing dialogue
Principle 3 - Ongoing dialogue 3.3.1 Giving and obtaining consent is a process, not a one-off event. It should be part of on-going communication between patients and all members of the dental team involved in their care. You should keep patients informed about the progress of their care. Requirement for consent is obvious and nothing new, but this slide illustrates the greater recognition in the new document of the role that all members of the dental team play in creating a positive experience for patients…

20 Principle 6 - Team Working
Principle 6 - Team Working 6.1.2 You must treat colleagues fairly and with respect in all situations and in all forms of interaction and communication. You must not bully, harass or unfairly discriminate against them. 6.1.5 You must ensure that patients are fully informed of the names and roles of those involved in their care. 6.3.1 You should only delegate or refer to another member of the team if you are confident that they have been trained and are both competent and indemnified to do what you are asking. Previous booklet on team working has now become a principle - patients expect that all members of the team will work effectively together

21 Principle 6 – For Managers
Principle 6 – For Managers You should display information about the members of your team (including their registration number where appropriate), in an area where it can be easily seen by patients. You should display the following information in an area where it can be easily seen by patients: the fact that you are regulated by the GDC; and the nine principles contained in this document. Research showed that patients feel more confident when they know that someone is setting standards and can deal with breaches of those standards. So practices are now required to display that information – Practices are free to design their own way of displaying this information or can use the poster which can be downloaded from the GDC website.

22 Principle 8 – Raising concerns
Principle 8 – Raising concerns 8.1.2 You must not enter into any contract or agreement with your employer or contracting body which contains a ‘gagging clause’ that would prevent you from raising concerns about patient safety or restrict what you could say when raising a concern. Employers cannot offer these contracts either 8.3.4 In the post-Francis environment it is vital that every healthcare professional accepts their responsibility to raise concerns, but that can be very difficult. It’s now a breach of the standards to accept a contract which includes a gagging clause – but it’s also a breach to offer such a contract.

23 Principle 8 - Organisational culture
Principle 8 - Organisational culture Standard 8.3 You must make sure if you employ, manage or lead a team that you encourage and support a culture where staff can raise concerns openly without fear of reprisal. 8.3.1 You must promote a culture of openness in the workplace so that staff feel able to raise concerns. 8.3.2 You should embed this culture into your policies and procedures, beginning with staff training and induction. In order to effect real change, healthcare professionals need to feel that they can raise a concern safely, so it was important to point out to employers that culture change is vital and it’s not just down to individual registrants to raise concerns – employers have a major role too. The GDC will be doing more research about this with registrants next year.

24 Principle 9 – Personal behaviour
Principle 9 – Personal behaviour 9.1 You must ensure that your conduct, both at work and in your personal life, justifies patients’ trust in you and the public’s trust in the dental profession. 9.3 You must inform the GDC if you are subject to criminal proceedings or a regulatory finding is made against you anywhere in the world. Some registrants still don’t understand that there is a link between their personal behaviour and their professional life and that what they do outside work can impact on how they are seen as health professionals. The new document tries to make that clearer. It also makes clearer when registrants do – and don’t – need to report criminal proceedings to the GDC as that was another area of confusion previously.

25 Additional guidance documents
Additional guidance documents Guidance on advertising Guidance on commissioning and manufacturing dental appliances Guidance on indemnity Guidance on prescribing medicines Guidance on reporting criminal proceedings Guidance on using social media Scope of Practice These are the additional guidance documents. The first four are revisions of guidance that already existed, updated into the ‘must and should’ style and the two in red are entirely new. The new guidance on reporting criminal proceedings makes clear that registrants must report charges, cautions, convictions to the GDC and it also makes clear that they do not need to report fixed penalty notices for road traffic offences. During the review it became evident that one of the principal gaps in the current standards was the lack of guidance on social media. There is now new guidance on using social networking sites and other social media. Registrants are not discouraged from using social networking but the guidance makes clear that registrants need to be extremely cautious when using any social media sites and that they need to remember that even with the highest privacy settings, information posted on line can easily become public as they cannot control what other people share. Scope of Practice guidance has been revised in light of decisions on direct access and is now on the website All of these guidance documents are available to view and download from the website.

26 Reporting criminal proceedings 1
Reporting criminal proceedings 1 You must inform the GDC if anywhere in the world you: a. are charged with a criminal offence; b. are found guilty of a criminal offence; c. receive a conditional discharge for an offence; d. accept a criminal caution (including a conditional caution), or otherwise formally admit to committing a criminal offence New additional guidance documents in more detail. Don’t need to tell us about most fixed penalty notices Guidance sets out more details. Always better to report – will not necessarily lead to issues with registration, but not reporting and then the facts coming to light another way almost certainly will. Need to get that message out to young registrants and potential registrants

27 Social media 4.2.3 You must not post any information or comments about patients on social networking or blogging sites. If you use professional social media to discuss anonymised cases for the purpose of discussing best practice you must be careful that the patient or patients cannot be identified. See our website for further guidance on social networking. One of the areas where the research highlighted that registrants wanted guidance was on the use of social media. This is a prime example of where some registrants don’t understand the link between their personal and professional lives. This is from Standards for the Dental Team and we have also produced a separate guidance sheet which provides more guidance for registrants.

28 Guidance on social media
Guidance on social media As a registrant you have a responsibility to behave professionally and responsibly both online and offline. Your online image can impact on your professional life and you should not post any information, including photographs and videos, which could bring the profession into disrepute. You should think carefully before accepting friend requests from patients You should remember that even the strictest privacy settings do not guarantee that your information will be kept secure Infamous ‘dental nurses who hate patients’ from a few years ago – BADN was instrumental in getting the message out that not acceptable. But many registrants still don’t realise the risk – and it’s a real risk Recent NMC case where a nurse was suspended for 6 months for posting a series of offensive messages on Facebook including profanities directed to the hospice where she worked. She thought only her friends would see her Facebook status which cursed the fact she had to go to work the next day. The nurse initially argued that Facebook was a site where people went to vent and that it was nothing to do with her professional life, but after being reported to the NMC she accepted that her comments had been irresponsible. The NMC pointed out that she had listed her place of work and it was clear that she was a nurse. Also her postings were accessible to the public. The NMC decided that her comments had been wholly inappropriate, had called her judgment and integrity into question and her acts had also brought the profession into disrepute.

29 Website… New Focus on Standards pages FAQs
Scenarios which are designed to encourage registrants to use their judgment and decide the right answer Case studies Other learning materials such as advertising checklists, social media dos and don’ts Seeking feedback on the early content via registrant research so that what is developed next will be as useful as possible.

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