GDC Maintaining Standards Guidance

General Dental Council
Maintaining Standards
Guidance to Dentists on Professional and Personal Conduct
GENERAL DENTAL COUNCIL
MAINTAINING STANDARDS
GUIDANCE
TO
DENTISTS
ON
PROFESSIONAL
AND
PERSONAL CONDUCT
NOVEMBER 1997
GENERAL DENTAL COUNCIL: MAINTAINING STANDARDS
AMENDMENTS
APPROVED BY
COUNCIL
IN
NOVEMBER 2001
Contents Paragraph 4.7
Revised to incorporate new paragraph titles Amended to include reference to emergency drugs Amended to include reference to before deciding to refer Amended to cover patients unable to respond to verbal contact Amended to include reference to before referring for treatment Widened to include techniques and drugs used in control of pain and anxiety Amended to expand upon advice given in paragraph (iii) and to include a new paragraph (iv) about justifying the use of the method selected Wording slightly amended Amended to include the fact that general anaesthesia for dental treatment should only be administered in a hospital setting with critical care facilities and to include the need to avoid or reduce future episodes of general anaesthesia Advice on decision to treat expanded Section heading changed Section heading changed New paragraph (i) included and paragraph (iv) modified to include references to HDUs and ICUs
Paragraph 4.9
Paragraph 4.11
Paragraph 4.12
Paragraph 4.13
Paragraph 4.14
Paragraph 4.16 Paragraph 4.17
Paragraph 4.19 Paragraph 4.20 Paragraph 4.22
Paragraph 4.23
Amended to include the need to give post-operative advice Amended to include new publications and new addresses
Bibliography
AMENDMENTS, NOVEMBER 2001
CONTENTS
All paragraphs are as approved in November 1997 unless otherwise indicated by means of a numeric superscript, immediately following the paragraph number, which shows the year of amendment (1999).
INTRODUCTION
2001
1: BEFORE BEGINNING TO PRACTISE

Registering with the General Dental Council Obtaining indemnity Keeping up-to-date The use of qualifications and titles Specialist lists
NOVEMBER 1997 1.1 1.2 1.32000 1.4 1.51998
2: WHAT THE PUBLIC EXPECTS

Personal behaviour Alcohol and drugs Improper statements or certificates and misleading announcements Protecting patients Physical impairment
NOVEMBER 1997 2.1 2.21999 2.3 2.4 2.52000 NOVEMBER 1997 3.1 3.2 3.31999 3.42000 3.52000 3.6 3.71999 3.81999 3.9 3.10
3: WHAT THE PATIENT EXPECTS

Acting in the best interests of patients Providing a high standard of care Making a referral Accepting a referral Maintaining confidentiality Explaining treatment and costs Consent Having a third party present Domiciliary treatment Treating difficult patients and children
CONTENTS, NOVEMBER 1997, REVISED MAY 2001
Providing for dental emergencies and out of hours care Extended absence from practice Handling complaints Complaints of rudeness and discourtesy
3.11 3.12 3.13 3.14 NOVEMBER 1997 4.1 4.2 4.31999 4.41999 4.51999 4.61999
4: WHAT THE PROFESSION EXPECTS

Dealing with cross-infection Dealing with transmissible disease Contemporaneous records Dental radiography and radiation protection Prescribing Misleading claims
RESUSCITATION
Dealing with medical emergencies 4.72001
PAIN
AND
ANXIETY CONTROL
4.81999 4.92001 4.101999 4.112001 4.122001 4.132001 4.142001 4.151999 4.162001
Duty and expectations Behavioural management Local anaesthesia Conscious sedation Assessment, consent and instructions Record keeping Responsibilities, education and skills Equipment, drugs and monitoring Fitness for discharge
GENERAL ANAESTHESIA
Risks of general anaesthesia 4.172001
DUTIES DUTIES
OF THE
REFERRING DENTIST
4.181999
Decision to refer
OF THE
TREATING DENTIST
4.192001 4.202001 4.211999 4.222001 4.232001 4.241999
Decision to treat Consent Instructions and records Responsibilities of those providing dental treatment under general anaesthesia Recovery and discharge Training
5: THE DENTAL TEAM

Employing staff
NOVEMBER 1997 5.12000
CONTENTS, NOVEMBER 1997, REVISED NOVEMBER 2001
Illegal practice Dental hygienists and dental therapists Delegation of oral hygiene instruction
5.2 5.3 5.4
6: PRACTICE ARRANGEMENTS
NOVEMBER 2000 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 6.18 6.19 6.20
Professional responsibility Practice agreements Unreasonable financial pressure Leaving a practice Disposal of clinical and hazardous waste Dental records and radiographs Disposal of patient records Debt collection Bankruptcy Carrying on the business of dentistry restrictions Bodies corporate Companies to run the administrative side of a dental practice/letting of premises Use of the words dental and dentistry in company titles Practice titles Signs and professional plates Appearance of names other than a dentists Screening of windows Canvassing Incentives Product promotion
7: PROMOTING
THE
PRACTICE
NOVEMBER 1997 7.1 7.2 7.3 7.4 7.5 7.6 7.7 NOVEMBER 1997 8.1
Legal, decent, honest, truthful Name of dentist to be included Unacceptable content Clarity of treatment available Interactions with the media Specialist claims Clarity of information on fees
8: THE COUNCILS JURISDICTION

Jurisdiction
PROFESSIONAL CONDUCT
A dentists professional duty and liability Scope and definition of serious professional misconduct Extent of disciplinary jurisdiction
8.2 8.3 8.4
Undergraduate behaviour Sources of information Convictions
8.5 8.62000 8.7
DISCIPLINARY PROCEDURE
Stages 8.8
PRELIMINARY SCREENING
Preliminary Screener Action 8.92000 8.102000
PRELIMINARY PROCEEDINGS COMMITTEE

Meetings and membership Notifying the dentist Considering the information Notifying the decision Advice and warnings Interim suspension 8.11 8.12 8.13 8.14 8.15 8.162000
PROFESSIONAL CONDUCT COMMITTEE

Meetings and membership Notifying the dentist Notice of Inquiry Presentation of case and rules of evidence Finding of serious professional misconduct Disposal of case Immediate suspension Appeals and imposition of determination Restoration after suspension Restoration after erasure for misconduct 8.17 8.18 8.19 8.20 8.21 8.22 8.23 8.24 8.25 8.26
FITNESS
TO
PRACTISE
8.27 8.28 8.29 8.30 8.31
Information about a dentist Initial consideration of information Notifying the dentist Medical examinations Consideration of medical reports
HEALTH COMMITTEE
Meetings and membership Notifying the dentist Notice of Referral Conduct of hearing Information considered by the Health Committee Finding concerning fitness to practise Determination of Health Committee
8.32 8.33 8.34 8.35 8.36 8.37 8.38
Notice of Resumed Hearing Immediate suspension Conditions Appeals and imposition of determination Jurisdiction of the Health Committee
8.39 8.40 8.41 8.42 8.43 NOVEMBER 2001 NOVEMBER 2000
BIBLIOGRAPHY INDEX
INTRODUCTION
The General Dental Council has a statutory duty to promote high standards of personal and professional conduct within the dental profession. As part of that duty the Council has published Maintaining Standards as a set of ethical guidelines for the profession.
Maintaining Standards contains advice to dentists, dental hygienists and dental therapists on principles of personal and professional conduct, includes guidance on the expectations of the public and the patient, and also explains the Councils jurisdiction.
Maintaining Standards is not a set of rules and regulations covering every aspect of behaviour in every possible set of circumstances. The practice of dentistry requires the exercise of professional judgement and an acceptance of personal responsibility, informed by the Councils ethical guidelines and the principles on which these are based.
Whilst this document is primarily designed as constructive guidance for the profession, it may be used to inform the Councils fitness to practise procedures.
Maintaining Standards is regularly updated in the light of current expectations and is intended to be helpful advice to the profession rather than a statutory code of conduct. Members of the dental team should at all times behave reasonably and in the public interest.
INTRODUCTION, MAY 2001
REGISTERING
WITH THE
1, 2
1.1 It is the responsibility of a dentist who intends to practise to register with the GDC before beginning to practise and to renew that registration annually. Failure to do so may lead to disciplinary proceedings. A dentist should not practise dentistry in a name other than that which appears in the Dentists Register. It is unlawful for anyone to give or to suggest that they are prepared to give any advice or treatment such as is normally given by a dentist, unless that person is registered in the Dentists Register or the Medical Register. Advice or treatment includes the fitting, insertion or fixing of dentures, artificial teeth or other dental appliances. Those who supervise students undertaking the dental treatment of patients must be on the Dentists Register. Enrolled dental hygienists and dental therapists may only practise under the direction of a registered dentist to the extent permitted by the relevant Regulations.
OBTAINING
INDEMNITY
1.2 A dentist involved in advising or treating patients must either hold appropriate membership of a defence organisation or otherwise be indemnified against claims for professional negligence. This is in the interest both of patients, who may have a right to compensation and of dentists, who may require professional and legal advice. A lack of appropriate defence organisation membership or adequate indemnity cover which includes professional and legal advice, would almost certainly lead to a charge of serious professional misconduct.
KEEPING
UP-TO-DATE
1.3 In the interests of patients, a dentist must continue professional education on a regular and frequent basis throughout professional life. The recording of all continuing professional development (CPD) activity is the responsibility of the individual dentist. Records must be accurate and must be retained, together with external verification where relevant. Records and verification must be produced when requested by the Council. A dentist who fails to maintain and update professional knowledge and skills and who, as a result, provides treatment which falls short of the standards which the public and the profession have a right to expect, may be liable to a charge of serious professional misconduct.
1: BEFORE BEGINNING TO PRACTISE, NOVEMBER 1997, REVISED NOVEMBER 2000
THE
USE OF QUALIFICATIONS AND TITLES
1.4 A dentist may use in connection with dental practice only those qualifications which are entered against that dentists name in the Dentists Register and any specialist lists, and the description dentist, dental practitioner or dental surgeon. A dentist who uses the courtesy title doctor has a duty to ensure that it is not used in a way which misleads the public. Additional qualifications which are generally recognised for inclusion in the Dentists Register are listed in the preliminary pages of the Dentists Register. Further guidance may be obtained from the GDCs Registration Department.
SPECIALIST
LISTS
1.5 Only a dentist whose name is entered in a specialist list is entitled to use the title prescribed in connection with that list; no dentist should imply possession of specialist status in terms which could mislead patients. See also 7.6 Specialist lists held by the GDC are indicative, not restrictive. This means that holders of prescribed specialist titles remain free to practise across the whole spectrum of dentistry within their acknowledged competence.
1: BEFORE BEGINNING TO PRACTISE, NOVEMBER 1997, REVISED NOVEMBER 1998
PERSONAL
2.1
BEHAVIOUR
A dentist must adhere to the appropriate standards of personal as well as professional conduct. Any behaviour or activity by a dentist which is liable to bring the profession into disrepute or to undermine public confidence in the profession may lead to a charge of serious professional misconduct. Behaviour which reflects adversely on the profession such as dishonesty, indecency or violence, may also lead to a charge of serious professional misconduct even if such behaviour is not directly connected with the dentists professional practice.
ALCOHOL
2.2
AND DRUGS
Complaints of drunkenness or the misuse of drugs, particularly if this involves an abuse of a dentists prescribing powers, may lead to a charge of serious professional misconduct, even if the offence has not been the subject of criminal proceedings. Problems with alcohol and/or drug dependency could lead to a dentist being referred to the Health Committee. A dentist should prescribe drugs only in connection with the provision of bona fide treatment. See also 4.5
IMPROPER STATEMENTS OR CERTIFICATES AND MISLEADING ANNOUNCEMENTS

2.3 A dentist should not make a statement or declaration that is untrue or misleading or unethical, nor induce any other person to do so. Any act or omission by a dentist in connection with dental practice which is liable to mislead the public may lead to a charge of serious professional misconduct. A dentist should not, for example, demand or receive fees for which there is no entitlement nor persuade a patient to accept private treatment by giving incorrect information.
PROTECTING
2.4
PATIENTS
A dentist must act to protect patients when there is reason to believe that they are threatened by a colleagues conduct, performance or health. The safety of patients must come first at all times and should over-ride personal and professional loyalties. As soon as a dentist becomes aware of any situation which puts patients at risk, the matter should be discussed with a senior colleague or an appropriate professional body.
2. WHAT THE PUBLIC EXPECTS, NOVEMBER 1997, REVISED MAY 1999
2.5
A dentist who is suffering from physical impairment which might jeopardise the wellbeing of patients should seek medical advice, and, if necessary, restrict the scope of his or her dental practice. The conduct of a dentist who wilfully continues to practise when a physical impairment may be expected to prejudice the safety of patients may be regarded as serious professional misconduct.
2. WHAT THE PUBLIC EXPECTS, NOVEMBER 1997, REVISED MAY 2000
ACTING
3.1
IN THE BEST INTERESTS OF PATIENTS
As a member of a caring profession, a dentist has a responsibility to put the interests of patients first. The professional relationship between dentist and patient relies on trust and the assumption that a dentist will act in the best interests of the patient. Abuses of this professional relationship may lead to a charge of serious professional misconduct.
A HIGH STANDARD OF CARE
PROVIDING
3.2
A patient is entitled to expect that a dentist will provide a high standard of care. The Council takes a serious view of any neglect of a dentists professional responsibilities to patients for their care and treatment
A REFERRAL
MAKING
3.3
When accepting a patient a dentist assumes a duty of care which includes the obligation to refer the patient for further professional advice or treatment if it transpires that the task in hand is beyond the dentists own skills. A patient is entitled to a referral for a second opinion at any time and the dentist is under an obligation to accede to the request and to do so promptly. See also 4.18
A REFERRAL
ACCEPTING
3.4
It is the responsibility of a dentist when accepting a referral to ensure that the request is fully understood. The treatment or advice requested should only be provided where this is felt to be appropriate. If this is not the case, there is an obligation on the dentist to discuss the matter, prior to commencing treatment, with the referring practitioner and the patient. See also 4.19
CONFIDENTIALITY
5
MAINTAINING
3.5
The dentist/patient relationship is founded on trust and a dentist should not disclose to a third party information about a patient acquired in a professional capacity without the permission of the patient. To do so may lead to a charge of serious professional misconduct. A dentist should also be aware that the duty of confidentiality extends to other members of the dental team. Where information is held on computer, a dentist should also have regard to the provisions of the Data Protection Act. See also 6.5 There may, however, be circumstances in which the public interest outweighs a dentists duty of confidentiality and in which disclosure would be justified. A dentist in such a situation should consult a defence or professional organisation or other appropriate adviser.
3. WHAT THE PATIENT EXPECTS, NOVEMBER 1997, REVISED NOVEMBER 2000
Communications with patients should not compromise patient confidentiality. In the interests of security and confidentiality, for example, it is advisable that all postal communications to patients are sent in sealed envelopes.
EXPLAINING
3.6
TREATMENT AND COSTS
It is the responsibility of a dentist to explain clearly to the patient the nature of the contract and in particular whether the patient is being accepted for treatment under a particular scheme, including the NHS, or under some other arrangement. The charge for an initial consultation and the probable cost of the subsequent treatment must be made clear to the patient at the outset. A written treatment plan and estimate will avoid misunderstandings and should always be provided for extensive or expensive courses of treatment. A dentist who obtains the patients agreement to these terms in writing is better placed to refute an allegation that a patient has been misled with regard to the nature of the contract or the type or cost of treatment provided. If it becomes apparent to the dentist, after the estimate has been agreed, that a modified treatment plan will become necessary the Council would expect the dentist to discuss this with the patient; obtain the patients consent to the further treatment and additional cost; and provide a written, amended estimate before proceeding further. Patients are entitled to an itemised account of treatment received and should normally be provided with one.
CONSENT
3.7 A dentist must explain to the patient the treatment proposed, the risks involved and alternative treatments and ensure that appropriate consent is obtained. If a general anaesthetic or sedation is to be given, all procedures must be explained to the patient. The onus is on the dentist to ensure that all necessary information and explanations have been given either personally or by the anaesthetist/sedationist. In this situation written consent must be obtained. See also 4.12 and 4.20
HAVING
3.8
A THIRD PARTY PRESENT
A dentist should normally be assisted by a dental nurse. When attending a patient, a dentist would be well advised to have a member of the dental team or other person present at all times in the operating room and in the recovery room. When general anaesthesia or sedation is being used, such an arrangement is mandatory. See also 4.14, 4.22 and 4.23
3. WHAT THE PATIENT EXPECTS, NOVEMBER 1997, REVISED MAY 1999
DOMICILIARY
3.9
TREATMENT
Dental treatment provided on a domiciliary basis should be appropriate within that setting, taking into account the nature of the problem, the facilities available and the welfare of the patient. Having a third party present is particularly relevant in this environment.
DIFFICULT PATIENTS AND CHILDREN
TREATING
3.10 There can be no justification for intimidation or, other than in the most exceptional circumstances, for the use of physical restraint in dealing with a difficult patient. When faced with a child who is uncontrollable for whatever reason, the dentist should consider ceasing treatment, making an appropriate explanation to the parent or representative and arranging necessary future treatment for the child, rather than continuing in these circumstances.
PROVIDING
FOR DENTAL EMERGENCIES AND OUT OF HOURS CARE
3.11 A dentist working in any branch of dentistry must make appropriate arrangements to ensure that patients, for whom responsibility has been accepted, have access to emergency treatment outside normal working hours and that such arrangements are made known to those patients. While a sympathetic response to patients in pain is to be expected, it is extremely difficult to define what constitutes a dental emergency. If a patient has an acute spreading infection, or a dental haemorrhage which is difficult to control, or has suffered damage to a tooth or jaws as a result of external trauma, it is the dentists duty to provide, or make arrangements for the patient to receive, advice or treatment within a reasonable time.
EXTENDED
ABSENCE FROM PRACTICE
3.12 If a dentist is absent from a practice for an extended period, arrangements should be made to notify patients and for them to receive care as appropriate.
HANDLING
COMPLAINTS
3.13 If a patient has cause to complain about the service provided, every effort should be made to resolve the matter at practice level. The complaint may relate to the treatment provided or some other matter such as the payment of fees or the attitude of a member of the dental team. The Council endorses the detailed guidance on handling complaints which has been issued by the NHS Executive and the British Dental Association and would expect compliance.
COMPLAINTS
OF RUDENESS AND DISCOURTESY
3.14 The Council receives complaints from patients about rudeness and discourtesy on the part of dentists. While such behaviour may not, of itself, amount to serious professional misconduct it is of concern. The Council may, with the patients consent, seek the observations of the dentist on an informal basis.
4: WHAT THE PROFESSION EXPECTS

DEALING
4.1
WITH CROSS-INFECTION
7, 8, 9, 10, 11
There has always existed the risk of cross-infection in dental treatment. Therefore, a dentist has a duty to take appropriate precautions to protect patients and other members of the dental team from that risk. The publicity surrounding the spread of HIV infection has served to highlight the precautions which a dentist should already have been taking and which are now more important than ever. Detailed guidance on cross-infection control has been issued by the Health Departments and the British Dental Association, and is endorsed by the Council. It is unethical for a dentist to refuse to treat a patient solely on the grounds that the person has a blood borne virus or any other transmissible disease or infection. Failure to employ adequate methods of cross-infection control would almost certainly render a dentist liable to a charge of serious professional misconduct.
DEALING
4.2
WITH TRANSMISSIBLE DISEASE
12
A dentist who is aware of being infected with a blood borne virus or any other transmissible disease or infection which might jeopardise the well being of patients and takes no action is behaving unethically. The Council would take the same view if a dentist took no action when having reason to believe that such infection may be present. It is the responsibility of a dentist in either situation to obtain medical advice which may result in appropriate testing and, if a dentist is found to be infected, regular medical supervision. The medical advice may include the necessity to cease the practice of dentistry altogether, to exclude exposure prone procedures or to modify practice in some other way. Failure to obtain such advice or to act upon it would almost certainly lead to a charge of serious professional misconduct.
CONTEMPORANEOUS
4.3
RECORDS
A dentist must always obtain a medical history of a patient before commencing treatment and check the history for any changes at subsequent visits. Changes must be recorded on the patient's notes. Full contemporaneous records should be kept for all dental treatment. See also 4.13 and 4.21
4: WHAT THE PROFESSION EXPECTS, NOVEMBER 1997, REVISED MAY 1999
DENTAL
4.4
RADIOGRAPHY AND RADIATION PROTECTION
14
A dentist has a number of statutory duties in relation to radiation protection during dental radiography. A dentist who owns or operates an X-ray machine must ensure full compliance with the Regulations and safe radiological practice for the protection of the patient, members of the dental team and others. Failure to do so may lead to a charge of serious professional misconduct. A dentist who delegates the taking of dental radiographs must ensure that the person to whom this task is delegated has received training in accordance with the Regulations.
PRESCRIBING
4.5
15
The Council takes the view that a dentist should only prescribe drugs in connection with the provision of bona fide treatment. The right to prescribe is a privilege conferred upon a registered dentist by legislation and should be regarded in that light. See also 2.2 A dentist should not self-prescribe.
MISLEADING
4.6
CLAIMS
The Council takes a very serious view of any misleading claims made by a dentist in relation to treatment. This may be with regard to the efficacy of any treatment, or to misleading claims about a dentist's own skill or expertise in relation to a particular treatment. The Council is also concerned about forms of treatment or therapy not amounting to the practice of dentistry but which a dentist chooses to perform as ancillary aspects of dental practice. A dentist should take particular care when employing techniques and forms of therapy which are unproven. A dentist wishing to publicise views on a particular concept of dentistry should subject those views to challenge and scrutiny by professional colleagues through the medium of professional journals and any other forum of dental debate. See also 7.5
4: WHAT THE PROFESSION EXPECTS, NOVEMBER 1997, REVISED MAY 1999
RESUSCITATION DEALING
WITH MEDICAL
EMERGENCIES
13
4.7 A medical emergency could occur at any time in premises where dental treatment takes place. It is, therefore, imperative that a dentist ensures that all members of the dental team are properly trained, have available the necessary resources, and are prepared to deal with an emergency, including a collapsed patient. Training should include preparing for medical emergencies, including the use of emergency drugs, and practice of resuscitation routines in a simulated emergency. It is essential that all premises where dental treatment takes place have available and in working order: portable suction apparatus to clear the oropharynx, oral airways to maintain the natural airway, equipment with appropriate attachments to provide intermittent positive pressure ventilation of the lungs, and a portable source of oxygen together with emergency drugs15,43. Practitioners have an obligation to be conversant with current guidelines such as those issued by the Resuscitation Council (UK)
PAIN AND ANXIETY CONTROL DUTY AND EXPECTATIONS

4.8 Dentists have a duty to provide and patients have a right to expect adequate and appropriate pain and anxiety control. Pharmacological methods of pain and anxiety control include local anaesthesia and conscious sedation techniques. The provision of pain and anxiety control carries responsibilities and a dentist who undertakes treatment on a patient without ensuring that the following conditions are met is liable to a charge of serious professional misconduct.
BEHAVIOURAL MANAGEMENT
4.9 In assessing the needs of an individual patient, due regard should be given to all aspects of behavioural management before deciding to refer, to prescribe or to proceed with treatment.
LOCAL ANAESTHESIA
4.10 Local anaesthesia is the mainstay of pain control during dental treatment. A dentist has a duty to use the most appropriate and effective method of local anaesthesia for each patient. The technique chosen must take into account the patient's medical and dental history as well as the physical and pharmacological properties of the agent used.
4: WHAT THE PROFESSION EXPECTS, NOVEMBER 1997, REVISED NOVEMBER 2001
CONSCIOUS SEDATION
4.11 Conscious sedation can be an effective method of facilitating dental treatment and is normally used in conjunction with appropriate local anaesthesia. Conscious sedation is defined as: A technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation. The drugs and techniques used to provide conscious sedation for dental treatment should carry a margin of safety wide enough to render loss of consciousness unlikely. The level of sedation must be such that the patient remains conscious, retains protective reflexes, and is able to understand and to respond to verbal commands. Deep sedation in which these criteria are not fulfilled must be regarded as general anaesthesia. In the case of patients who are unable to respond to verbal contact even when fully conscious the normal method of communicating with them must be maintained.
ASSESSMENT, CONSENT
AND INSTRUCTIONS
4.12 A careful assessment of the patient, including a full medical and dental history, must be made before the decision to treat or to refer for treatment under conscious sedation can be taken. An explanation of the conscious sedation technique proposed and of appropriate alternative methods of pain and anxiety control must be given. In advance of the procedure the patient must be given clear and comprehensive pre- and post-operative instructions in writing, and written consent must be obtained.
RECORD KEEPING
4.13 Careful contemporaneous records must be kept including details of the techniques and drugs used in the control of pain and anxiety. See also 4.3
RESPONSIBILITIES, EDUCATION
AND
SKILLS
4.14 Dentists have a duty of care, in accordance with section 3.3, to administer conscious sedation only within the limits of their knowledge, training, skills and experience. A dentist who assumes the dual responsibility of sedating the patient as well as providing treatment must: (i) have completed relevant postgraduate education and training;
(ii)
have a demonstrable commitment to relevant continuing education and training;
(iii) ensure that the method and nature of the conscious sedation chosen is the most appropriate to enable treatment to be carried out for the patient as an individual, taking into account specific factors such as age, state of health, social circumstances and special needs. The choice of techniques and drugs used should be governed by the principle of minimum intervention and the amount of any drug administered should be the minimum necessary to achieve the desired effect. In general only one sedative drug (administered by the oral, inhalational or intravenous route) will be necessary for the vast majority of patients. Combinations of sedative drugs may only be justified in exceptional circumstances. Intravenous conscious sedation is rarely justified in children; (iv) be able to justify the use of the method selected with reference to current guidelines such as those listed in the Bibliography 41,42; (v) have clinical experience of the particular conscious sedation technique employed;
(vi) be assisted by a second appropriately trained person who is present throughout and is capable of monitoring the clinical condition of the patient and assisting the dentist in the event of any complication. Where a second dental or medical practitioner is providing conscious sedation for a patient, the treating dentist must ensure that the person acting as the sedationist has undertaken relevant postgraduate education and training, accepts the definition of conscious sedation given in paragraph 4.11 and the principle of minimum intervention, and has specific experience of the use of conscious sedation in dentistry as described above.
EQUIPMENT, DRUGS
AND
MONITORING
4.15 Conscious sedation must only be administered when suitable equipment and adequate facilities including appropriate drugs for treating complications are immediately available at the chairside. All staff must be trained in the use of the relevant conscious sedation techniques and must train as a team in the management of sedationrelated complications. See also 4.7 Contemporary standards of monitoring must be adopted.
FITNESS
FOR
DISCHARGE
4.16 Patients who have received conscious sedation should be appropriately protected and monitored in adequate and supervised recovery facilities. When, in the opinion of the sedationist, they are sufficiently recovered to leave the premises, the patient must be accompanied by a responsible adult. A dentist may exercise discretion as to whether an adult patient may be discharged unaccompanied when nitrous oxide/oxygen sedation alone is used. Due regard must be given to both the pharmacology of
the drugs administered and the patient's response to the sedative before the patient is discharged. All patients must be assessed for their suitability for discharge. Patients and escorts must be given post-operative advice specific to the individual regarding after care arrangements. See also 4.12.
GENERAL ANAESTHESIA RISKS

OF
GENERAL ANAESTHESIA
4.17 General anaesthesia is a procedure which is never without risk. In assessing the needs of an individual patient, due regard should be given to all aspects of behavioural management and anxiety control before deciding to treat or refer for treatment under general anaesthesia. General anaesthesia for dental treatment should only be administered in a hospital setting with critical care facilities.39 All dentists involved in arranging or providing treatment under general anaesthesia should discuss with the patient advice and treatment options to avoid or reduce future episodes of general anaesthesia. A dentist who refers a patient for treatment or carries out treatment on a patient under general anaesthesia without ensuring that the relevant conditions set out below are met is liable to a charge of serious professional misconduct.
DUTIES OF THE REFERRING DENTIST DECISION

TO
REFER
4.18 The decision to refer a patient for treatment under general anaesthesia should not be taken lightly. As part of this decision, a full medical history of the patient must be taken and agreement to refer obtained following a thorough and clear explanation of the risks involved and the alternative methods of pain control available. Clear justification for the use of general anaesthesia, together with details of the relevant medical and dental histories of the patient, must be contained in the referral letter. The referring dentist must retain a copy of this letter. See also 3.3
DUTIES OF THE TREATING DENTIST DECISION

TO
TREAT
4.19 The decision to treat a patient under general anaesthesia should not be taken lightly. As part of this decision the treating dentist must satisfy him or herself that it is necessary and appropriate to carry out the proposed treatment under general anaesthesia. Before carrying out treatment under general anaesthesia the patient must be given a
thorough and clear explanation of the risks involved and the alternative methods of pain control available. See also 3.4
CONSENT
4.20 When the decision to carry out treatment under general anaesthesia has been finally agreed by the patient, dentist and anaesthetist, written consent must be obtained. See also 3.7
INSTRUCTIONS
AND
RECORDS
4.21 In advance of the procedure patients must be given clear and comprehensive pre- and post-operative instructions in writing. Careful contemporaneous records must be kept of all the procedures undertaken. See also 4.3
RESPONSIBILITIES OF THOSE PROVIDING DENTAL TREATMENT UNDER GENERAL ANAESTHESIA38,13

4.22 Dentists with responsibilities for the provision of dental treatment under general anaesthesia must: (i) (ii) ensure that the facilities and arrangements (including location) for the general anaesthesia meet contemporary requirements.39,40 ensure that they have the assistance of an appropriately trained dental nurse. See also 3.8
(iii) ensure that the general anaesthetic is administered by an individual who: a) is on the specialist register of the General Medical Council as an anaesthetist. Such specialists are advised to comply with the voluntary Continuing Medical Education requirements of the Royal College of Anaesthetists, or b) is a trainee working under supervision as part of a Royal College of Anaesthetists' approved training programme, or c) is a non-consultant career grade anaesthetist with an NHS appointment, for example staff grade or associate specialist, working under the supervision of a named consultant anaesthetist who must be a member of the NHS anaesthetic department where the nonconsultant career grade anaesthetist is employed. d) is supported by an individual specifically trained and experienced in the necessary skills to assist in monitoring the patient's condition and in any emergency. Contemporary standards of monitoring should be adopted; the current Recommendations for Standards of Monitoring During Anaesthesia and Recovery issued by the Association of Anaesthetists of Great Britain and Ireland are appropriate.
(iv) be satisfied that there is a written protocol, arranged in conjunction with, and agreed by the anaesthetist, for the provision for immediate critical care. In this connection the current guidelines issued by the Resuscitation Council (UK) are appropriate. The protocol must include appropriate arrangements for the supervised transfer of a patient to a high dependency unit (HDU) or intensive care unit (ICU), which may be on a separate site. Such arrangements must be agreed between the parties providing the treatment and the HDU and ICU.
RECOVERY
AND
DISCHARGE
4.23 Patients who are recovering from general anaesthesia must be appropriately protected and monitored continuously in adequate recovery facilities. Monitoring must be undertaken by the anaesthetist or a dedicated individual who is appropriately trained and directly responsible to the anaesthetist. When, in the opinion of the anaesthetist, the patient is sufficiently recovered to leave the premises, the patient must be accompanied by a responsible adult. All patients must be assessed specifically for fitness for discharge and must be given post-operative advice specific to the individual regarding after care arrangements. See also 3.8
TRAINING
13
4.24 All those involved in the provision of general anaesthesia or the supervision of patients during recovery must train together as a team to deal with an emergency. Resuscitation procedures must be practised frequently in a simulated emergency as a routine training exercise. Current guidelines such as those issued by the Resuscitation Council (UK) should be adopted.
5: THE DENTAL TEAM

EMPLOYING
5.1
STAFF
2
It is the duty of a dentist to be registered with the Council and to ensure that any other dentist invited into the practice to provide dental treatment is also registered. A dentist should employ suitably trained and, where appropriate, qualified staff. A dentist may employ a trainee dental nurse, provided he or she is undergoing training as part of a structured training programme. All staff must be provided with training appropriate to their role. A dentist should encourage staff to undertake continuing professional development. A dentist who employs any person to practise dentistry has to be satisfied that the person is permitted by law to practise, by inspecting the persons practising certificate or checking registration or enrolment status with the Council. A dentist who knowingly or through neglect of this duty enable a person to provide dental treatment which that person is not permitted by law to do is liable to a charge of serious professional misconduct. A dentist should, therefore, check, annually, the practising certificates of employees. A dentist should also check that employees providing dental treatment have appropriate membership of a defence organisation or are otherwise indemnified against claims for professional negligence. A dentist who employs professionals complementary to dentistry must ensure that they only carry out work in accordance with the Regulations. A dentist will generally be held responsible for the actions of employees.
ILLEGAL
5.2
PRACTICE
A dentist who knowingly allows, or encourages, others to practise dentistry illegally on the dentists premises may be liable to a charge of serious professional misconduct. Similarly, a dentist should not encourage a patient to seek the services of a dental technician for the illegal practice of dentistry.
HYGIENISTS AND DENTAL THERAPISTS
DENTAL
5.3
When referring a patient to a dental hygienist or a dental therapist the dentist must always have first examined the patient and indicated in writing the treatment to be provided. A dentist who permits a dental hygienist to work without direct personal supervision or to administer local infiltration analgesia under the dentists direct personal supervision must be satisfied that the dental hygienist is competent to do so.
5. THE DENTAL TEAM, NOVEMBER 1997, REVISED MAY 2000
In order to be competent to administer local infiltration analgesia a dental hygienist must: (i) have completed additional training in local infiltration analgesia and gained a certificate in the administration of local infiltration analgesia, or (ii) hold the Diploma in Dental Therapy (formerly Certificate of Proficiency as a Dental Therapist) in addition to the Diploma (formerly Certificate of Proficiency) in Dental Hygiene awarded before July 1992, or (iii) hold the Diploma in Dental Hygiene awarded after July 1992.
DELEGATION
5.4
OF ORAL HYGIENE INSTRUCTION
A dentist should only delegate responsibility for instructing patients in the principles and practice of oral hygiene if: (i) the person to whom the responsibility is delegated is fully competent to discharge it; and (ii) the dentist accepts personal responsibility for whatever instruction is given.
5. THE DENTAL TEAM, NOVEMBER 1997, REVISED MAY 1999
6: PRACTICE ARRANGEMENTS
PROFESSIONAL
6.1
RESPONSIBILITY
A dentist is responsible for his or her personal and professional conduct, whether or not the dentist is in a position to control or influence the practise, business or institutional arrangements within which he or she is practising. A dentist who plays a part in the direction or management of arrangements within which other dentists and professionals complementary to dentistry practise has a responsibility to those professional colleagues to facilitate and promote their adherence to appropriate standards of personal and professional conduct and continuing professional development.
AGREEMENTS
PRACTICE
6.2
It is essential that a dentist should sign a formal written agreement about practice arrangements before entering into a partnership or other association in dental practice. The existence of such an agreement, with appropriate prior discussion, will help to reduce the likelihood of disputes. A dentist is advised to seek professional advice before signing an agreement.
FINANCIAL PRESSURE
UNREASONABLE
6.3
A dentist employed as an assistant or working as an associate in a practice should not be required to achieve a fixed target earning. Such a requirement places an unreasonable pressure on a dentist and it is not in the interests of patients for a dentist to be practising under such a constraint.
A PRACTICE
LEAVING
6.4
A dentist who leaves a practice should ensure that arrangements have been made both for the completion of any treatment which has been started and for the continuing care of patients, for whom responsibility has been accepted, irrespective of the financial agreement under which they are being treated. In the case of treatment under the NHS, the NHS authorities should be informed of the arrangements which have been made.
OF CLINICAL AND HAZARDOUS WASTE
DISPOSAL
6.5
The risk of cross-infection is not limited to the dental surgery itself and a dentist must abide by the legislation which governs the disposal of clinical and other hazardous waste. Failure to do so may lead to a charge of serious professional misconduct.
6: PRACTICE ARRANGEMENTS, NOVEMBER 1997, REVISED NOVEMBER 2000
DENTAL
6.6
RECORDS AND RADIOGRAPHS
5, 16, 17
Patient records, including radiographs and study models, provide valuable information as to the treatment carried out and, where possible, should be retained. A dentist with computerised patient records must ensure that the computer system used includes appropriate features to safeguard the security and integrity of those records. The Data Protection Act 1998, which covers computer-held records made at any time, gives the patient the right to see and/or have copies of computer-held records. The Access to Health Records Act 1990 gives the same rights to patients concerning manual records made after 1 November 1991. See also 3.5
DISPOSAL
6.7
OF PATIENT RECORDS
In view of the confidentiality of patient records, at the time of disposal they must be disposed of securely, usually by incineration or shredding.
DEBT
COLLECTION
6.8
There is a need for good in-practice systems for fee collection in order to minimise the need to resort to court action or debt collectors. The use of court action or debt collectors as a means of obtaining settlement of outstanding accounts should only be considered when all reasonable steps to obtain payment have first been taken in writing.
BANKRUPTCY 18
6.9 A dentist who is declared bankrupt may continue to practise dentistry provided that registration is maintained. The general law of insolvency is complicated and any dentist who is declared bankrupt should seek specific advice as to the extent to which dental work may be continued and appropriately remunerated without infringing insolvency legislation. The dentists trustee in bankruptcy (in Northern Ireland, the official assignee) may carry on the business of dentistry for three years from the date of the declaration of bankruptcy.
CARRYING
ON THE BUSINESS OF DENTISTRY
RESTRICTIONS
19
6.10 A person is said to be involved in the business of dentistry when, either as an individual or as a member of a partnership, that person receives payment for services amounting to the practice of dentistry provided by that person, by a partner, or by an employee of either of them. Under the Dentists Act there are a number of circumstances in which a body corporate or a person who is not a registered dental or medical practitioner may be involved in the business of dentistry. These include persons and bodies corporate who were involved in the business of
dentistry before 21 July 1955; spouses or children of deceased dentists; trustees in bankruptcy; and companies providing dental treatment for their employees where the company does not profit from this. A dentist who becomes a partner or an employee of someone who is carrying on the business of dentistry illegally may be liable to a charge of serious professional misconduct. A dentist who becomes a director or an employee of a body corporate which is carrying on the business of dentistry illegally would be similarly liable.
BODIES
CORPORATE
6.11 A dentist who enters into a partnership or becomes a director of a body corporate legally carrying on the business of dentistry accepts responsibility for the maintenance of a high standard of professional conduct in that business.
COMPANIES TO RUN THE ADMINISTRATIVE PRACTICE/LETTING OF PREMISES
SIDE OF A DENTAL
6.12 There is no legal or ethical objection to the setting up of a limited company with the sole object of running the administrative or clerical side of a dental practice. Such a limited company might acquire and hold the premises, fittings and equipment of the practice; employ the clerical and other non-clinical staff to run the administration of the practice; and charge a dentist rent in respect of the property and a fee in respect of the administrative services rendered. A dentists responsibility to patients must remain unaltered, in that there is a direct liability to individual patients in respect of any dental treatment provided. The fees for the treatment would be payable to the dentist and not to the company and as such it is not possible for the company to own the goodwill of the practice. There is no objection to an unregistered person or a company owning premises which are leased to a registered dentist for the purpose of carrying on the business of dentistry. However, it would be contrary to the Dentists Act 1984 for the rental to be linked to the dentists earnings. It would also be contrary to the Act for an unregistered person or a company to own in full, or in part, a dental practice or to take profits from the proceeds of a dental practice.
USE
OF THE WORDS DENTAL AND DENTISTRY IN COMPANY TITLES
20
6.13 Under the provisions of the Companies Act 1985 the words dental and dentistry are protected. A company, or applicant for a Consumer Credit Licence, which proposes to use either or both of these words in its registered title is therefore required by Companies House to obtain a letter of non-objection from the Council.
PRACTICE
TITLES
6.14 The approval of the Council is not needed for practice titles. The main consideration in relation to the title of a dental practice is that it should not mislead the public. When choosing a practice title, dentists should have regard for other practices in the area. A practice title may only mention a particular form of dentistry, for example, Denture Clinic or Orthodontic Practice if the practice in question is limited to the provision of that particular type of treatment.
SIGNS
AND PROFESSIONAL PLATES
6.15 The name of each dentist who regularly attends patients should be shown at the premises where the dentist practises by means of a professional plate. The display of a sign indicating that a dentist is in regular attendance at a practice when this is not the case is misleading. When a dentist ceases to work at a practice the relevant professional plate should be removed within a reasonable period. For the information of patients, the use of words such as late or formerly to indicate a previous association of a dentist with the practice is acceptable for a reasonable time after the named dentist has left the practice.
APPEARANCE
OF NAMES OTHER THAN A DENTISTS
6.16 The names of dental hygienists working in the practice of a registered dentist may appear on headed paper and in practice information leaflets or brochures. Dentists may, at their discretion, also permit a dental hygienists name with the designation dental hygienist or EDH, to be displayed outside the practice premises. The names of persons other than dentists and dental hygienists may not be displayed outside the premises. The names of persons other than dentists in the practice may not appear in advertisements.
SCREENING
OF WINDOWS
6.17 A dentist should take care that the windows of the surgery area are adequately screened so as to take account of the sensibilities of patients and public.
CANVASSING
6.18 There is no objection to a dentist distributing leaflets to promote a dental practice providing that the leaflet conforms to the guidelines in section 7, Promoting the Practice. The use of personal contact, such as unsolicited telephone calls or house to house visits, to promote a practice would diminish public confidence in the profession and bring the profession into disrepute.
6: PRACTICE ARRANGEMENTS, NOVEMBER 1997, REVISED MAY 2001
INCENTIVES
6.19 The Council takes the following view with regard to the use of incentives: (i) there is no objection to a token or other gift being given by a dentist directly to a patient who attends for treatment; (ii) it is not acceptable for a financial incentive to be paid to a third party by a dentist in return for encouraging or promoting the uptake of dental care by individual members of the public; (iii) a dentists professional relationship with patients may be compromised if any member of the dental team were to accept financial incentives from third party interests in return for promoting to patients: a) enrolment in a particular scheme for the provision of dental care; b) specific dental products; c) the uptake of insurance; (iv) when referrals are made between professional colleagues no inducements should be offered or accepted.
PRODUCT
PROMOTION
6.20 Printed matter relating to a dental practice may include advertisements for other products and services. A dentist should ensure that the acceptance of commercial sponsorship or payment for advertising does not cause a conflict of interest which might be detrimental to the professional relationship with patients. In particular, a dentist who includes advertisements in printed matter should ensure that no products or services are promoted which would be in conflict with dentistry or the principles of health care.
7: PROMOTING THE PRACTICE

LEGAL,
7.1
DECENT, HONEST, TRUTHFUL
A dentist may only use publicity or advertising material which is legal, decent, honest and truthful and has regard for professional propriety. Responsibility for all publicity and advertising in relation to a practice rests with the dentist.
NAME
OF DENTIST TO BE INCLUDED
7.2
All advertisements and printed material relating to a given practice should include the name of at least one dentist normally in attendance at the practice in question. Advertisements in a foreign language should include the name of the dentist in the form in which it is listed in the Dentists Register. However, the name may also be written in the language concerned.
UNACCEPTABLE
7.3
CONTENT
Publicity or advertising material should not: (i) be of a character that could reasonably be regarded as likely to bring the profession into disrepute; (ii) make a claim which is not capable of substantiation; (iii) contain any reference to the efficiency, skills or knowledge of any other dentist or practice; (iv) make a claim which suggests superiority over any other dentist or practice; (v) recommend a specific product.
CLARITY
7.4
OF TREATMENT AVAILABLE
The Council takes a serious view of any advertising or publicity material which is liable to mislead patients about the availability of treatment or the nature of the services to be provided.
WITH THE MEDIA
INTERACTIONS
7.5
Publicity about a dentist or a practice which arises through, or from interviews with representatives of, the media and which may be regarded as likely to bring the profession into disrepute should be avoided. A dentist who comments to the media has a particular responsibility to ensure that all statements are factually accurate. There is a duty to distinguish between personal opinion or political belief and established facts and a dentist should, whenever possible, request access to the article, statement or interview before publication or broadcast.
7: PROMOTING THE PRACTICE, NOVEMBER 1997
The Council will generally hold a dentist, who gives interviews to representatives of the media, responsible for any publicity which may ensue. Any public statement which is calculated to mislead the public or damage public confidence in the profession may lead to a charge of serious professional misconduct. See also 4.6
SPECIALIST
7.6
CLAIMS
No publicity or advertising material should indicate that a dentist has specialist expertise unless the dentist is the holder of a specialist title and the dentists name is entered in a specialist list. A statement to that effect may appear in publicity or advertising material. No other claim to specialist expertise should be made by any dentist. See also 1.5 Advertising material may indicate that a practice is wholly or mainly restricted to a particular type or types of treatment. A dentist who chooses to give such an indication has a responsibility to ensure that it does not imply or amount to a claim to specialist expertise. As stated above, only a dentist whose name is entered on a specialist list may claim to be a specialist.
CLARITY
7.7
OF INFORMATION ON FEES
If advertising material includes reference to fees for professional advice or treatment, it should indicate: (i) if free-of-charge items will be provided under the NHS; (ii) whether the stated fee relates to treatment provided under the NHS or some other arrangement; (iii) whether the stated fee is liable to vary; (iv) that further details may be obtained on request.
7: PROMOTING THE PRACTICE, NOVEMBER 1997, REVISED MAY 1999
8: THE COUNCILS JURISDICTION

JURISDICTION
8.1 The Council has a statutory remit to promote high standards of professional conduct among dentists. It also has jurisdiction in cases where a dentists fitness to practise is seriously impaired by reason of mental or physical condition. Such matters are dealt with by the Councils Professional Conduct Committee and Health Committee. Both Committees have the power to suspend a dentists registration. The Health Committee may impose conditions on a dentists registration and the Professional Conduct Committee may erase a dentists name from the Dentists Register.
PROFESSIONAL CONDUCT A
DENTISTS PROFESSIONAL DUTY AND LIABILITY
8.2
The conduct of a dentist must at all times be compatible with the high standard which the public and the profession have a right to expect. Responsibility to patients is the first priority. A dentists name is liable to be erased from the Dentists Register or a dentists registration suspended or refused if at any time that dentist has been convicted of a criminal offence or is found guilty of serious professional misconduct.
SCOPE
AND DEFINITION OF SERIOUS PROFESSIONAL MISCONDUCT
21
8.3
It is not possible to be explicit as to what constitutes serious professional misconduct. However, it has been broadly defined as ... conduct connected with the profession in which the dentist concerned has fallen short, by omission or commission, of the standards of conduct expected among dentists and that such falling short as is established should be serious. Earlier sections of this guidance indicate a variety of matters which could lead to a charge of serious professional misconduct. The scope of such a charge is not limited and will vary depending on the circumstances.
EXTENT
8.4
OF DISCIPLINARY JURISDICTION
The Councils disciplinary jurisdiction as regards criminal offences and in cases of serious professional misconduct extends to all registered dentists.
8: THE COUNCILS JURISDICTION, NOVEMBER 1997, REVISED NOVEMBER 2000
UNDERGRADUATE
8.5
BEHAVIOUR
Behaviour reflecting adversely on the profession, such as dishonesty, indecency or violence; conviction in a court of law; or problems related to alcohol or drugs, during the time as an undergraduate dental student could lead to the first application for registration being referred to the President. It could equally well be taken into consideration later if the Council had cause to consider the conduct of a registered dentist.
OF INFORMATION
22
SOURCES
8.6
Information to be considered under the Councils disciplinary jurisdiction may be received from a number of sources: (i) the police report criminal convictions to the Council but may also provide information about formal cautions or other matters of concern; (ii) a patient, a member of the public or another dentist (iii) a person acting in a public capacity which would include an officer of a Health Authority, Trust or similar body; (iv) the Councils solicitors.
CONVICTIONS
8.7 The Council may consider any criminal conviction including those for offences which are not directly connected with a dentists profession or practice or which occurred while the dentist was not registered. Dentists should be aware that if a conviction is referred to the Professional Conduct Committee the Committee must accept the findings of the court on matters of fact as conclusive proof of those facts. This means that a dentist cannot then claim to have been innocent of the original charges.
DISCIPLINARY PROCEDURE STAGES

8.8
23
Convictions and complaints alleging serious professional misconduct may be considered in up to three stages: - Preliminary Screening - Preliminary Proceedings Committee - Professional Conduct Committee
PRELIMINARY SCREENING PRELIMINARY SCREENER

8.9 A senior member of the Council acts as Preliminary Screener and considers whether the conviction or complaint may suggest evidence of serious professional misconduct.
ACTION
8.10 When a complaint is received, the dentist involved will be told about it. If it is decided that there is no case to answer the matter proceeds no further. Where appropriate the complainant, for example a patient, is informed of the decision. If it is considered that there may be a case to answer, the matter is referred to the Preliminary Proceedings Committee.
PRELIMINARY PROCEEDINGS COMMITTEE MEETINGS

AND MEMBERSHIP
24, 25
8.11 The Preliminary Proceedings Committee normally meets twice each year, in March and September, but may meet at other times if necessary. It sits in private and considers documentary information only, except when interim suspension may be considered. The membership of the Committee comprises the President and five other Council members, one of whom is a lay member. See also 8.16
NOTIFYING
THE DENTIST
8.12 If a matter is referred to the Preliminary Proceedings Committee, the dentist in question is either notified that the conviction has been reported to the Council or sent a copy of the information which has been considered by the Preliminary Screener. The dentist is invited to submit written comments or observations on the matter for consideration by the Committee. Such notification is generally issued at least 28 days prior to the meeting.
CONSIDERING
THE INFORMATION
8.13 The Preliminary Proceedings Committee considers the conviction or complaint together with any written response received from the dentist or a representative. The Committee may decide there is no case to answer and the matter should proceed no further. If, however, the Committee decides that there is evidence to support an allegation of serious professional misconduct the matter will be referred to the Professional Conduct Committee for inquiry. The Committee also has the option of referring the matter to the Health Committee.
NOTIFYING
THE DECISION
8.14 Following the meeting the dentist and, where appropriate the complainant, for example the patient, are notified of the Committees decision.
ADVICE
AND WARNINGS
8.15 If a matter is not referred for inquiry the Committee may direct that some advice as regards behaviour be given to the dentist. The Committee may also direct that the dentist be warned that the matter may be reconsidered if further information about the dentist is formally brought to the attention of the Council.
INTERIM
SUSPENSION
26
8.16 The Preliminary Proceedings Committee has the power, if it feels that members of the public may be at risk, to order that a dentists registration be suspended immediately, pending the outcome of an inquiry by the Professional Conduct Committee. See also 8.24 In referring a matter of a particularly serious nature to the Preliminary Proceedings Committee the Preliminary Screener can indicate that the Committee may wish to consider interim suspension. The dentist will be advised of this and offered the opportunity to make representations to the Committee, either in person or through a representative, as to whether such an order should be made. The Preliminary Proceedings Committee first considers whether the matter should be referred to the Professional Conduct Committee and only if it is, does the Committee then consider whether to impose interim suspension. On such occasions a Legal Assessor sits with the Committee. See also 8.17
PROFESSIONAL CONDUCT COMMITTEE MEETINGS

AND MEMBERSHIP
27, 28, 29
8.17 The Professional Conduct Committee normally meets twice each year, in May and November, but may meet at other times if necessary. Meetings are held in public. The membership of the Committee comprises the President and ten other members of Council, five of whom must be elected members and two of whom must be lay members. A Legal Assessor, who is a barrister, advocate or solicitor of not less than ten years standing, sits with the Committee to advise on matters of law and procedure.
NOTIFYING
THE DENTIST
8.18 If a matter is referred to the Professional Conduct Committee a formal Notice of Inquiry is sent to the dentist, by the Councils solicitors, at least 28 days before the date of inquiry.
NOTICE
OF INQUIRY
8.19 The Notice includes the charge to be faced by the dentist. In conviction cases the charge sets out the basic details of the conviction and the penalty imposed by the Court. For conduct cases the charge sets out the facts which, if proved, may constitute serious professional misconduct.
PRESENTATION
OF CASE AND RULES OF EVIDENCE
8.20 A barrister or solicitor will present the Councils case. The dentist is usually similarly represented. The Committee does have the power to proceed in the absence of the respondent dentist. Evidence is taken on oath and either party to the proceedings may subpoena witnesses. The procedure is similar to that used in a court of law and the standard of proof is the same as in criminal proceedings, namely beyond reasonable doubt.
FINDING
OF SERIOUS PROFESSIONAL MISCONDUCT
8.21 In conduct cases the Professional Conduct Committee must first determine whether the facts alleged in the charge have been proved. Only if some or all of the facts are found proved does the Committee then consider whether the facts found proved amount to serious professional misconduct.
DISPOSAL
OF CASE
8.22 Where a dentist has already been convicted in a criminal court or is found guilty of serious professional misconduct, there are a number of options open to the Committee: (i) the Committee may conclude the case with an admonition; (ii) judgement may be postponed until a future meeting when the Committee will consider the dentists conduct during the intervening period. Postponement is generally for one year; (iii) the Committee may direct that the dentists registration be suspended for a specified period not exceeding 12 months; (iv) the Committee may direct that the dentists name be erased from the Dentists Register. The Committee also has the option of directing that the matter be referred to the Health Committee.
IMMEDIATE
SUSPENSION
30
8.23 Following a determination of suspension or erasure the Professional Conduct Committee may, if it feels it is necessary for the protection of the public or that it would be in the best interests of the dentist, further direct that a dentists registration be suspended with immediate effect. See also 8.40
8: THE COUNCILS JURISDICTION, NOVEMBER 1997
APPEALS
AND IMPOSITION OF DETERMINATION
31, 32
8.24 A determination of immediate suspension, or interim suspension by the Preliminary Proceedings Committee, takes effect immediately but the dentist may apply to the appropriate Court, for example in England the High Court, for the suspension to be terminated. If the Committees direction is for suspension or erasure there follows a period of 28 days during which the dentist may choose to lodge an appeal with the Judicial Committee of the Privy Council. If the dentist does not exercise this right of appeal the determination takes effect at the end of the appeal period. If an appeal is lodged the dentist may continue to practise at least until the outcome of the appeal is known. See also 8.42
RESTORATION
AFTER SUSPENSION
8.25 If a dentists registration is suspended that dentists name is automatically restored to the Dentists Register at the end of the period of suspension.
RESTORATION
AFTER ERASURE FOR MISCONDUCT
33, 34
8.26 An application for a dentists name to be restored to the Dentists Register may be made not less than ten months after the date of erasure. The application is considered by the Professional Conduct Committee. The Committee will be reminded of the circumstances which led to the erasure and will take account of the dentists behaviour during the intervening period and any evidence of professional rehabilitation submitted by the applicant. If the application is granted the dentists name is restored to the Dentists Register as soon as the appropriate registration fee has been paid. If the application is refused the dentist must wait at least ten months from the date of the hearing before submitting another application.
FITNESS TO PRACTISE INFORMATION

ABOUT A DENTIST
35
8.27 A person, who is not a person acting in a public capacity, writing to the Council with information concerning a dentists fitness to practise may be asked to submit a statutory declaration or affidavit.
INITIAL
CONSIDERATION OF INFORMATION
8.28 The information is submitted to the President who acts as Preliminary Screener. If the President feels a question does arise as to whether or not the dentists fitness to practise may be seriously impaired the President will direct that the dentist be invited to be medically examined.
If the President feels there is no question to be answered the person who provided the information is notified accordingly and the matter goes no further.
NOTIFYING
THE DENTIST
8.29 If the President directs that the matter should proceed the dentist is sent a copy of the information considered by the President and invited to submit to one or more medical examinations. The dentist is asked to reply within 14 days and must reply within 28 days.
MEDICAL
EXAMINATIONS
8.30 Medical examiners are chosen from persons nominated by the appropriate professional body. They will be asked to report on the dentists fitness to engage in practice either generally or on a limited basis. They will also be asked for recommendations as to the management of the case. The examinations are generally arranged at a venue local to the dentist. The dentist may also nominate other medical practitioners to undertake an examination and report to the Council. However, such examinations would be at the dentists expense. The opportunity is also given for the dentist to submit observations on the matter.
CONSIDERATION
OF MEDICAL REPORTS
8.31 The President will consider the medical reports and decide whether or not the matter should be referred for the consideration of the Health Committee. If it is not referred, the dentist is notified accordingly and sent a copy of the reports. If a dentist fails to respond to the invitation to be medically examined or refuses to be examined the President may still refer the matter to the Committee.
HEALTH COMMITTEE MEETINGS

AND MEMBERSHIP
35, 36, 37
8.32 The Health Committee normally meets twice each year, in January and July, but may meet at other times if necessary. The Committee meets in private. The membership of the Committee comprises a Chairman who must be a registered dentist and ten other members of the Council of whom five must be elected members and two lay members. The President may choose whether to sit as a member of the Health Committee and if so would act as Chairman. As with the Professional Conduct Committee the Health Committee is assisted by a Legal Assessor. One or more Medical Assessors also sits with the Committee to advise on the significance of the medical evidence.
NOTIFYING
THE DENTIST
8.33 If a dentists case is referred to the Health Committee the dentist is sent a formal Notice of Referral at least 28 days before the date of the hearing.
NOTICE
OF
REFERRAL
8.34 The Notice will be accompanied by a copy of all the information to be presented to the Committee.
CONDUCT
OF HEARING
8.35 While the proceedings of the Health Committee are of a judicial nature they are rather less formal than those of the Professional Conduct Committee. The Councils case is presented by a solicitor and the dentist is usually similarly represented. The Committee does have the power to proceed in the absence of the dentist.
INFORMATION
CONSIDERED BY THE
HEALTH COMMITTEE
8.36 In most cases the principal evidence considered by the Committee consists of the reports prepared by the medical examiners. In some cases witnesses may be called to give evidence and such evidence is given on oath.
FINDING
CONCERNING FITNESS TO PRACTISE
8.37 Having considered all the evidence the Health Committee must first decide whether or not a dentists fitness to practise is seriously impaired by reason of physical or mental condition. If the Committee finds that it is not, the matter is concluded. If the case has been referred by either the Preliminary Proceedings Committee or the Professional Conduct Committee, the Health Committee notifies its determination to that Committee which will then continue its consideration of the case.
DETERMINATION
OF
HEALTH COMMITTEE
8.38 If the Committee finds that a dentists fitness to practise is seriously impaired it may impose conditions on the dentists registration for an initial period not exceeding three years or suspend the dentists registration for a period not exceeding 12 months. Such cases are reviewed by the Committee before the end of the period of the original determination.
NOTICE
OF
RESUMED HEARING
8.39 When a case is due to be reviewed by the Committee the dentist is sent a Notice of Resumed Hearing at least 28 days before the date of the hearing. As with the original referral the Notice is accompanied by a copy of all the information to be presented to the Committee.
IMMEDIATE
SUSPENSION
8.40 The Health Committee has the same powers as the Professional Conduct Committee in that it may direct that a dentists registration be suspended with immediate effect. See also 8.23
CONDITIONS
8.41 Conditions imposed by the Health Committee may relate to dentists health or practice. Any conditions relating to the practice will be printed on the back of the annual practising certificate. Conditions are tailored to the particular case. If, having reviewed the case after the initial period of conditional registration, the Committee makes a direction for a further period of conditional registration, that period shall not exceed 12 months.
APPEALS
AND IMPOSITION OF DETERMINATION
8.42 The procedure as regards appeals and the imposition of the Committees determination is the same as for the Professional Conduct Committee except that in the case of the Health Committee the direction will either be for conditional registration or suspension. See also 8.24
JURISDICTION
OF THE
HEALTH COMMITTEE
8.43 The jurisdiction of the Health Committee extends to all registered dentists. Once the Committee has determined that a dentists fitness to practise is seriously impaired the dentist will remain under the jurisdiction of the Health Committee until such time as the Committee determines that fitness to practise is no longer seriously impaired. At that point any conditions which had previously been imposed on the dentists registration will be revoked.
BIBLIOGRAPHY
This list is not exhaustive but is intended as a guide for anyone seeking further information.
Dentists Act 1984, section 38. HMSO, ISBN 0 10 542484 6. Dental Auxiliaries Regulations 1986 (SI 887) as amended by the Dental Auxiliaries (Amendment) Regulations 1991 (SI 1706). HMSO, ISBN 0 11 066887 1 (1986) and 0 11 014706 5 (1991). Statement of Policy on Postgraduate Education. General Dental Council, May 1995. Dentists Act 1984, section 26. Data Protection Act 1998. HMSO, ISBN 0 10 542998 8. Complaints, Listening ... Acting ... Improving. Guidance Pack for General Dental Practitioners. Department of Health 1996, 3959 1P 25K Feb 96 (24). Chief Dental Officer, letter to all dentists in England. Cross Infection Control. Department of Health 1993, PL/CDO (93) 3. Guidance for Clinical Health Care Workers: Protection Against Infection with HIV and Hepatitis Viruses. Recommendations of the Expert Advisory Group on AIDS. HMSO, January 1990, ISBN 0 11 321249 6. (Currently under revision). AIDS-HIV Infected Health Care Workers. Occupational Guidance for Health Care Workers, Their Physicians and Employers. Recommendations of the Expert Advisory Group on AIDS. Department of Health, December 1991. Available from BAPS.
4 5
10 Protecting Health Care Workers and Patients from Hepatitis B. Recommendations of the Advisory Group on Hepatitis. Department of Health, August 1993. Available from BAPS. 11 Guidelines on Post-Exposure Prophylaxis for Health Care Workers Occupationally Exposed to HIV. Department of Health, June 1997. PL/CO(97)1. 12 Exposure prone procedures are defined as: Those where there is a risk that injury to the worker may result in the exposure of the patients open tissues to the blood of the worker. These procedures include those where the workers gloved hands may be in contact with sharp instruments, needle tips or sharp tissues (spicules of bone or teeth) inside a patients open body cavity, wound or confined anatomical space where the hands or fingertips may not be completely visible at all times.
BIBLIOGRAPHY, NOVEMBER 1997, REVISED NOVEMBER 2000
Taken from: AIDS/HIV-Infected Health Care Workers: Guidance on the Management of Infected Health Care Workers. Recommendations of the Expert Advisory Group on AIDS. Department of Health, March 1994. Available from BAPS. 13 The 2000 Resuscitation Guidelines for Use in the United Kingdom. Resuscitation Council (UK). 14 The Ionising Radiation (Medical Exposure) Regulations 2000 (SI 1059). HMSO, ISBN 0 11 099131 1. 15 Dental Practitioners Formulary 1998-2000. The British Medical Association and the Royal Pharmaceutical Society of Great Britain. ISBN 0 85369 426 5. 16 How to Store Patients Dental Records on a Computer. Department of Health/Dental Practice Board, January 1995, 1944 1P 28,900 Dec 94. 17 Access to Health Records Act 1990. HMSO, ISBN 0 10 542390 4. 18 Dentists Act 1984, section 41(6). 19 Dentists Act 1984, sections 40 to 44. 20 Companies Act 1985. HMSO, ISBN 0 10 540685 6. 21 Privy Council Appeal No. 15 of 1987. Doughty v The General Dental Council. 22 General Dental Council Rules and Regulations, November 1998 (as revised), paragraph 4.11. 23 General Dental Council Rules and Regulations, November 1998 (as revised), paragraph 4.11 and 4.12. 24 Dentists Act 1984, Schedule 1 Part II. 25 General Dental Council Rules and Regulations, November 1998 (as revised), paragraph 3.13 and 4.12. 26 Dentists Act 1984, section 32. 27 Dentists Act 1984, section 27; Schedule 1 Part II; Schedule 3. 28 The General Dental Council Professional Conduct Committee (Procedure) Rules Order of Council 1984 (SI 1517). HMSO, ISBN 0 11 047517 8. 29 General Dental Council Rules and Regulations, November 1998 (as revised), paragraph 3.14. 30 Dentists Act 1984, section 30. 31 Dentists Act 1984, sections 29 and 30.
32 The Judicial Committee (Dentists Rules) Order 1985 (SI 172). HMSO, ISBN 0 11 056172 4. 33 Dentists Act 1984, section 34. 34 General Dental Council Rules and Regulations, November 1998 (as revised), paragraph 4.16. 35 The General Dental Council Health Committee (Procedure) Rules Order of Council 1984 (SI 2010). HMSO, ISBN 0 11 048010 4. 36 Dentists Act 1984, section 28; Schedule 3. 37 The General Dental Council Health Committee (Constitution) Order 1984 (SI 1816). HMSO, ISBN 0 11 047816 9. 38 Recommendations for Standards of Monitoring during Anaesthesia and Recovery. Revised Edition 1994. The Association of Anaesthetists of Great Britain and Ireland. 39 CMO/CDO (England) Report A Conscious Decision: A review of the use of general anaesthesia and conscious sedation in primary dental care [ref 21967 PC 1P 3.2k July 00 (CWP)] can be obtained from the Department of Health by e-mail request to doh@prologistics.co.uk and at www.doh.gov.uk/dental/conscious.htm and associated letters of advice from Chief Dental Officers in England, Northern Ireland, Scotland and Wales. 40 Dental Anaesthesia Committee. Standards & Guidelines for General Anaesthesia for Dentistry. Royal College of Anaesthetists, February 1999 41 Implementing and ensuring Safe Sedation Practice for healthcare procedures in adults: Academy of Medical Royal Colleges and their Faculties: Report of an Intercollegiate Working Party chaired by the Royal College of Anaesthetists, November 2001. 42 Standards in Conscious Sedation for Dentistry: the report of an independent working group produced by the Society for the Advancement of Anaesthesia in Dentistry, email saad@dental-clinic.co.uk / www.saaduk.org/sedbooklet.pdf, October 2000 43 NHS MEL (1999) 22. Emergency Dental Drugs (1999): National Dental Advisory Committee. The Scottish Office Department of Health, ISBN 07480 8121 6
USEFUL ADDRESSES
Academy of Medical Royal Colleges, 1 Wimpole Street, London, W1G 0AE Tel: 020 7290 3913, Fax: 020 7290 3914, Email: academy@aomrc.org.uk, Website: www.aomrc.org.uk Association of Anaesthetists of Great Britain and Ireland, 9 Bedford Square, London, WC1B 3RA Tel: 020 7631 1650, Website: www.aagbi.org BAPS, Health Publications Unit, DSS Distribution Centre, Heywood Stores, Manchester Road, Heywood, Lancashire, OL10 2PZ. British Dental Association, 64 Wimpole Street, London, W1M 8AL. Tel: 020 7935 0875. Dental Practice Board, Compton Place Road, Eastbourne, East Sussex, BN20 8AD. Tel: 01323 417000. Department of Health, Richmond House, 79 Whitehall, London, SW1A 2NS. Tel: 020 7210 3000 General Dental Council, 37 Wimpole Street, London, W1G 8DQ. Tel: 020 7887 3800, Website: www.gdc-uk.org HMSO is now The Stationery Office Ltd. The Stationery Office, 123 Kingsway, London, WC2B 6PQ. Tel: 020 7242 6393, Fax: 020 7242 6394, www.thestationeryoffice.com. Resuscitation Council (UK), 5th Floor, Tavistock House North, Tavistock Square, London, WC1H 9HR. Tel: 020 7388 4678, Website: www.resus.co.uk The Pharmaceutical Press, PO Box 151, Wallingford, Oxon, OX10 8QU. Tel: 01491 824 486. Royal College of Anaesthetists, 48-49 Russell Square, London WC1B 4JY Tel: 020 7813 1900, Fax: 020 7813 1876, E-mail: info@rcoa.ac.uk, Website: www.rcoa.ac.uk Society for the Advancement of Anaesthesia in Dentistry 53 Wimpole Street, London, W1G 8YH, E-mail: saad@dental-clinic.co.uk, Website: www.saaduk.org
INDEX
References are to paragraph number; where an entire section refers to the subject, the section reference is given in bold type.
A
absence, extended 3.12 Access to Health Records Act 1990 6.5 account, itemised 3.6 administration, practice 6.12 admonition 8.22 Advanced Life Support 4.22 advertisements 6.16, 6.18, 6.20, 7.1-7.6 advice definition of 1.1 legal, professional 1.2, 2.4, 3.5 agreements practice 6.2 treatment 3.6 alcohol and drugs, misuse of 2.2 anaesthesia, sedation administration of 4.22 consent procedure 3.7 drugs 4.15 equipment 4.15 monitoring 4.15, 4.23 recovery from 4.16, 4.23 risks of 4.17 third partys presence 3.8 see also conscious sedation; intravenous sedation analgesia, local infiltration 5.3 anxiety control 4.8 appeals 8.24, 8.42 associate in practice 6.1, 6.2, 6.3
C
canvassing 6.18 case, disciplinary 8.20, 8.22 certificate, practising 5.1, 8.41 Certificate of Proficiency as a Dental Therapist 5.3 Certificate of Proficiency in Dental Hygiene 5.3 charge, disciplinary 8.19 charges see fees, treatment children difficult, treatment of 3.10 clerical administration 6.12 clinical and hazardous waste 6.5 collapse of patient 4.7 colleagues, relationships between 2.4 commercial sponsorship 6.20 communication, postal 3.5 companies, provision of dental treatment by 6.10 Companies Act 1985 6.13 Companies House 6.13 company, administrative 6.12 company titles 6.13 comparison with other practitioners 7.3 claims see complaints; professional negligence claims, misleading see patients, public (misleading) compensation 1.2 complainant 8.14 complaints 2.2, 3.13, 3.14, 8.6, 8.8, 8.13 computerised records 3.5, 6.6 conditions of practising certificate 8.41 of registration 8.38, 8.41, 8.42 revocation of 8.43 confidentiality 3.5, 6.6, 6.7 see also privacy conscious sedation definition of 4.11 drugs 4.11, 4.13, 4.14, 4.15 techniques 4.8, 4.11, 4.12, 4.13, 4.14, 4.15
B
bankruptcy 6.9, 6.10 behaviour advice, warnings 8.15 conduct, professional 6.11, 8.2-8.7 patient, management of 3.10, 4.9, 4.17 personal 2 undergraduate 8.5 bibliography Appendix I bodies corporate 6.10, 6.11 British Dental Association, guidance by 3.13, 4.1
INDEX, NOVEMBER 1997, REVISED NOVEMBER 2000
consent patients 3.7, 4.12, 4.20 written 3.7, 4.12, 4.20 consultation, initial 3.6 Consumer Credit Licence 6.13 Continuing Professional Development (CPD) 1.3 convictions see criminal offence costs account, itemised, of 3.6 estimate of 3.6 scheme 3.6 criminal offence 8.2, 8.5, 8.6, 8.7 criminal proceedings 2.2 cross-infection 4.1, 6.5
D
Data Protection Act 1984 3.5, 6.6 debt collection 6.8 decisions on misconduct 8.14, 8.15 defence organisation advice from 3.5 membership of 1.2, 5.1 delegation of tasks 4.5 dental 1.4, 6.13 dental auxiliaries, duties of 5.1dental hygienists competence of 5.3 employment of 5.3 name, display of 6.16 Regulations 1.1 dental nurse 3.8, 4.22 dental practitioner 1.4 dental radiography see radiography dental surgeon 1.4 dental team arrangements for 5 assistance by 3.8, 4.22 confidentiality 3.5 incentives 6.19 protection of 4.1, 4.5 training 4.7, 4.15, 4.24 see also second person; third party, presence of dental technician 5.2 dental therapists employment of 5.3 Regulations 1.1 dentist absence, extended, of 3.12 claims by 4.6 deceased, spouses, children of 6.10 description of 1.4 in employment see employment; practice
arrangements fitness to practice 8.1, 8.27-8.31, 8.32-8.43 leaving practice 6.4, 6.15 medical reports on 8.31, 8.36 name as on Register 1.1, 7.2 qualifications as on Register 1.4 registration of see registration responsibility to patients of 3, 6.12 statutory duties of 4.4 dentistry ancillary, unproven forms of 4.6 business of 6.10 dentistry and company title 6.13 Dentists Act Foreword, 6.10 Dentists Register 1.1, 1.4, 7.2 see also erasure; registration; restoration of name; suspension determination imposition of 8.24, 8.38, 8.42 notification of 8.37 difficult patients 3.10 Diploma in Dental Hygiene 5.3 Diploma in Dental Therapy 5.3 discharge of patient 4.16, 4.23 disciplinary case 8.20, 8.22 disciplinary charge 8.19 disciplinary jurisdiction of GDC 8.4, 8.6 disciplinary proceedings, procedure 1.1, 8.8 see also notification; Preliminary Proceedings Committee; President; Professional Conduct Committee disclosure 3.5 disease see cross-infection; transmissible disease dishonesty 2.1, 8.5 disrepute see profession, confidence in doctor as courtesy title 1.4 domiciliary treatment 3.9 drugs in conscious sedation 4.11, 4.13, 4.14, 4.15 misuse of 2.2 prescribing 2.2, 4.5 for treating complications 4.15
E
emergency, medical 4.7 emergency treatment arrangements for 3.11, 4.24 need for 3.11, 4.24 employees, company dental treatment for 6.10
employment duties of employed dentist 6.2, 6.4 duties of employing dentist 5.1 illegal 5.2, 6.9 practice procedures 6.2, 6.3, 6.4, 6.10 enrolment status 5.1 equipment, facilities 4.4, 4.7, 4.15, 4.16, 4.17, 4.23 erasure 8.1, 8.22, 8.24, 8.26 ethical guidance aim and format Introduction evidence in disciplinary case 8.20, 8.22 of fitness to practise 8.36, 8.37 of misconduct 8.11, 8.13 rules of 8.20 expectation see professional expectation of standards; public expectation of standards
guidance, publications, useful addresses Appendix I
H
hazardous waste 6.5 Health Authority 8.6 Health Committee (of GDC) jurisdiction 8.43 meetings and membership 8.32 powers 8.1 proceedings 8.33-8.42 referral to 2.2, 8.22, 8.31 Health Departments, guidance by 4.1 High Court 8.24 HIV infection 4.1 home visit 3.9 hygiene, oral 5.4
F
fees, registration 8.26 fees, treatment description of 7.7 explanation of 3.6 fraudulent 2.3 payment of 6.8, 6.12 financial pressure 6.3 fitness to practise 8.1, 8.27-8.31, 8.32-8.43 see also notification foreign language, advertisements in 7.2
I
illegal practice 5.2, 6.10 immediate suspension 8.23, 8.40 incentives 6.19 indecency 2.1, 8.5 indemnity cover 1.2, 5.1 infection see cross-infection; transmissible disease information concerning a dentist 8.6, 8.13, 8.27, 8.28, 8.29, 8.34, 8.39 on fees 7.7 misleading see patients, public (misleading) insolvency 6.9 insurance see indemnity cover interim suspension 8.11, 8.16, 8.24
G
general anaesthesia see anaesthesia, sedation General Dental Council (GDC) Committees 8.1 see also individually, by name complaints guidance 3.13, 3.14 disciplinary procedure 8.8 fitness to practise 8.27-8.31, 8.32-8.43 jurisdiction 8.1, 8.6 preliminary screening 8.8-8.10 professional conduct procedures 8.2-8.7 promotion by dentist, view of 7.4, 7.5 registration see Dentists Register; registration Registration Department 1.4 specialist lists 1.4, 1.5, 7.6 titles, approval of 6.13, 6.14 goodwill of the practice 6.12
J
judgement postponed 8.22
L
leaflets, brochures 6.16, 6.18, 6.20 leaving arrangements 6.4, 6.15 Legal Assessor 8.16, 8.17, 8.32 local infiltration analgesia 5.3
INDEX, NOVEMBER 1997, REVISED MAY 2001
M
media, statements in 4.6, 7.5 Medical Assessors 8.32 medical examination of a dentist 8.28-8.31, 8.36 medical history of patient 4.3, 4.10, 4.18 Medical Register 1.1 medical reports on dentist 8.31, 8.36 misconduct decision on 8.14, 8.15 see also professional misconduct, serious misleading statements see patients, public (misleading) monitoring 4.14, 4.15, 4.16, 4.22, 4.23
N
name plates 6.15, 6.16 names on stationery 6.16, 7.2 National Health Service (NHS) 3.6, 6.4, 7.7 Executive, guidance by 3.13 Trust 8.6 negligence, professional 1.2, 5.1 notes, patients 4.3, 4.18 Notice of Inquiry 8.18, 8.19 Notice of Referral 8.33, 8.34 Notice of Resumed Hearing 8.39 notification in disciplinary proceedings 8.12, 8.14, 8.18, 8.19 in fitness to practise proceedings 8.33, 8.34, 8.37, 8.39
O
oral hygiene 5.4
P
partnership 6.2, 6.10, 6.11 patient best interest of 3.1 records see records see also referral; treatment patients, public expectations of 3 misleading: claims, statements 1.4, 1.5, 2.3, 4.6, 7.3, 7.6 practice description 7.4, 7.5 protection of 2.4, 4.1, 4.2, 4.4, 4.8, 4.17 responsibility to 8.2
payment see fees, registration; fees, treatment personal behaviour 2.1, 3.14 physical impairment 2.5 practice agreements 6.2 practice arrangements 6 see also equipment, facilities; premises practice ownership 6.12 practice promotion content 7.2, 7.3, 7.6 fee information 7.7 leaflets, brochures 6.16, 6.18, 6.20 media involvement 7.5 misleading 7.4, 7.5 signs 6.15 standard 7.1 stationery 6.16, 7.2 treatment 7.4 practice titles 6.14 practising certificate 5.1, 8.41 Preliminary Proceedings Committee (of GDC) meetings, membership 8.11 proceedings 8.12-8.16, 8.24 referral by 8.37 referral to 8.8, 8.10, 8.16 Preliminary Screener 8.9, 8.28 Preliminary Screening 8.8, 8.10 premises rented 6.12 windows, screening of 6.17 prescribing see drugs President in disciplinary proceedings 8.12, 8.16, 8.17 in fitness to practise proceedings 8.28, 8.29, 8.31 as Preliminary Screener 8.9, 8.28 referral of application to 8.5 privacy 6.17 see also confidentiality private treatment, persuasion to 2.3 Privy Council, Judicial Committee of 8.24 products, services, promotion of 6.20, 7.3 profession, confidence in 6.18, 7.3, 7.5 professional conduct see behaviour Professional Conduct Committee (of GDC) meetings and membership 8.17 powers 8.1 proceedings 8.18-8.26 referral by 8.37 referral to 8.7, 8.8, 8.16 professional debate 4.6 professional duty and liability 8.2
professional expectation of standards 4, 8.2 professional knowledge and skills anaesthesia 4.22 conscious sedation 4.14 maintaining and updating 1.3, 4.14, 4.22 professional misconduct, serious charge of, reasons for 1.2, 1.3, 2.1-2.3, 3.1, 3.5, 3.14, 4.1, 4.2, 4.4, 4.8, 4.17, 5.1, 5.2, 6.5, 6.10, 7.5, 8.19 evidence of 8.11, 8.13 finding of 8.2, 8.12 scope, definition of 8.3, 8.4 stages of 8.8 professional negligence, claims for 1.2, 5.1 professional plate 6.15 professional propriety 7.1 professional rehabilitation 8.26 professional relationships between colleagues 2.4 between dentist and patient 3.1, 6.19, 6.20 between dentists 7.3 professional responsibility 6.1 Professionals complementary to dentistry, duties of 5.1 Promoting the Practice 6.18 promotion see advertisements; practice promotion public see patients, public public expectation of standards 1.3, 2, 8.2 publications Appendix I publicity see advertisements; practice promotion
retention of 6.6 recovery attendance during 3.8, 4.16, 4.23 facilities 4.16, 4.23 procedures 4.16, 4.23 referral accepting 3.4 making 1.5, 3.3, 4.18, 5.3, 6.19 refusal to treat 4.1 Register see Dentists Register; Medical Register registration 1.1, 5.1, 6.9, 8.1 conditions of 8.38, 8.41, 8.42 fee 8.26 see also erasure; restoration of name; suspension Regulations 1.1 rented premises 6.12 restoration of name after erasure 8.26 after suspension 8.25 resuscitation drugs 4.15 routines and guidelines 4.7, 4.15, 4.22, 4.24 Resuscitation Council (UK) 4.7, 4.22, 4.24 review proceedings 8.38, 8.39, 8.41 rudeness, discourtesy 3.14
S
screening of windows 6.17 screening procedures 8.8-8.10 second opinion 3.3 second person administration of anaesthesia by 4.22 during conscious sedation 4.14 sedation see anaesthesia; conscious sedation self-prescribing 4.5 self-referral 1.5 services, promotion of 6.20, 7.3 signs, practice 6.15, 6.16 solicitors Councils 8.6, 8.18 use of 8.17, 8.20, 8.35 specialist lists 1.4, 1.5, 7.6 sponsorship, commercial 6.20 standard of care and treatment 1.3, 3.2 standard of professional conduct 6.11 standard of professional promotion 7 stationery 6.16, 7.2 statutory duties of a dentist 4.4 students
Q
qualifications 1.4, 5.3
R
radiation protection 4.4 radiographs, dental 4.4, 6.6 radiography Regulations 4.4 safe procedure 4.4 records access to 6.6 computerised 3.5, 6.6 disposal of 6.7 patient, medical history of 4.3, 4.18 patients notes 4.3, 4.18
behaviour of 8.5 supervisors of 1.1 surgery see premises suspension 8.1, 8.16, 8.24, 8.42 immediate 8.23, 8.40 interim 8.11, 8.16, 8.24 restoration of name after 8.25 review of 8.38 for specified period 8.22, 8.38 termination of 8.24
instructions, pre- and post-, to patient 4.9 out of hours 3.11 of patient collapse 4.7, 4.22 plan 3.6 private, persuasion to 2.3 refusal of 4.1 standard of 1.3, 3.2 terms of 3.6 trust 3.1, 3.5 Trust, NHS 8.6
T
third party, presence of 3.8, 3.9 titles, use of 1.4, 1.5, 6.13, 6.14 training postgraduate 4.14, 4.22 see also dental team (training); professional knowledge and skills; qualifications transmissible disease 4.2 treatment ancillary or unproven forms of 4.6 of children 3.10 consent to, patients 3.7, 4.9 costs see fees, treatment definition of 1.1 description of 7.4 of difficult patients 3.10 domiciliary 3.9 emergency 3.11, 4.12, 4.18
U
undergraduate behaviour 8.5 unregistered person or company 6.12 useful addresses Bibliography
V
violence 2.1, 8.5
W
waste disposal 6.5 windows, screening of 6.17
X
X-ray machine 4.4

37 Wimpole Street London W1G 8DQ Telephone: 020 7887 3800 Fax: 020 7224 3294
MAINTAINING STANDARDS
GUIDANCE DENTAL THERAPISTS
TO
ON
DENTAL HYGIENISTS AND PROFESSIONAL AND PERSONAL CONDUCT
SEPTEMBER 1999
Throughout the guidance where reference is made to communication with a patient, for example with regard to consent, this should be taken to also refer to the patients representative where appropriate. A numeric superscript (1) immediately following a paragraph heading indicates that additional information, such as a reference to a legal or advisory document, is to be found in the bibliography.
SEPTEMBER 1999
AMENDMENTS
APPROVED BY
COUNCIL
IN
MAY 2000
Paragraph 2.1
New guidance on placement of temporary dressings. Cross-reference amended. Amended to include reference to new Dental Auxiliaries Regulations. Amended to include reference to temporary dressings.
Paragraph 2.2 Bibliography
Index
AMENDMENTS, NOVEMBER 1997, REVISED MAY 2000
GUIDANCE
TO
DENTAL HYGIENISTS
AND
DENTAL THERAPISTS
CONTENTS
INTRODUCTION
2001

Enrolling with the General Dental Council Indemnity Keeping up-to-date The use of titles Student behaviour
September 1999 1.1 1.2 1.3 1.4 1.5
2: SCOPE
OF
WORK
July 2000 2.1 2.2 2.3 2.4 2.5
Legally permitted duties Sedated patients Local infiltration anaesthesia Dental radiography and radiation protection Oral hygiene instruction

Personal behaviour Alcohol and drugs Improper statements Protecting patients
September 1999 3.1 3.2 3.3 3.4

Acting in the best interests of patients Providing a high standard of care Explaining treatment and obtaining consent Working with the dentist Updating the medical history Contemporaneous records Maintaining confidentiality Having a third party present
CONTENTS, SEPTEMBER 1999, REVISED MAY 2001
September 1999 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8
Domiciliary treatment Treating difficult patients and children Handling complaints Complaints of rudeness and discourtesy
4.9 4.10 4.11 4.12
5: WHAT THE PROFESSIONS EXPECT

Professional Responsibility Dealing with infection control Dealing with transmissible diseases Dealing with medical emergencies Non-dental treatment Business of dentistry Illegal practice of dentistry Advertising Signs and professional plates Incentives Interactions with the media
November 2000 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 September 1999
6: PROCEDURE FOR DEALING WITH MISCONDUCT BIBLIOGRAPHY INDEX
CONTENTS, SEPTEMBER 1999, REVISED MAY 2001
INTRODUCTION
The General Dental Council has a statutory duty to promote high standards of personal and professional conduct within the dental profession. As part of that duty the Council has published Maintaining Standards as a set of ethical guidelines for the profession.
Maintaining Standards contains advice to dentists, dental hygienists and dental therapists on principles of personal and professional conduct, includes guidance on the expectations of the public and the patient, and also explains the Councils jurisdiction.
Maintaining Standards is not a set of rules and regulations covering every aspect of behaviour in every possible set of circumstances. The practice of dentistry requires the exercise of professional judgement and an acceptance of personal responsibility, informed by the Councils ethical guidelines and the principles on which these are based.
Whilst this document is primarily designed as constructive guidance for the profession, it may be used to inform the Councils fitness to practise procedures.
Maintaining Standards is regularly updated in the light of current expectations and is intended to be helpful advice to the profession rather than a statutory code of conduct. Members of the dental team should at all times behave reasonably and in the public interest.
INTRODUCTION, MAY 2001
SEPTEMBER 1999

ENROLLING WITH THE GENERAL DENTAL COUNCIL
1, 2
1.1 Dental hygienists and dental therapists must enrol with the General Dental Council (GDC) before they begin to practise and must renew their enrolment annually if they wish to continue to practise. To practise without being enrolled is illegal, and may lead to disciplinary proceedings. Dental hygienists and dental therapists should not practise dentistry in a name other than that which appears in the Rolls of Dental Auxiliaries. The title 'dental hygienist' or 'dental therapist' may be used only by a person whose name is included in the relevant Roll.
INDEMNITY
1.2 Dental hygienists and dental therapists must ensure that they are indemnified against claims for professional negligence. Failure to have appropriate indemnity will be taken seriously by the Council and would almost certainly lead to a charge of misconduct.
KEEPING UP-TO-DATE
1.3 In the interests of patients, dental hygienists and dental therapists have a duty to continue professional education whilst continuing to practise in order to keep up-to-date with current developments in their respective disciplines. Dental hygienists and dental therapists who fail to maintain and update professional knowledge and skills and who, as a result, provide treatment which falls short of the standards which the public and the professions have a right to expect, may be liable to a charge of misconduct.
THE USE OF TITLES

1.4 The titles 'dental hygienist' or 'dental therapist' should be used only in connection with the practice of dentistry i.e. these titles may not be used in connection with the provision of non-dental treatment (see paragraph 5.4 below). A dental hygienist or dental therapist may use the letters 'EDH' or 'EDT' after their name.
STUDENT BEHAVIOUR
1.5 If a student dental hygienist or dental therapist is convicted in a court of law or otherwise engages in behaviour reflecting adversely on the professions, such as dishonesty, indecency, violence or abuse of alcohol or drugs, their first application for enrolment could be referred to the
1: BEFORE BEGINNING TO PRACTISE, SEPTEMBER 1999
President of the Council. It could equally well be taken into consideration later if the Council had cause to consider the conduct of an enrolled hygienist or therapist.
2: BEFORE BEGINNING TO PRACTISE, SEPTEMBER 1999
2: SCOPE OF WORK
LEGALLY PERMITTED DUTIES
3, 4
2.1 Dental hygienists and dental therapists may practise dentistry only under the direction of a registered dentist and to the extent permitted by the Dental Auxiliaries Regulations 1986. The Dental Auxiliaries Regulations set out the duties amounting to the practice of dentistry which dental hygienists and dental therapists are permitted to undertake and the circumstances in which these duties may be undertaken. It is an offence under the Dentists Act 1984 for dental hygienists and dental therapists to practise outside these limits. Permitted Duties of Dental Hygienists Dental hygienists are permitted to carry out the following kinds of dental work under the direction of a registered dentist who has examined the patient and has indicated in writing the course of treatment to be provided: (i) cleaning and polishing teeth; (ii) scaling teeth (that is to say, the removal of deposits, accretions and stains from those parts of the surfaces of the teeth which are exposed or which are directly beneath the free margins of the gums, including the application of medicaments appropriate thereto); (iii) the application to the teeth of such prophylactic materials as the Council may from time to time determine. A dental hygienist may scale teeth under local infiltration anaesthesia administered by the dental hygienist or under any local or regional block anaesthesia administered by a registered dentist. Dental hygienists may work in any sector of dentistry but are permitted to administer local infiltration anaesthesia only under the direct personal supervision of a registered dentist who is present on the premises at which the hygienist is carrying out such work at the time it is being carried out. Permitted Duties of Dental Therapists Dental therapists are permitted to carry out the following kinds of work under the direction of a registered dentist who has examined the patient and has indicated in writing the course of treatment to be provided: (i) (ii) extracting deciduous teeth; undertaking simple dental fillings;
3: SCOPE OF WORK, SEPTEMBER 1999
(iii) cleaning and polishing teeth; (iv) scaling teeth (that is to say, the removal of deposits, accretions and stains from those parts of the surfaces of the teeth which are exposed or which are directly beneath the free margins of the gums, including the application of medicaments appropriate thereto); (v) the application to the teeth of such prophylactic materials as the Council may from time to time determine; (vi) giving advice within the meaning of Section 37(1) of the Dentists Act such as may be necessary for the proper performance of the dental work described. A dental therapist may extract deciduous teeth, undertake simple dental fillings, scale teeth and apply prophylactic materials under local infiltration anaesthesia administered by the dental therapist or under any local or regional block anaesthesia administered by a registered dentist. Dental therapists may work in the public health services. They are not permitted to work in general dental practice, except in pilots for Personal Dental Services authorised under the National Health Service (Primary Care) Act 1997. Dental hygienists and dental therapists are permitted to place a temporary dressing in a tooth, under the direction of a dentist, if a filling falls out during the course of dental treatment carried out by the dental hygienist or dental therapist, provided they: (i) inform the patients dentist as soon as possible after the treatment, and (ii) advise the patient to see his or her dentist as soon as possible. Dental hygienists and dental therapists should not place temporary dressings unless they have received appropriate training. Dental hygienists and dental therapists must not represent themselves as being prepared to practise dentistry beyond the extent permitted by the Dentists Act and the Dental Auxiliaries Regulations, as described above.
SEDATED PATIENTS
2.2 Dental hygienists and dental therapists are not permitted to treat patients under conscious sedation or general anaesthesia. (Please refer to paragraph 4.11 of Maintaining Standards - Guidance to Dentists on Professional and Personal Conduct for a definition of conscious sedation.).
4: SCOPE OF WORK, JULY 2000
LOCAL
INFILTRATION ANAESTHESIA
2.3 In order to be competent to administer local infiltration anaesthesia a dental hygienist must: (i) hold the Diploma in Dental Hygiene awarded after July 1992, or
(ii) hold the Diploma in Dental Therapy (formerly Certificate of Proficiency as a Dental Therapist) in addition to the Diploma (formerly Certificate of Proficiency) in Dental Hygiene awarded before July 1992, or (iii) have completed additional training in local infiltration anaesthesia and gained a certificate in the administration of local infiltration anaesthesia.
DENTAL RADIOGRAPHY
AND
RADIATION PROTECTION
2.4 Dental hygienists and dental therapists who take dental radiographs must have received adequate training in accordance with the relevant regulations. Dental hygienists and dental therapists who operate X-ray machines must comply fully with the regulations so that safe radiological practice is ensured for the protection of the patient, members of the dental team and others. Failure to do so may lead to a charge of misconduct.
ORAL HYGIENE INSTRUCTION

2.5 Dental hygienists and dental therapists who give advice on oral hygiene and related matters, whether to individual patients or on a group basis, should recognise their legal and ethical obligations towards the patients or people concerned. In giving such advice dental hygienists and dental therapists should act within the limits of their knowledge and professional competence. (See also paragraph 5.7)
5: SCOPE OF WORK, SEPTEMBER 1999
SEPTEMBER 1999

PERSONAL BEHAVIOUR
3.1 Dental hygienists and dental therapists must adhere to appropriate standards of personal as well as professional conduct. Any behaviour or activity which is liable to bring the professions into disrepute or to undermine public confidence in the professions may lead to a charge of misconduct. Behaviour which reflects adversely on the professions such as dishonesty, indecency or violence, may lead to a charge of misconduct even when such behaviour is not directly connected with practice as a dental hygienist or dental therapist.
ALCOHOL AND DRUGS

3.2 Complaints of drunkenness or the misuse of drugs may lead to a charge of misconduct, even if the offence has not been the subject of criminal proceedings.
IMPROPER STATEMENTS
3.3 A dental hygienist or dental therapist should not make a statement or declaration that is untrue or misleading or unethical, nor induce any other person to do so. Any act or omission by a dental hygienist or dental therapist in connection with the practice of dentistry which is liable to mislead the public may lead to a charge of misconduct.
PROTECTING PATIENTS
3.4 A dental hygienist or dental therapist must act to protect patients when there is reason to believe that the patient is threatened by the conduct, performance or health of another member of the dental team. The safety of patients must come first at all times and should over-ride personal and professional loyalties. As soon as a dental hygienist or dental therapist becomes aware of any situation which puts patients at risk, the matter should be discussed with a senior colleague or appropriate professional body.
7: WHAT THE PUBLIC EXPECTS, SEPTEMBER 1999
SEPTEMBER 1999

ACTING
IN THE
BEST INTERESTS
OF
PATIENTS
4.1 As members of caring professions, dental hygienists and dental therapists have a responsibility to put the interests of patients first. Their relationship with the patient relies on trust and the assumption that they will act in the best interests of the patient. Abuses of this relationship may lead to a charge of misconduct.
PROVIDING
HIGH STANDARD
OF
CARE
4.2 A patient is entitled to expect that a dental hygienist or dental therapist will provide a high standard of care. The Council takes a serious view of any neglect by a dental hygienist or dental therapist of their responsibilities for the care and treatment of the patient.
EXPLAINING TREATMENT
AND
OBTAINING CONSENT
4.3 A dental hygienist or dental therapist must inform the patient of the treatment proposed and ensure that appropriate consent has been obtained. This is especially important when dealing with children under the age of consent or adults who are not mentally competent and for whom the consent of an appropriate person is required.
WORKING
WITH THE DENTIST
4.4 Dental hygienists and dental therapists are obliged to carry out the lawful and reasonable directions of the dentist under whose direction they are working, regarding the care and treatment of the patient. They must not carry out directions which are unlawful or unreasonable. If in doubt they should seek advice from an appropriate professional organisation. The format and content of prescriptions are properly a matter for the prescribing dentist. However, it is the responsibility of the dental hygienist or dental therapist to ensure that they understand fully the treatment that the dentist has prescribed. The use of abbreviations or code in a written prescription is permissible, provided the abbreviation or code used is fully understood by both the dentist and the dental hygienist or dental therapist. The prescription should be dated and signed or otherwise authenticated by the prescribing dentist. The Council has determined that dental hygienists and dental therapists should be permitted to carry out interim treatments between examinations of the patient, as specified by the dentist, provided that the dentist has examined the patient within the last twelve months.
9: WHAT THE PATIENT EXPECTS, SEPTEMBER 1999
UPDATING THE MEDICAL HISTORY

4.5 Dental hygienists and dental therapists are responsible for ensuring that the patient's medical history is updated prior to carrying out the prescribed treatment. Any relevant changes should be brought to the attention of the prescribing dentist before commencing treatment.
CONTEMPORANEOUS RECORDS
4.6 Full contemporaneous records should be kept of all dental treatment.
MAINTAINING CONFIDENTIALITY
4.7 The relationship between the patient and the dental hygienist or dental therapist is founded on trust. Dental hygienists and dental therapists should not disclose information about a patient acquired in a professional capacity, except to the dentist directing the treatment of that patient, and then only in relation to their work. They should not disclose information of a personal or confidential nature relating to the practice in which they are employed. There may, however, be circumstances in which the public interest outweighs the duty of confidentiality and in which disclosure would be justified. In such a situation the dental hygienist or dental therapist should consult their defence or professional organisation. Where information is held on computer, dental hygienists and dental therapists should have regard to the provisions of the Data Protection Act. The Act gives the patient the right to see and/or have copies of computer-held records. Communications with patients should not compromise patient confidentiality. In the interests of security and confidentiality, for example, it is advisable that all postal communications to patients are sent in sealed envelopes.
HAVING
THIRD PARTY PRESENT
4.8 A third person should be present on the premises at all times when dental hygienists and dental therapists undertake the treatment of patients.
DOMICILIARY TREATMENT
4.9 Dental treatment provided on a domiciliary basis should be appropriate within that setting, taking into account the nature of the problem, the facilities available and the welfare of the patient. Having a third party present is particularly relevant in this environment.
TREATING DIFFICULT PATIENTS
AND
CHILDREN
4.10 There can be no justification for intimidation or, other than in the most
exceptional circumstances, for the use of physical restraint in dealing with a difficult patient. When faced with a child who is uncontrollable for whatever reason, the dental hygienist or dental therapist should decide whether it would be better to cease treatment rather than continue. If treatment is stopped, the dental hygienist or dental therapist should provide a clear explanation of the reasons to the parent or representative and refer the child back to the dentist for future treatment to be arranged.
HANDLING COMPLAINTS
4.11 The Council advises dentists that if a patient has cause to complain about the service provided, every effort should be made to resolve the matter at practice level. Dental hygienists and dental therapists should be aware of the procedures for handling complaints that apply in their place of work and ensure that any patient who wishes to complain is able to obtain advice on the correct procedures.
COMPLAINTS OF RUDENESS AND DISCOURTESY

4.12 It would be a matter of concern to the Council if it were to receive complaints about rudeness and discourtesy on the part of a dental hygienist or a dental therapist, even though such behaviour may not, of itself, amount to misconduct. In such circumstances, the Council may, with the patient's consent, seek the observations of the prescribing dentist and the dental hygienist or dental therapist.
SEPTEMBER 1999
5: WHAT THE PROFESSIONS EXPECT

PROFESSIONAL RESPONSIBILITY
5.1 A dental hygienist or dental therapist is responsible for his or her personal and professional conduct, whether or not the hygienist or therapist is in a position to control or influence the practice, business or institutional arrangements within which he or she is practising. A dental hygienist or dental therapist who plays a part in the direction or management of arrangements within which other dental professionals practise has a reponsibility to those professional colleagues to facilitate and promote their adherence to appropriate standards of personal and professional conduct and continuing professional development.
DEALING
WITH INFECTION
CONTROL
7, 8, 9, 10
5.2 The risk of cross-infection in dental treatment has always existed and appropriate precautions, which form part of a clear practice policy on infection control procedures, must be taken to protect patients and all members of the dental team from that risk. The publicity surrounding the spread of HIV infection has served to highlight the precautions which should be in place whenever dental treatment is undertaken. Detailed guidance on infection control has been issued by the Health Departments and the British Dental Association, and is endorsed by the Council. It is unethical for a dental hygienist or dental therapist to refuse to treat a patient solely on the grounds that the person has a blood-borne virus or any other transmissible disease or infection. Failure to implement adequate methods of infection control would almost certainly render a dental hygienist or dental therapist liable to a charge of misconduct.
DEALING
WITH
TRANSMISSIBLE DISEASES
11
5.3 A dental hygienist or dental therapist behaves unethically if they take no action when they know that they are infected with a blood-borne virus or any other transmissible disease or infection which might jeopardise the well being of patients. The Council would take the same view if a dental hygienist or dental therapist took no action when they had reason to believe that they might be infected. In either situation, it is the responsibility of the dental hygienist or dental therapist to obtain medical advice which may result in appropriate testing and, if the dental hygienist or dental therapist is found to be infected, regular medical supervision. The medical advice may include the necessity to cease the practice of dentistry altogether, to exclude exposure-prone procedures or to modify practice in some other way.
13: WHAT THE PROFESSION EXPECTS, SEPTEMBER 1999, REVISED NOVEMBER 2000
Failure to obtain such advice or to act upon it would almost certainly lead to a charge of misconduct.
DEALING
WITH
MEDICAL EMERGENCIES
12
5.4 A medical emergency could occur in a dental practice at any time. It is, therefore, imperative that dental hygienists and dental therapists are properly trained and prepared to deal with an emergency, including a collapsed patient. Training should include frequent practice of resuscitation routines in a simulated emergency. All dental practices are expected to have suction apparatus to clear the oropharynx, oral airways to maintain the natural airway, equipment with appropriate attachments to provide intermittent positive pressure to the lungs, and a portable source of oxygen. Current guidelines such as those issued by the Resuscitation Council (UK) should be adopted.
NON-DENTAL TREATMENT
5.5 Non-dental treatment should not be provided in such a way as to mislead the public that it is part of the practice of dentistry.
BUSINESS
OF
DENTISTRY
13
5.6 It is illegal for an individual who is not a registered dentist or a registered medical practitioner to carry on the business of dentistry. This means that dental hygienists cannot be paid directly by the patient for the dental treatment they provide. A dental hygienist should not employ a dentist to examine patients or prescribe treatment.
ILLEGAL PRACTICE
OF
DENTISTRY
5.7 A dental hygienist or dental therapist who condones or encourages others to practise dentistry illegally may be liable to a charge of misconduct.
ADVERTISING
5.8 It is permissible for dental hygienists and dental therapists to advertise for employment, for example, by a notice in a newspaper or journal stating their name, title, private address or box number, telephone number and a statement of the post required. It is also permissible to make a direct approach to potential employers. Dental hygienists should not advertise or canvass for the purpose of obtaining patients for any dental practice, whether or not they are employed in it. The title 'dental hygienist' or 'dental therapist' should not be used to advertise or promote the sale of a commercial product. Advice on the use of any dental product should be based on its clinical efficacy.
If dental hygienists or dental therapists engage in dental health education work for a commercial company they should use a title such as 'dental health educator'. Use of the title 'dental hygienist' or 'dental therapist' is not permissible in this context.
SIGNS
AND
PROFESSIONAL PLATES
5.9 The names of dental hygienists working in the practice of a registered dentist may appear on headed paper and in practice information leaflets or brochures. The name of a dental hygienist, with the designation 'dental hygienist' or 'EDH', may be displayed outside the practice premises with the permission of the dentist.
INCENTIVES
5.10 The Council take the following view on the use of incentives: (i) there is no objection to a token or other gift being given by a dental hygienist directly to a patient who attends for treatment, provided they have obtained the agreement of the dentist; (ii) it is not acceptable for a financial incentive to be paid to a third party by a dental hygienist in return for encouraging or promoting the uptake of dental care by individual members of the public; (iii) a dental hygienist's professional relationship with patients may be compromised if they were to accept financial incentives from third parties in return for promoting to patients: a) enrolment in a particular scheme for the provision of dental care; or b) specific dental products; or c) the uptake of insurance.
INTERACTIONS WITH THE MEDIA

5.11 Publicity about a dental hygienist or dental therapist which arises through, or from interviews with representatives of, the media and which may be regarded as likely to bring the professions into disrepute should be avoided. A dental hygienist or dental therapist who comments to the media has a particular responsibility to ensure that all statements are factually accurate. There is a duty to distinguish between personal opinion or political belief and established facts, and a dental hygienist or dental therapist should, whenever possible, request access to the article, statement or interview before publication or broadcast. The Council will generally hold a dental hygienist or dental therapist, who gives interviews to representatives of the media, responsible for any publicity which may ensue. Any public statement which is calculated to mislead the public or damage public confidence in the professions may lead to a charge of misconduct.
6: PROCEDURE FOR DEALING WITH MISCONDUCT
14
6.1 The Dental Auxiliaries Committee of the General Dental Council (or its duly appointed Disciplinary Sub-committee) may, after holding an inquiry, direct the Registrar of the Council to erase from the Rolls of Dental Auxiliaries the name of any dental hygienist or dental therapist who has: (a) been convicted of a criminal offence, or
(b) been judged by the Committee to be guilty of conduct unbefitting a dental hygienist or dental therapist.
The name of the dental hygienist or dental therapist may be erased even if the conviction or misconduct occurred before enrolment. The Dental Auxiliaries Committee, in considering a conviction reported to the Council, has to decide whether the gravity of the offence committed by the dental hygienist or dental therapist, or the cumulative gravity of offences committed on more than one occasion, makes it necessary in the public interest to erase their name from the Roll. Convictions for trivial offences are not normally referred to the Committee for inquiry. The circumstances of the offence need not be directly concerned with the occupation or practice of a dental hygienist or dental therapist to render them liable to have their names erased from the Roll, but the Committee is particularly concerned with offences which affect a dental hygienist's or dental therapist's fitness to practise. In considering convictions, the Dental Auxiliaries Committee accepts the findings of the court on matters of fact as evidence of the facts proved. It is, therefore, unwise for a dental hygienist or dental therapist to plead guilty in a court of law to a charge which they believe has a defence since such a plea will be regarded by the court, and subsequently by the Dental Auxiliaries Committee, as an admission that the charge against them is well-founded.
17: PROCEDURE FOR DEALING WITH MISCONDUCT, SEPTEMBER 1999
6: PROCEDURE FOR DEALING WITH MISCONDUCT
14
6.1 The Dental Auxiliaries Committee of the General Dental Council (or its duly appointed Disciplinary Sub-committee) may, after holding an inquiry, direct the Registrar of the Council to erase from the Rolls of Dental Auxiliaries the name of any dental hygienist or dental therapist who has: (a) been convicted of a criminal offence, or
(b) been judged by the Committee to be guilty of conduct unbefitting a dental hygienist or dental therapist.
The name of the dental hygienist or dental therapist may be erased even if the conviction or misconduct occurred before enrolment. The Dental Auxiliaries Committee, in considering a conviction reported to the Council, has to decide whether the gravity of the offence committed by the dental hygienist or dental therapist, or the cumulative gravity of offences committed on more than one occasion, makes it necessary in the public interest to erase their name from the Roll. Convictions for trivial offences are not normally referred to the Committee for inquiry. The circumstances of the offence need not be directly concerned with the occupation or practice of a dental hygienist or dental therapist to render them liable to have their names erased from the Roll, but the Committee is particularly concerned with offences which affect a dental hygienist's or dental therapist's fitness to practise. In considering convictions, the Dental Auxiliaries Committee accepts the findings of the court on matters of fact as evidence of the facts proved. It is, therefore, unwise for a dental hygienist or dental therapist to plead guilty in a court of law to a charge which they believe has a defence since such a plea will be regarded by the court, and subsequently by the Dental Auxiliaries Committee, as an admission that the charge against them is well-founded.
17: PROCEDURE FOR DEALING WITH MISCONDUCT, SEPTEMBER 1999
BIBLIOGRAPHY
This list is not exhaustive but is intended as a guide for anyone seeking further information. 1 2 3 4 Dentists Act 1984, Sections 45 and 47. HMSO, ISBN 0 10 542484 6. Dental Auxiliaries Regulations 1986 (SI 887) Regulations 2 to 6 HMSO, ISBN 0 11 066887 9 Dentists Act 1984, Section 46 Dental Auxiliaries Regulations 1986, as amended by the Dental Auxiliaries (Amendment) Regulations 1999 (SI 3460), Regulations 23 and 27. HMSO, ISBN 0 11 085723 2 The Ionising Radiation (Protection of Persons Undergoing Medical Examination or Treatment) Regulations 1988 (SI 778). These are due to be replaced by the Ionising Radiation (Medical Exposure) Regulations 1999 HMSO, ISBN 011 086778 5 (1988) Data Protection Act 1984 HMSO, ISBN 0 10 543584 8 Guidance for Clinical Health Care Workers: Protection Against Infection with HIV and Hepatitis Viruses. Recommendations of the Expert Advisory Group on AIDS. (Currently under revision) HMSO, January 1990, ISBN 0 11 321249 6 AIDS-HIV Infected Health Care Workers. Occupational Guidance for Health Care Workers, Their Physicians and Employers. Recommendations of the Expert Advisory Group on AIDS. Department of Health, December 1991. Available from BAPS. Protecting Health Care Workers and Patients from Hepatitis B. Recommendations of the Advisory Group on Hepatitis. Department of Health, August 1993. Available from BAPS.
6 7
10 Guidelines on Post Exposure Prophylaxis for Health Care Workers Occupationally Exposed to HIV. Department of Health, June 1997. PL/CO (97) 1. 11 Exposure prone procedures are defined as: Those where there is a risk that injury to the worker may result in the exposure of the patient's open tissues to the blood of the worker. These procedures include those where the worker's gloved hands may be in contact with sharp instruments, needle tips or sharp tissues (spicules of bone or teeth) inside a patient's open body cavity, wound or confined anatomical space where the hands or fingertips may not be completely visible at all times.
BIBLIOGRAPHY, JULY 2000
Taken from: AIDS/HIV-Infected Health Care Workers: Guidance on the Management of Infected Health Care Workers. Recommendations of the Expert Advisory Group on Aids. Department of Health, March 1994. Available from BAPS. 12 The 1998 Resuscitation Guidelines for Use in the United Kingdom. Resuscitation Council (UK) 13 Dentists Act 1984, Sections 40 to 44 14 Dental Auxiliaries Regulations 1986 Regulations 9 to 17
USEFUL ADDRESSES
BAPS, Health Publications Unit, DSS Distribution Centre, Heywood Stores, Manchester Road, Heywood, Lancashire, OL10 2PZ British Association of Dental Therapists, Dental Auxiliary School, University Dental Hospital, Heath Park, Cardiff, CF4 4XY Tel: 01222 744251 British Dental Association, 64 Wimpole Street, London, WIM 8AL Tel: 020 7935 0875 British Dental Hygienists Association, 13 The Ridge, Yatton, Bristol, BS19 4DQ Tel: 01934 876 389 Department of Health, Richmond House, 79 Whitehall, London, SW1A 2NS Tel: 020 7210 3000 General Dental Council, 37 Wimpole Street, London, W1M 8DQ Tel: 020 7887 3800
BIBLIOGRAPHY, SEPTEMBER 1999
INDEX
References are to paragraph numbers.
A
advertising 5.8 advice, professional 1.2, 3.4, 4.4, 4.7 alcohol and drugs, misuse of 3.2 anaesthesia, general 2.2 anaesthesia, local infiltration 2.1, 2.3
title, use of 1.4 dental radiography 2.4 dental therapists, enrolment of 1.1 permitted duties 2.1 title, use of 1.4 dentist, working with 4.4 Dentists Act 1984 2.1 difficult patients 4.10 diploma in dental hygiene 2.3 diseases, transmissible 5.3 dishonesty 1.5, 3.1 domiciliary treatment 4.9 drugs, misuse of 3.2 student 1.5 personal 3.1
B
behaviour, business of dentistry 5.6
C
canvassing 5.8 children, treatment of 4.10 colleagues, relationship with dentist 4.4 complaints 4.11, 4.12 computerised records 4.7 confidentiality 4.7 conscious sedation 2.2 criminal convictions 1.5, 6.1 cross-infection 5.2, 5.3
E
emergencies, medical 5.4 employment, dental therapists 2.1 enrolment 1.1 equipment, X-ray 2.4 emergencies 5.4 erasure 6.1
G
general anaesthesia 2.1 General Dental Council enrolment 1.1
D
Data Protection Act 1984 4.7 Dental Auxiliaries Committee 6.1 dental hygienists, enrolment of 1.1 name, display of 5.9 permitted duties 2.1
H
hazardous waste, see infection control HIV infection 5.2 hygiene, instruction 2.5
INDEX, SEPTEMBER 1999, REVISED NOVEMBER 2000
I
illegal practice 1.1, 5.7 incentives 5.10 indemnity 1.2 infection control 5.2, 5.3 insurance, see indemnity
personal behaviour 3.1 personal dental services 2.1 premises 5.9 privacy, see confidentiality products, promotion of 5.8 professional knowledge and skills 1.3 professional negligence, claims of 1.2 professional plate 5.9 professional responsibility 5.1 promoting the practice 5.8, 5.10 publications, see bibliography publicity, see advertising and promoting the practice
L
leaflets, brochures 5.8, 5.9 legally permitted duties 2.1 local infiltration anaesthesia 2.1, 2.3
M
media statements 5.11 medical history, updating 4.5 misconduct, procedure for dealing with 6.1 charge of 1.2, 1.3, 2.4, 3.1, 3.2, 3.3, 4.1, 5.2, 5.3, 5.7, 5.11
R
radiation protection 2.4 radiographs, dental 2.4 radiography regulations 2.4 records 4.5, 4.6, 4.7 refusal to treat 4.10 resuscitation 5.4 rudeness 4.12
N
name plates 5.9 negligence, professional 1.2 non-dental treatment 5.5
S
sedated patients 2.2 sponsorship, commercial 5.8 standards of care 1.3, 4.2, 4.4 stationery, display of name 5.9 students, behaviour of 1.5
O
oral hygiene instruction 2.5
T
temporary dressings 2.1 third party, presence of 4.8, 4.9 titles, use of 1.1, 1.4 training 1.3
P
patients, protection of 2.4, 3.4, 5.2, 5.3 patient records 4.6
transmissible diseases 5.3 treatment, consent 4.3 definition of 2.1 domiciliary 4.9 emergency 5.4 non-dental 5.5 of children 4.10 of difficult patients 4.10 of patient collapse 5.4
V
violence 1.5, 3.1
X
X-ray machine 2.4

37 Wimpole Street London W1G 8DQ Telephone: 020 7887 3800 Fax: 020 7224 3294

GDC Maintaining Standards Guidance

Загружено:

Сведения о документе

Исходное описание:

Оригинальное название

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

GDC Maintaining Standards Guidance

Загружено:

Авторское право:

Доступные форматы

General Dental Council

GENERAL DENTAL COUNCIL

GENERAL DENTAL COUNCIL: MAINTAINING STANDARDS

Contents Paragraph 4.7

Paragraph 4.16 Paragraph 4.17

Paragraph 4.19 Paragraph 4.20 Paragraph 4.22

AMENDMENTS, NOVEMBER 2001

GENERAL DENTAL COUNCIL: MAINTAINING STANDARDS

1: BEFORE BEGINNING TO PRACTISE

NOVEMBER 1997 1.1 1.2 1.32000 1.4 1.51998

2: WHAT THE PUBLIC EXPECTS

3: WHAT THE PATIENT EXPECTS

CONTENTS, NOVEMBER 1997, REVISED MAY 2001

GENERAL DENTAL COUNCIL: MAINTAINING STANDARDS

4: WHAT THE PROFESSION EXPECTS

5: THE DENTAL TEAM

NOVEMBER 1997 5.12000

CONTENTS, NOVEMBER 1997, REVISED NOVEMBER 2001

GENERAL DENTAL COUNCIL: MAINTAINING STANDARDS

5.2 5.3 5.4

8: THE COUNCILS JURISDICTION

8.2 8.3 8.4

GENERAL DENTAL COUNCIL: MAINTAINING STANDARDS

Undergraduate behaviour Sources of information Convictions

8.5 8.62000 8.7

PRELIMINARY PROCEEDINGS COMMITTEE

PROFESSIONAL CONDUCT COMMITTEE

8.32 8.33 8.34 8.35 8.36 8.37 8.38

GENERAL DENTAL COUNCIL: MAINTAINING STANDARDS

8.39 8.40 8.41 8.42 8.43 NOVEMBER 2001 NOVEMBER 2000

CONTENTS, NOVEMBER 1997, REVISED NOVEMBER 2001

GENERAL DENTAL COUNCIL: MAINTAINING STANDARDS

CONTENTS, NOVEMBER 1997, REVISED NOVEMBER 2000

INTRODUCTION, MAY 2001

GENERAL DENTAL COUNCIL: MAINTAINING STANDARDS

1: BEFORE BEGINNING TO PRACTISE

GENERAL DENTAL COUNCIL

1: BEFORE BEGINNING TO PRACTISE, NOVEMBER 1997, REVISED NOVEMBER 2000

GENERAL DENTAL COUNCIL: MAINTAINING STANDARDS

USE OF QUALIFICATIONS AND TITLES

1: BEFORE BEGINNING TO PRACTISE, NOVEMBER 1997, REVISED NOVEMBER 1998

GENERAL DENTAL COUNCIL: MAINTAINING STANDARDS

2: WHAT THE PUBLIC EXPECTS

IMPROPER STATEMENTS OR CERTIFICATES AND MISLEADING ANNOUNCEMENTS

2. WHAT THE PUBLIC EXPECTS, NOVEMBER 1997, REVISED MAY 1999

GENERAL DENTAL COUNCIL: MAINTAINING STANDARDS

2. WHAT THE PUBLIC EXPECTS, NOVEMBER 1997, REVISED MAY 2000

GENERAL DENTAL COUNCIL: MAINTAINING STANDARDS

3: WHAT THE PATIENT EXPECTS

IN THE BEST INTERESTS OF PATIENTS

3. WHAT THE PATIENT EXPECTS, NOVEMBER 1997, REVISED NOVEMBER 2000

GENERAL DENTAL COUNCIL: MAINTAINING STANDARDS

TREATMENT AND COSTS

A THIRD PARTY PRESENT

3. WHAT THE PATIENT EXPECTS, NOVEMBER 1997, REVISED MAY 1999

GENERAL DENTAL COUNCIL: MAINTAINING STANDARDS

FOR DENTAL EMERGENCIES AND OUT OF HOURS CARE

ABSENCE FROM PRACTICE

3. WHAT THE PATIENT EXPECTS, NOVEMBER 1997, REVISED MAY 1999

GENERAL DENTAL COUNCIL: MAINTAINING STANDARDS

OF RUDENESS AND DISCOURTESY

3. WHAT THE PATIENT EXPECTS, NOVEMBER 1997, REVISED MAY 1999