Principle One

Put patient's interests first

 

Principle Two

Communicate effectively with patients

 

Principle Three

Obtain valid consent

 

Principle Four

Maintain and protect patients' information

 

Principle Five

Have a clear and effective complaints procedure

 

Principle Six

Work with colleagues in a way that is in patients' best interests

 

Principle Seven

Maintain, develop and work within your professional knowledge and skills

 

Principle Eight

Raise concerns if patients are at risk

 

Principle Nine

Make sure your personal behaviour maintains patients' confidence in you and the dental profession

 

Learning Material Case Study

Working outside scope of practice

Mr Wilson is a clinical dental technician. A patient, Ms Singh visited Mr Wilson’s practice as she wanted a new full upper denture and partial lower denture.

Mr Wilson made a full upper denture and partial lower denture but Ms Singh was not happy with the fit of either denture and she returned to see Mr Wilson on a number of occasions to have the dentures readjusted. One of the anterior teeth also came loose from the upper denture during that period.

Mr Wilson re-bonded the tooth, but it subsequently fell off. Ms Singh wrote to Mr Wilson requesting a refund but he did not respond.

She contacted the Dental Complaints Service and was advised to write to Mr Wilson again stating that she wanted a refund. Mr Wilson replied to say he had lost her previous letter and that he only offered replacements, not refunds. Ms Singh remained dissatisfied and reported Mr Wilson to the GDC.

The fitness to practise caseworker considered that Mr Wilson may have breached a number of the standards and guidance in Standards for the Dental Team including (but not limited to):

  • 6.3.3 You should refer patients on if the treatment required is outside of your scope of practice or competence. You should be clear about the procedure for doing this.
  • 7.2 You must work within your knowledge, skills and professional competence and abilities.
  • 7.2.1 You must only carry out a task or type of treatment if you are appropriately trained, competent, confident and indemnified. Training can take many different forms. You must be sure that you have undertaken training which is appropriate for you and equips you with the appropriate knowledge and skills to perform a task safely.
  • 5.1 You must make sure that there is an effective complaints procedure readily available for patients to use, and follow that procedure at all times.
  • 5.3 You must give patients who complain a prompt and constructive response.

The Investigating Committee decided to refer Mr Wilson to the Professional Conduct Committee. It thought that acting outside of his scope of practice and not working under the prescription of a dentist was a serious matter as was failing to provide a good standard of care and not responding appropriately to complaints.

When the Professional Conduct Committee considered the case, Mr Wilson admitted that he had worked outside of scope of practice by providing a partial denture to a dentate patient without the prescription of a dentist. The committee thought that Mr Wilson’s deliberate decision to work outside of his scope of practice represented a serious departure from the standards expected of a clinical dental technician.

The committee stated that the GDC’s Scope of Practice document exists to protect the public and to ensure that dental professionals work within their level of skill and competence and that working outside of his scope of practice was a breach of a fundamental tenet of the profession. It also considered that Mr Wilson’s handling of Ms Singh’s complaint was unsatisfactory. The committee decided to issue Mr Wilson with a reprimand.

Our Scope of Practice document outlines who can do what in the dental team. You must work within your scope of practice at all times. However, even when a task or treatment falls within your scope of practice, it doesn’t mean you can automatically do it, you have to make sure you are appropriately trained, competent, confident and indemnified.

If you find yourself in a position where you have started treatment and then something happens which you are not trained and competent to deal with, you must stop and refer the patient to someone who is trained and competent.

Patients have a right to complain about any treatment or service that they find unsatisfactory and you must respond to that complaint. Ignoring a complaint won’t make it go away and it will only make the patient even more dissatisfied – you should deal with complaints as quickly as possible and take steps to deal with the concerns raised in the complaint. More often than not a simple apology or agreeing to put things rights is all a patient wants.