AS you know the GDC is the regulatory body for dental healthcare professionals, but what does that really mean for us as dentists? We pay an annual retention fee to be on the register but what do we get for our money?
To give you a hint, the not-so-catchy strapline for the GDC is: “We regulate dental professionals in the UK - We set and maintain standards for the benefit of patients”. What they have omitted to say is that they prosecute dentists if they think they might not be fit to practise. All well and good you might think; those whose treatment is so poor that they have harmed patients probably shouldn’t be allowed to practise.
But a quick look at the homepage of the GDC today headlined that on 21 May this year a dentist was “struck off for poor record keeping”. Yes, that’s right …struck off for poor record keeping! I’m not familiar with that case and this was only a headline but the message here is that times are changing. The GDC is keen to prosecute and lots of good dentists are finding themselves in the glare of the regulator’s headlights.
In the first quarter of 2014, MDDUS had nearly four times more members referred for a GDC investigation as in the same period in the preceding year. Why? Well it’s difficult to be certain but I don’t think dentists have got worse in the last 12 months! What did change was that at the end of September 2013 the new guidance Standards for the Dental Team came into force. This document produced by the GDC is essentially the rule book. If you’ve not read it yet, might I suggest you go on the GDC website and download a copy.
Be warned, it’s not a great read. There are no interesting characters and the ending is as dull as the beginning. However, it is essential reading for practising dentists; it tells us what we must do for all our patients. Interestingly, it divides the rules into those that “must” be obeyed and those that “should” be obeyed, then goes on to define that “should” is essentially “must” except in exceptional circumstances!
In truth, it’s a fairly sensible set of rules for professional people to be abiding by. The document is laid out according to nine basic principles:
1. Put patients’ interests first
2. Communicate effectively with patients
3. Obtain valid consent
4. Maintain and protect patients’ information
5. Have a clear and effective complaints procedure
6. W ork with colleagues in a way that is in patients’ best interests
7. Maintain, develop and work within your professional knowledge and skills
8. Raise concerns if patients are at risk
9. Make sure your personal behaviour maintains patients’ confidence in you and the dental profession.
Consenting adults and others
So what’s new? Well there’s a whole set of rules concerning consent, so it follows that it’s important to ensure patients are fully informed of treatment proposals, are given written estimates for their treatment and that there is a note in the records detailing the options discussed and something to say that they have consented or agreed to a particular treatment. It’s not necessary to have a specific consent form for dentistry carried out on conscious patients but it is essential to make a note that consent has been obtained verbally.
You must, however, have a signed written consent form for patients being treated under sedation or general anaesthetic. I think it’s also a good idea to have a signed form when the treatment is going to take a long time, is complex or expensive. Why? Well, it’s common for patients to claim that they did not consent to treatment when it has gone wrong and it’s much more difficult to defend if there is nothing in the notes to support the dentist’s position.
Banging on about records
Other aspects of record keeping are also prominent issues within the guidance. I can’t think of a single clinical GDC case that hasn’t also had charges relating to some aspect of record keeping. I know defence organisations always bang on about record keeping but while good records helped in defending a claim in the past, nowadays they might just keep you in a job. The standard expected of our record keeping is that contained in the pithily titled Clinical Examination and Record-Keeping: Good Practice Guidelines of the Faculty of General Dental Practice. It’s an essential read and as most of our dental records are on computer it’s possible to make up templates to fill in to ensure the essential information is present.
As an aside, in Scotland records are increasingly being requested from Practitioner Services to check that the claim made for payment is justified, so for example if you are claiming a 1a examination the claim might be considered unjustified if you haven’t assessed and recorded any malocclusion. So that’s another document to read – the Statement of Dental Remuneration. In England and Wales, the situation is similar. It’s important to ensure that your records show you have completed all necessary assessments and proper recordings before making any claim for payment.
Take care out there
The new GDC standards also include some subtle but important changes regarding when dentists are required to notify the regulator of any criminal charges. Before September 2013 the GDC only required notification by a dentist once they had been convicted of a crime but now dentists have to notify the GDC if they have been arrested, charged or even accepted a formal Adult Warning (Police Caution in England). So beware! No ridiculous speeding, being drunk and disorderly or getting caught short on the way home from a night out. Not that you would!
I am sorry if all of this scares you. It shouldn’t. The advice is simple: know what the rules are, keep up-to-date with changes and ensure that you treat patients the way you would treat someone you are fond of. If you are in any doubt, give us a ring on the advice line. We are always happy to chat things through.
Claire Renton is a dento-legal adviser at MDDUS