Dentistry in Society - GDC principles and laws

What kind of things may Clinical Governance involve?

"• Finding out about current "good practice" • Quality Improvement • Evidence Based Dentistry • Risk Management • Investigation of Significant Events • Performance Monitoring • Team Training, and Continuing Education • Complaints Management" - dental juce

How long can we keep medical records for?

- 11 years or until patient is 25yo

How long after a problem can a patient make a complaint?

- 3 years after issue

Which law protects an individual from discrimination?

- Equality Act 2010 - protects people from discrimination in the workplace and wider community

Who sets clinical governance guidelines?

- NICE - national institute of clinical excellence - about approaching patient care in an evidence-based approach

What is the SPIKES protocol for breaking bad news?

- Setting - Perception - Invitation - Knowledge - Empathy - Summary

What are some essential audits we must do? How do they relate to the GDC principles?

- Essential audits include audits on the level of Infection control and decontamination. This should comply with HTM01-05, and is audited every 6 months. - Also radiographs - number of acceptable x-rays taken vs non -acceptable - we try to keep radiation to as low as possible - Accessibility in the dental practice ie comply with Equality Act 2010 - auditing ensures high standards of care which ties into GDP principle 1, putting patient's best interests first

What is the Freedom of Information act?

- FOI 2000 - allows the public to access info held by public authorities such as the police/nhs/local authorities (ie pt complaints) - court orders can mean information must be released - links to GDP Principle 4 - maintain/protect patient info

What governing body regulates X-rays? What is the ALARP principles?

- IRR or IRMER - Ionising Radiation (Medical Exposure) Regulations Responsibilities include: minimising unintended, excessive or incorrect medical exposures justifying each exposure to ensure the benefits outweigh the risks optimising diagnostic doses to keep them "as low as reasonably practicable" for their intended use.

What is the Medical Device regulations of 2002?

- Law affecting active implantable medical devices, medical devices, in vitro diagnostic medical devices - To ensure that medical devices placed on market and put into service in the UK meet these regulatory requirements we perform the following activities:

What is the compensation act 2006?

"The Compensation Act 2006 states; 'An apology, an offer of treatment or other redress, shall not of itself amount to an admission of negligence or breach of statutory duty'"

What does informed consent include?

"The GDC says you must find out what your patients want to know, as well as telling them what you think they need to know. Examples of information which patients may want to know include: • why you think a proposed treatment is necessary; • the risks and benefits of the proposed treatment; • what might happen if the treatment is not carried out ;• other forms of treatment, their risks and benefits, • whether or not you consider the treatment appropriate. • the (estimated) cost of the treatment • the nature of the contract (e.g. NHS or Private) .(GDC Document: Principles of Patient Consent)" - important to find out what is important to the patient and inform them well enough - very important to tell patient what potential treatment may be needed in the future if the current plan were to fail!

What is the Duty of Candour?

"What about the Duty of Candour? The statutory Duty of Candour requires all NHS staff to act in an open and transparent way."

How do you give smoking cessation advice?

- Very brief advice - Ask - Advise - Act - do they want to stop smoking - ask again at every appointment - advise that it may be best for them - if they say yes then act on it and refer to nearest smoking cessation centre, documenting discussions and verbal consent in notes

What is the difference between Statutory law and Common Law?

- common law is made by judges - statutory is made by parliament

What is Beneficience?

- doing what is best for the patient

When may we need to re-take consent?

- if the treatment plan changed - if another member of the team is taking on care

When may you be able to use identifiable images/xrays of a patient?

- if they have given you explicit consent to do so, specifically for the means that you are using it for too - otherwise you must share it so it not identifiable and is anonymous

What is the age of consent?

- over 16 the patient can make the decision themselves as long as can show capacity

What needs to be true for consent to be valid?

- patient must be deemed competent to consent - they must be well informed before making the decision - the consent must be freely given - patient must actually give there decision or there is no consent

What is HTM01-05?

- regulations surrounding infection control and decontamination

Describe the calgary cambridge model of care

- see pic

What is Gillick's competency?

- this is used to assess capacity under the age of 16

When do you need written signed consent (ss well as always notes)?

- treatment plan - photos/xrays for use - For treatments under General Anaesthetic or Sedation.

What is the 2 stage test to identify mental capacity?

1. Does the person have an impairment of their mind or brain, whether as a result of an illness, or external factors such as alcohol or drug use? 2. Does the impairment mean the person is unable to make a specific decision when they need to?

Outline how we may conduct a risk assessment?

1. Identify the hazard - a chemical, a piece of equipment, a procedure that occurs in the workplace, etc. 2. Identify who may be harmed - certain staff, certain patients, visitors, everyone, etc. 3. Evaluate the risk - is there a hazard only if misused, is there a hazard with every use, or is there a hazard if certain precautions are not followed? 4. Control the risk - train all staff in correct usage, improve precautions to prevent misuse, keep hazards away from untrained persons, install health monitoring where appropriate, remove the risk where possible, etc. 5. Record the risk assessment findings - to prove compliance, to provide a reference for all users, to ensure all staff are fully informed of the potential hazards in the dental workplace. 6. Review the assessment process - on a regular basis to ensure that hazardous events or injuries do not occur.

Explain Principle 1 in more depth?

1.2 You must treat every patient with dignity and respect at all times 1.2.1 You should be aware of how your tone of voice and body language might be perceived 1.2.3 You must treat patients with kindness and compassion 1.3.2 You must make sure you do not bring the profession into disrepute 6.1.2 You must treat colleagues fairly and with respect, in all situations and all forms of interaction and communication. You must not bully harass, or unfairly discriminate against them.

Describe GDC principle 2 in more depth?

2.1 You must communicate effectively with patients - listen to them, give them time to consider information and take their individual views and communication needs into account 2.2 You must recognise and promote patients' rights to and responsibilities for making decisions about their health priorities and care 2.3 You must give patients the information they need, in a way they can understand, so that they can make informed decisions 2.4 You must give patients clear information about costs

Describe GDC principle 3 in more depth

3.1 You must obtain valid consent before starting treatment, explaining all the relevant options and the possible costs 3.2 You must make sure that patients (or their representatives) understand the decisions they are being asked to make 3.3 You must make sure that the patient's consent remains valid at each stage of investigation or treatment

Describe GDC principle 4 in more depth?

4.1 You must make and keep contemporaneous, complete and accurate patient records 4.2 You must protect the confidentiality of patients' information and only use it for the purpose for which it was given 4.3 You must only release a patient's information without their permission in exceptional circumstances 4.4 You must ensure that patients can have access to their records 4.5 You must keep patients' information secure at all times, whether your records are held on paper or electronically

Describe GDC principle 5 in more depth?

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 5.2 You must respect a patient's right to complain 5.3 You must give patients who complain a prompt and constructive response

Describe GDC principle 6 in more detail?

6.1 You must work effectively with your colleagues and contribute to good teamwork 6.2 You must be appropriately supported when treating patients 6.3 You must delegate and refer appropriately and effectively 6.4 You must only accept a referral or delegation if you are trained and competent to carry out the treatment and you believe that what you are being asked to do is appropriate for the patient 6.5 You must communicate clearly and effectively with other team members and colleagues in the interests of patients 6.6 You must demonstrate effective management and leadership skills if you manage a team

Describe principle 7 in more detail

7.1 You must provide good quality care based on current evidence and authoritative guidance 7.2 You must work within your knowledge, skills, professional competence and abilities 7.3 You must update and develop your professional knowledge and skills throughout your working life

Describe principle 8?

8.1 You must always put patients' safety first 8.2 You must act promptly if patients or colleagues are at risk and take measures to protect them 8.3 You must make sure if you employ, manage or lead a team that you encourage and support a culture where staff can raise concerns openly and without fear of reprisal 8.4 You must make sure if you employ, manage or lead a team, that there is an effective procedure in place for raising concerns, that the procedure is readily available to all staff and that it is followed at all times 8.5 You must take appropriate action if you have concerns about the possible abuse of children or vulnerable adults

Describe principle 9 in more detail?

9.1 You must ensure that your conduct, both at work and in your personal life, justifies patients' trust in you and the public's trust in the dental profession 9.2 You must protect patients and colleagues from risks posed by your health, conduct or performance 9.3 You must inform the GDC if you are subject to criminal proceedings or a regulatory finding is made against you, anywhere in the world 9.4 You must co-operate with any relevant formal or informal inquiry and give full and truthful information

What are the 4 pillars of medical ethics?

Autonomy Beneficence Non-maleficence Justice

What is the CQC?

Care quality commission Independent body that regulates the health and social care Annual health checks looking at: 1) Quality of service (according to standards for better care) 2) Financial management - It looks for care that is: o Safe? o Effective? o Caring? o Responsive to people's needs? o Well-led?

Define Clinical Governance

Clinical governance is the system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which clinical excellence will flourish - "The idea behind CG is that patients will be better protected if we all strive for excellence, and can prove it to the regulatory authorities" - Dental Juce - this links to GDP principle 1 (patient's best interests) and principle 7 regarding maintaining and improving our own professional skills

What is GDC principle 2?

Communicate effectively with patients

What is the Mental Capacity Act 2005?

For any patient who can legally consent you need to assess capacity to consent (Mental Capacity Act 2005)

What is GDPR?

General Data Protection Regulation 2018 - enforced by the ICO and focuses on the management of electronic info (incl. Photos,notes, media, xrays) - information: - used fairly, lawfully and transparently - used for specified, explicit purposes - used in a way that is adequate, relevant and limited to only what is necessary - accurate and, where necessary, kept up to date - kept for no longer than is necessary - handled in a way that ensures appropriate security, including - protection against unlawful or unauthorised processing, - access, loss, destruction or damage

What is GDC principle 5?

Have a clear and effective complaints procedure

What law covers occupational health?

Health and Safety at Work Act - Primary piece of legislation covering occupational health and safety in GB - considers factors such as: Dental unit water lines - Emergency drugs - Infection control - Medical emergencies - Adverse incidents - Amalgam use and disposal - ergonomics

What is GDC principle 4?

Maintain and protect patient's information

What is principle 7?

Maintain, develop and work within your professional knowledge and skills

What is principle 9?

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

What is GDC principle 3?

Obtain valid consent

What is Principle 1?

Put patients' interests first

What is principle 8?

Raise concerns if patients are at risk

When is a patient unable to have capacity to consent?

The MCA says a person is unable to make a decision if they cannot do 1 or more of these things: • understand the information relevant to the decision • retain that information for long enough to make the decision • use or weigh up that information as part of the process of making the decision • communicate their decision in any way - competence to make a decision is specific, just because a patient is competent enough to make one decision it does not make them automatically competent enough to make another!

What is an audit and why do we do them?

The clinical audit is a mechanism which we use to measure the standard of care in a clinical setting. We usually measure this against what are already accepted set standards which are usually already published in documents - it is about identifying areas to improve on and actually measuring if we do improve them/or are meeting the standards of care

What is the guidance around using Social media?

When using social media, you must: a. maintain and protect patients' information by not publishing any information which could identify them on social media without their explicit consent b. maintain appropriate boundaries in the relationships you have with patients and other members of the dental team c. comply with any internet and social media policy set out by your employer. - relates to principle 4 - also don't cyberbully or harass colleagues online - gdc 6 - don't post anything that could damage your, your colleagues or the profession's reputation - gdc 9 - ie don't accept friend requests from patients if it is inappropriate - consider what you post on socials

What is GDC principle 6?

Work with colleagues in a way that serves the interests of patients

Define Information Governance

how to manage and share information about data collected digitally - ensures: confidentiality/data protection/info recording - this links to GDP Principle 4 - maintaining and protecting patient information