A practical resource to help in the support of non-uk, eea qualified dental practitioners practising in the uk january 2011 Updated April 2012 Contents



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Annex 3: Checklist


Below is a checklist of topic areas which may help as an aide memoir when supporting an organisation contracting/commissioning or employing any dentist who has not previously worked in the General Dental Services in the UK. It may be particularly helpful where the practitioner is younger or who has only previously worked in salaried services or those who qualified outside of the UK. These topics have been developed in accordance with guidance and regulations issued by the GDC and Departments of Health, (Department of Health, Social Services and Public Safety (Northern Ireland), NHS Scotland, NHS Wales).

The final column has been designed to provide an opportunity to record whether the topic has been discussed.


Checklist


Topic

Requirement

Context

Discussed?

(Y/N)

Regulation and registration

Registration with the GDC

All dentists who wish to practise dentistry in the UK are required to be registered with the GDC.

An annual retention fee (ARF) must be paid each year to remain on the Dentists’ Register. The deadline for dentists to pay every year is the 31 December. Dentists who work without having paid are practising illegally.






Ethics

Understanding GDC guidance documents

Dentists must understand the requirements of the GDC guidance document ’Standards for Dental Professionals’1 and the supplementary guidance booklets.




Indemnity insurance

Obtaining adequate and appropriate indemnity insurance

All GDC registrants are required to ensure that there are adequate and appropriate arrangements in place so that patients can claim any compensation they may be entitled to. Indemnity insurance from a dentist’s country of origin may not always provide cover for working in the UK.
The only appropriate arrangements recognised by the GDC are: membership of a dental indemnity organisation, i.e. Dental Protection Limited, Dental Defence Union or the Medical and Dental Defence Union of Scotland (whether your own membership or employer’s membership); arranged by yourself, or your employer; or NHS indemnity.




Health and safety at work


Understanding cross infection control procedures

A dentist is required to have knowledge of cross infection control procedures including knowledge of Control of Substances Hazardous to Health (COSHH) regulations, HTM 01-05 decontamination guidelines for dental surgeries, and other relevant health and safety policies.




Health and safety at work

Inoculation against hepatitis B

Dentists, and clinical dental care professionals who work for them, must be inoculated against hepatitis B, and checked for seroconversion after the primary course. Thereafter, if immunity levels are satisfactory, one booster is needed after five years.




Ionising radiation

Understanding radiation protection guidelines

Only a fully trained person is permitted to take radiographs in a dental practice. Ongoing training (continuing professional development (CPD)) in radiology and radiation protection is a mandatory GDC requirement.




Hazardous waste


Understanding hazardous waste regulations

Clinical waste is considered ‘hazardous’ under the Hazardous Waste (England and Wales) Regulations 2005. Similar regulations cover Scotland and Northern Ireland.
All waste dental amalgam is now classified as hazardous waste and must not be discharged to a sewer. Amalgam separation units must be installed in all dental practices. Collected waste amalgam must be disposed of in accordance with the regulations.




Clinical practice

Understanding drug prescribing protocols

Each practice is required to adhere to defined drug prescribing protocols.




Clinical practice

Managing medical emergencies

Dentists are required to be able to recognise and manage medical emergencies in the dental practice.
Cardio-Pulmonary Resuscitation (CPR) training is a mandatory requirement, as is an awareness of the practice emergency drug protocol.




Clinical practice

Understanding fluoride content levels in UK drinking water

Approximately six million people in the UK receive water in which the fluoride content has been adjusted to the optimum level for dental health of around one part of fluoride per million parts of water, or has a naturally occurring fluoride level of around this level. In some areas (e.g. parts of Essex, Wiltshire and Norfolk) naturally occurring fluoride levels can vary substantially between places and over time and it is very difficult to quantify this accurately. Dentists new to the area should familiarise themselves with the local situation by talking to colleagues (Consultant in Dental Public Health) or the commissioning/employing organisation.




Clinical practice

Delivering high quality dental treatment

Are there any aspects of clinical practice which the dentist is proposing not to offer? Are there any areas where the dentist might need further training before starting work in the practice? Is the dentist are of local referral to colleagues protocols and procedures?
It is also useful to establish if the applicant’s previous experience is mainly of working in a single unit practice, or a multi-surgery practice.




Clinical practice

Use of amalgam

A number of dental schools within the EEA, including some in the UK no longer train dental students in the use of amalgam as a filling material. Dentists not trained in the use of amalgam may need additional support to interpret NHS guidelines for this material.




Working in the NHS

Understanding NHS regulations

An applicant can only be included on one dental performers’ list in England at any one time, although this does allow the dentist to work in other geographic areas.
In order to work in Scotland, Wales and Northern Ireland, a dentist must also be included in a dental performers’ list or equivalent in that country.
A dentist must understand the NHS regulations in providing treatment for patients, including how different contractual arrangements exist in general dental practice in Scotland and Northern Ireland, and England and Wales.
Attendance at a nationally available ‘Introduction to NHS Course’ is recommended (e.g. organised by the British Dental Association (BDA) or deaneries), as part of the compulsory local induction plan, particularly for dentists who have qualified outside of the UK.
An understanding of employment and contract law in the UK is recommended. The BDA produces useful advice sheets and the ACAS website also has helpful material.




Private practice




Does the dentist understand the regulations describing the interface between NHS practice and private practice? The BDA produces useful advice sheets about private practice.




Working in a dental team

Understanding the importance of team work in dentistry

It is important to ascertain the applicant’s experience of working in a dental team and their level of understanding of the roles and responsibilities of other dental care professionals.
A dentist will be required to participate in staff training and staff meetings where necessary.
A dentist will be expected to work with a dental nurse when treating a patient.
There are six types of dental care professionals (registrants) in the UK:


  1. Dental nurses work at the chair-side to assist dentists. Education and training is through a combination of in-practice learning and formal training courses, leading to a registrable qualification. Assistants are able to undertake further training which qualifies them to provide assistance in undertaking sedation and working with special care patients, taking radiographs and oral health promotion. Expanded duties training is also available, e.g. topical fluoride application, impression taking and suture removal.

  2. Dental hygienists may only work under the direction of a dentist, who must develop a treatment plan. The dentist does not need to be present on the premises during treatment.

  3. Dental therapists may only work under the direction of a dentist, who must develop a treatment plan. The dentist does not need to be present on the premises during treatment.

  4. Orthodontic therapists undertake specified aspects of orthodontic treatment under the prescription of a dentist.

  5. Dental technicians are permitted to produce dental technical work to the prescription of the dentist, but cannot work in the mouth.

  6. Clinical dental technicians are qualified dental technicians who provide dental devices to patients under the prescription of a dentist. They can also provide, without a dentist’s prescription, complete dentures and mouth guards.




Maintaining quality in dental care delivery

Understanding quality assurance mechanisms in the UK

The treatment data of providers (contract holders) and their performers who receive payment through the NHS primary care dental services is monitored and reported to the commissioning/employing organisation via regular reports which make comparisons to local and national averages. The Dental Reference Service of the Business Support Agency provides risk based clinical monitoring of NHS primary dental services contracts. Clinical Policy Advisers are available to support and advise PCO’s with regard to concerns relating to particular primary dental services contracts.

From 1 April 2011, under the requirements of the Health and Social Care Act 2008, all providers of primary dental care services who provide regulated activities must be registered with the Care Quality Commission (CQC). The CQC will be responsible for ensuring that all dental providers in England comply with their requirements of registration.






Continuing dental education

Understanding continuing dental education requirements

All registered dentists must participate in continuing professional development (CPD): 250 hours in five years, as defined by the GDC. This requirement is subdivided into 75 hours verifiable CPD and 175 hours of general (informal) CPD. Certain core (compulsory) subjects must be included in the verifiable activity, including:


  • medical emergencies (at least ten hours in every five-year CPD cycle);

  • disinfection and decontamination (at least five hours in every CPD cycle);

  • radiography and radiation protection (at least five hours in every CPD cycle).

In addition, it is recommended that training is undertaken in law and ethics, complaints and oral cancer.
A dentist is required to keep a record of activity and certify compliance annually.

Awareness of the importance of clinical governance requirements is useful.

Awareness of the role of Postgraduate Dental Deans in continuing professional development and postgraduate education, including and understanding of the deanery competency frameworks is useful.





NHS complaints procedures

Understanding NHS complaints procedures

An understanding of practice NHS complaints procedures is required.
Each NHS practice and clinic is required to have a complaints procedure and that any patient complaint must first be made to the dentist.




Foundation Training (FT)

Understanding FT


Graduates of non-UK EEA dental schools are exempt from the requirement for foundation training, although they may apply for a place if they wish. Places cannot be guaranteed.
Foundation trainees are salaried at a national rate.




Specialist training in the UK

Understanding specialist training in the UK

There are 13 specialist lists held by the GDC.
Two dental specialties, oral surgery and orthodontics, are recognised by the EU but UK law allows the GDC to recognise any specialty where this would be justified in the interests of the public and the dental profession.
An application to the GDC is required in order to register as a specialist. The title “specialist” can only be used if a dentist is on the specialist list.
There is an annual retention fee for each of the specialist lists




Support systems in the UK

Understanding the role of support systems in the UK

The main dental organisation for dentists in the UK is the BDA. As well as acting as a professional organisation, it is also the trade union for dentists and a scientific society. The BDA publishes extensive guidance on practice management.

Membership of the BDA is not compulsory.


There are also other, smaller, general dental practitioner associations and scientific interest groupings (in addition to the specialist societies).
Guidance and advice on relationships and behaviour between dentists, and between dentists and their staff, is provided by the BDA and other associations.




Corporate dentistry


Understanding the legislation concerning dental body corporates

All GDC registrants can own a practice and also incorporate their practice into a company, becoming a legal entity. However, in all cases the majority of directors must be dentists or dental care professionals.






Annex 4: Further information from NHS Employers

NHS Employment Check Standards


NHS Employers provides guidance and advice to NHS organisations on policies and procedures designed to prevent unsuitable people obtaining employment in the NHS. NHS employers should carry out the necessary pre and post appointment checks in accordance with NHS Employment Check Standards2 which outline the legal and mandated requirements for pre-employment checks in the NHS. The standards cover: verification of identity checks, right to work checks, registration and qualification checks, criminal record checks, and occupational health checks.

Induction programmes


A sound and comprehensive induction programme3 should be in place. This ensures that international dentists are able to settle into their new environment as quickly as possible. It helps raise confidence and provides a familiarity with the practices of the NHS. An induction should cover the contracting/employing organisation itself and its procedures, as well as a more general induction into living in the UK. NHS Employers has developed induction programmes and collected examples of other organisations’ programmes to be shared across the NHS.

In addition, the Department of Health (England) has produced ‘Guidelines for NHS Employers: Induction programmes for Consultants and GPs recruited from abroad’ (29), a best practice guide to help NHS organisations prepare induction programmes for new consultants and general practitioners recruited from abroad. It draws together ideas generated by deaneries, trusts and other employer organisations, and has been developed with the help of overseas doctors themselves and so deals with concerns they have identified. Whilst individual learning needs of dentists will vary from that of consultants and GPs, many issues outlined in this guide will be equally appropriate for dentists.




1 General Dental Council, Standards for Dental Professionals, October 2009. http://www.gdc-uk.org/NR/rdonlyres/1B66D814-A197-4253-B331-A2DB7F3254DC/0/StandardsforDentalProfessionals.pdf

2 For more information visit: www.nhsemployers.org/RecruitmentAndRetention/InternationalRecruitment/Specific-guidance/Pages/SpecificGuidance-Dentists.aspx. Note: the NHS Employment Check standards ‘Safer Recruitment – a guide for employers was first published in March 2008 and re-published in June 2010

3 NHS Employers provide information on Induction Programmes on their website at: www.nhsemployers.org/RecruitmentAndRetention/InternationalRecruitment/Pages/Induction-programmes.aspx

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