Foundation training for general dental practice application form for



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Trainer Induction Course – Robens Suite, Guy’s Hospital YES NO

16th April 2013

DF1 Recruitment – Meet the Trainers Session – Postgraduate Centres YES NO

19th April 2013

Trainer Induction Course – Education Day – Mercure Tunbridge Wells YES NO

18th July 2013

FDP/FT Trainer Residential Course 2013 – Hilton Maidstone YES NO

13th/14th September 2013

HEKSS Dental Conference – Hilton Gatwick YES NO

13th November 2013
Sessions of DFT related activities attended during 2012/2013 Schemes (for all):

Trainer Induction/Update Course – Robens Suite, Guy’s Hospital YES NO

6th March 2012

DF1 Recruitment – Meet the Trainers Session – Postgraduate Centres YES NO

20th April 2012

Trainer Induction Course – Education Day – Mercure Tunbridge Wells YES NO

21st June 2012

FDP/FT Trainer Residential Course 2012 – Hilton Maidstone YES NO

14th/15thh September 2012

KSS Deanery Dental Conference – Hilton Gatwick YES NO

14th November 2012

Strictly Confidential - for HEKSS use only Part 2; page 1



Name of Applicant/s ________________________________

________________________________
PRACTICE QUESTIONNAIRE
PART 2
Training practices set the standards for new graduates, so it is important that, as far as possible, they comply with current legislation. A practitioner who wishes to be a Trainer must have reasonable experience within, and commitment to, the General Dental Services and demonstrate standards of good practice in keeping with current opinion. Please read every section carefully and tick the boxes as appropriate: it is essential that ALL questions are answered. If necessary, further information may be obtained from the offices of the HEKSS Foundation Training Department, or from your Course Programme Director. Supporting evidence may be required to be seen by the practice visitor(s). Original certificates and other relevant documentation need to be available for inspection during the visit.
 Yes or  No, or

N/A not applicable
SECTION 2.1 The Practitioner Applicant

1st

2nd

(Joint applicant to complete second column.)




Are you practising in the General Dental Services providing a wide range of NHS treatment to patients?

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Have you, or in the case of joint applicants, one of the pair of applicants been a principal in the intended training practice for at least one year?

But

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If you are an associate, you may, in exceptional circumstances, apply to be a sole Trainer when all other requirements are satisfied and if you have been in this practice for at least two years and will have complete control and responsibility for managing your part of the practice in relation to the FDP.

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Have you completed at least 75 hours of verifiable postgraduate education in the past five years?

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Have you completed any or all of the FGDP key/core skills?

If some of the key/core skills – please give details of which, and dates ……………

………………………………………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………



All  Date

………………….




Have you or your practice taken part in any other recognised clinical governance scheme?

Name of Scheme …………………………………………………………………


Date of initial completion ………………………………………………………..


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Strictly Confidential - for HEKSS use only Part 2; page2
 Yes or  No or

N/A not applicable

SECTION 2.2 The Practice
Date of last PCT Practice Inspection Report ………………………………. (please attach a copy)

(if you do not have a copy of this report, please explain the reason why this is not available)
Date of CQC Inspection ……………………………………………………………………………………….
2.2.1 EMPLOYMENT

  1. Contracts: Are there written contracts of employment for all eligible members of staff?

1978 Employment (Protection) Consolidation Act ISBN 0 10 544478 2

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  1. Legislation: Do these contracts conform to the employment legislation’s minimum entitlements?

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  1. PAYE: Are employees provided with regular itemised payslips?

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I attach an Area Team Practice Inspection Report (where the inspection was carried out less than three years ago) and any subsequent correspondence Yes NoIf yes, please proceed to Section 2.4.
If you have not had an Area Team Practice Inspection within three years, please complete Sections 2.2.2 to 2.3.4.
2.2.2 HEALTH AND SAFETY (Health and Safety at Work etc. Act 1974).

  1. Poster: Is there a poster on display from the Health and Safety Executive? HSE Poster:

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  1. Policy: Is there a recently updated written safety policy for the practice on display or accessible to all staff?

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  1. Risk Assessment: Has a risk assessment been carried out to identify the hazards within the practice? Have the risks been assessed? Have assessments been made of all the substances used within the practice to identify which might be hazardous to health? Have the risks been assessed? Are records of these assessments available? Specific risk assessment is required for young persons and new and expectant mothers (preferably in writing).

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  1. Welfare: Have you provided adequate facilities and arrangements for staff welfare?

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  1. Fire: Is there adequate fire fighting equipment and means of fire detection throughout the practice and are staff trained to deal with such situations? Is there a fire escape and is it adequately signposted? Are passages free from obstruction? Are fire extinguishers regularly inspected and serviced?

 

  1. Public Liability: Do you have adequate public liability insurance to cover your premises? Is a certificate displayed?

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  1. Employer’s Liability: Have you on display a current employer’s liability insurance certificate?

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  1. First Aid: Is there adequate first aid provision? Has a suitable person been appointed to give first aid and is this information displayed?

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  1. Accidents/RIDDOR: Is there an accident report book available and maintained? Are there systems in place for reporting relevant incidents to the HSE?

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  1. Waste Disposal: Is waste segregated into hazardous and non-hazardous and stored safely prior to disposal? Are there arrangements for the collection and disposal of these wastes? Are copies of the transfer notes and consignment notes available?

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  1. Mercury: Is there a mercury spillage kit? Are staff aware of the procedure to deal with mercury spillage? Is there proper storage (and disposal – is encapsulated amalgam used?) of metallic mercury and waste mercury material? Please confirm all questions.

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  1. Autoclave: Is there an inspection certificate? Is the autoclave maintained and tested, according to HTM 01-05?

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Strictly Confidential - for HEKSS use only Part 2; page3




 Yes or  No,

or N/A not applicable



m) Compressors: Is there an inspection certificate? Is there a service/maintenance contract in place? Regulations 2000, SI 2000 No 128, ISBN 0 11 085836 0; Provision and Use

 

  1. Gas Cylinders: Are they properly stored? Are the cylinders regularly serviced? Are records of servicing available?

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  1. Electrical Appliances: Are regular visual inspections of all portable equipment carried out? Are records available? Is all portable electrical equipment and the fixed supply inspected and tested at least every three to five years by a competent person? Are records available?

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  1. Radiation: Have you informed the Health and Safety Executive of your x-ray machines? Have you appointed a radiation protection adviser? Is there documentation of regular radiation safety assessment of all radiographic equipment? Are there local rules on display? Are all staff using x-ray equipment adequately trained and records of training kept? Is the quality of radiographic processing and radiographic images continually assessed

 

  1. Computers & Display Screen Equipment: If you use a computer, are you registered with the Office of Data Protection? Do you comply with the Health and Safety (Display Screen Equipment) Regulations 1992? Has an assessment of the workstation been carried out? Have employees using DSE regularly been offered eye and eyesight tests? Data Protection Act 1998; 90/270/EEC; Health and Safety (Display Screen Equipment) Regulations 1992; Display screen equipment work – guidance on regulations ISBN 0 11 886331 2

 

  1. Drugs: Do you have the emergency drugs recommended for dentists by the British Resuscitation Council?

  2. Are emergency drugs kept securely, but accessible at all times? Are strict records kept of the purchase and dispensing of drugs? Are drugs stored according to manufacturers’ recommendations and kept in a locked cupboard?

 

 


  1. Laboratory: If there is a laboratory on the premises has an assessment been made under the Factories Act and other special legal requirements? Is the Laboratory registered with MHRA?

 


SECTION 2.3 Good Practice
2.3.1 EMERGENCIES

  1. Does the practice record and regularly update patient medical history?

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  1. Is there a pocket mask?

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  1. Is there an up-to-date emergency drugs kit?

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  1. Is there an oxygen kit?

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  1. Are staff trained regularly in resuscitation? (Date____________)

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  1. If your practice undertakes inhalation or intravenous sedation, does your practice conform to the current recommendations?

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  1. Is there a first aid kit and is there a qualified first-aider or appointed person to give first aid?

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Strictly Confidential - for HEKSS use only Part 2; page4
 Yes or  No or

N/A not applicable

2.3.2 INFECTION CONTROL




  1. Are staff trained in infection control? (Date _____________)

 

  1. Are staff vaccinated against Hepatitis B and the other common illnesses; diphtheria, pertussis, poliomyelitis, rubella, tetanus, TB?

Are reports available indicating responses to the Hepatitis B vaccine and when boosters are due?

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  1. Is there an autoclave? (Make/Model __________________________)

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  1. Is the autoclave regularly serviced and tested? (Date _____________)

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  1. Is there an ultrasonic bath/washer disinfector?

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  1. Are all non-disposable clinical instruments, including burs and handpieces, sterilised after use?

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  1. Are there at least three of each of the following for the sole use of the VDP:




Slow hand pieces?

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three-in-one tips?

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Ultrasonic tips?

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turbines?

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  1. Are clinical items sent to others (eg impressions to the laboratory) properly treated for cross-infection control?

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  1. Do members of the practice either dispose of or sterilise between patients the following items:

aspirator tips?

 

impression trays?

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  1. Do members of the practice use disposable:




paper towels?

 

surgical blades?

 

local anaesthetic?

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gloves?

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needles?

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facemasks?

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mouthwash cups?

 

  1. Is eye protection provided & used by staff and patients?

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l) Is there appropriate and adequate ventilation of the premises, especially treatment rooms, sterilising rooms, storage areas and developing areas?

 

m) Does the practice comply with the “essential” requirements of HTM 01-05?

 

2.3.3 FACILITIES FOR THE FDP



  1. Is the FDP’s surgery greater than 9 square metres?

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  1. Is the surgery suitable for low-seated dentistry?

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  1. Is there regular provision for a trained dental nurse for the FDP?

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  1. Is there a light cure unit?

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  1. Is there a well-stocked rubber dam kit?

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  1. Are there adequate instruments available for examinations, conservation, endodontics, periodontics, oral surgery and prosthetics?

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  1. Is there a reasonable practice library?

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  1. Can the practice provide the FDP with more than 10 patients per day?

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  1. Is there a viewer for radiographs?

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  1. Are beam-aiming devices available for bitewing, periapical and endodontic radiography?

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Strictly Confidential - for HEKSS use only Part 2; page5

 Yes or  No or

N/A not applicable

  1. Does the practice have facilities for clinical photography?

 

  1. Is there a computer with broadband access that the FDP can easily access?

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2.3.4 DOCUMENTATION

Are copies of the following documentation available for inspection or on display:

  1. Health and Safety poster?

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  1. Practice policy on health and safety?

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  1. Autoclave maintenance and inspection?

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  1. Compressor maintenance and inspection?

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  1. Fire equipment maintenance?

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  1. Performing Rights Licence and/or TV licence (if applicable)?

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  1. Records relating to safety checks on:

(i) portable electrical equipment?

(ii) the fixed electrical supply? (NICEIC Test Certificate)


 


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  1. Data protection registration (if applicable)?

 

  1. Computer software licence (if applicable)?

 

  1. Employer’s liability insurance certificate?

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  1. Current Certificate of professional indemnity? Expiry Date …………………………………….

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  1. GDC annual practising certificate?

 

  1. Risk assessment and COSHH assessments?

 

  1. Clinical waste transfer contract (for sharps and other clinical waste) Provider …………………….

Transfer Note for period ……………………………..

Hazardous waste disposal contract Provider ……………………………………………...

Transfer Note for period


 




o) Records relating to radiation safety assessment of all radiographic equipment?

 

Details/Location of

X-Ray Machine

………………………

………………………

………………………


Date of Safety

Assessment

………………………

………………………

………………………


Details/Location of

X-Ray Machine

………………………

………………………

………………………


Date of Safety

Assessment

………………………

………………………

………………………





p) Local rules for radiographic equipment?

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q) Records of quality assessment systems for radiographs

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r) Registration with the Care Quality Commission

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Strictly Confidential - for HEKSS use only Part 2; Page 6

 Yes or  No or


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