3 Guidelines for structure and process in dental practice

3.1 Introduction

In the context of this section of Standards in Dentistry the term 'structure' encompasses all items and people at a location that enable oral healthcare to be provided; the premises, the instruments and equipment and the practice team are covered by the term. 'Process' refers to the manner in which the 'structure' is used to provide oral healthcare.

This section of the publication will be particularly useful in helping to support those individuals who aspire to Fellowship of the Faculty of General Dental Practice (UK) (the FFGDP[UK]) or undertaking the FGDP(UK)’s Key Skills in Primary Dental Care e-learning programme.1 Additionally, it refers to the standards of the various healthcare regulatory bodies that all healthcare workers (including dental professionals, providing services to the NHS and independent sectors) are required to understand and meet.

All dental professionals are also required to meet the standards set out by the General Dental Council (GDC) in Standards for the dental team (www.gdc-uk.org/professionals/standards).2 The GDC standards set out what you must do as a dental professional and the individual responsibility to behave professionally and follow these principles at all times. The GDC advise those individuals not meeting these standards may be removed from the register and be prevented from working as a dental professional.

 

In addition to these standards, the British Dental Association (BDA) has a good practice accreditation scheme. BDA Good Practice is a quality assurance programme that allows its members to communicate to patients an ongoing commitment to working to standards of good practice on professional and legal responsibilities. The ‘good practice’ requirements can be used by all providers of primary dental care, including general dental practices (both private and those providing NHS services), specialist practices, salaried primary dental care services, armed forces clinics and outpatient departments (https://bda.org/goodpractice).3 Other providers offer accreditation for dental practices and these schemes will set their own eligibility criteria.

 

Other guidelines and standards include the BDA advice sheets and evidence summaries, which BDA members can download directly from www.bda.org. They cover a wide range of subjects relating to all aspects of dental practice. Further standards for structure and process in dental practice include the International Organization for Standardization 9000 series (ISO-9000) which are standards in administration and business practice. The Health and Safety Executive (HSE), which is the UK independent regulator of health and safety in the workplace and the Medicine and Healthcare Products Regulatory Agency (MHRA) which is the agency responsible for ensuring all medicines and medical devices (including dental appliances) are effective and safe to use. The Dental Appliance Manufacturers Audit Scheme sets out standards for dental laboratories to follow (www.damas.co.uk).4

 

One major problem with standards for process and structure in dental practice is that unlike those for most clinical care, they are constantly evolving as new polices are developed and legislation is introduced. Today’s ‘good practice’ may well be considered as inadequate or even negligent in years to come. For this reason, printed publications that set out these standards may soon become outdated. In order to avoid this problem, this section of the publication does not provide detailed information in some areas, instead referring the reader to other sources and where possible websites, where up to date information may be found.

 

3.2 Overview of mandatory standards

Health and social care is managed and regulated differently in the four nations of the UK The Department of Health is the UK Government department with responsibility for health and social care in England. The devolved Governments of the UK each have their own health departments; the Department of Health and Social Services (Welsh Assembly Government), NHS Scotland and its Directorates (Scottish Executive) and the Department of Health, Social Services, and Public Safety (Northern Ireland Executive). Each department is responsible for its own health and social care policy with the Department of Health retaining overall responsibility for matters and issues common to all systems.

 

3.2.1 General Dental Council (GDC)

The GDC has nine core ethical principles of practice that apply to all dental professionals in the UK.2

  • Put patients’ interests first.
  • Communicate effectively with patients.
  • Obtain valid consent.
  • Maintain and protect patients’ information.
  • Have a clear and effective complaints procedure.
  • Work with colleagues in a way that is in patients’ best interests.
  • Maintain, develop and work within your professional knowledge and skills.
  • Raise concerns if patients are at risk.
  • Make sure your personal behaviour maintains patients’ confidence in you and the dental profession.

For each of the principles there is a list of the standards expected, what patients should expect and supporting guidance. Throughout the document ‘must’ is used where the duty is compulsory and ‘should’ is used where the duty would not apply in all situations and where there are exceptional circumstances outside the control of the dental professional that could affect whether, or how the guidance is complied with. Additional guidance documents to help dental professionals to meet the standards can be found on the GDC website (www.gdc-uk.org).

 

3.2.2 Dental regulation

Dental regulation has become an increasingly prominent area of dental practice and is in constant flux of change. The Health and Social Care Act 2008 established the Care Quality Commission (CQC) to replace the Healthcare Commission, Mental Health Act Commission and the Commission for Social Care Inspection to form a new independent regulator for the quality and safety of health and social care in England. The CQC operates at the ‘provider’ level (for example an individual, hospital trust, dental practice, care home or voluntary organisation) and describes what providers should do to ensure the public receive services that meet essential quality and safety standards. The guidance is based on outcomes rather than systems and processes and places the views and experiences of those using services at its centre (www.cqc.org.uk). The CQC currently inspect providers against a series of 12 fundamental standards which apply to all sectors of health and social care, and therefore interpretation of these generic outcomes and how they apply to dentistry is necessary.5

 

There are different regulators in Wales (Healthcare Inspectorate Wales),6 Scotland (Health Improvement Scotland)7 and Northern Ireland (Regulation and Quality Improvement Authority)8 and while there are minor differences in the regulatory responsibilities and frameworks, all work to the same principles of ensuring essential quality and safety standards are met. For the most up-to-date guidance on standards in each of the UK nations, the respective regulator should be consulted (see reference list for their websites).

 

3.2.3 Health and Safety Executive (HSE)

The HSE is the independent regulator for health and safety in the workplace and includes all health and social care settings in the UK. HSE sets out its overall public safety policy and priorities for enforcement on its website (www.hse.gov.uk). The HSE work with other regulators to inspect, investigate and where necessary take enforcement action. There are specific requirements for dental practices to report non-clinical accidents or injuries under the Reporting of Injuries Disease and Dangerous Occurrence Regulations 2013 (RIDDOR)9 and to register with HSE for work with ionising radiation. Further information can be found on their website along with guidance on risk assessment, control of hazardous substances (COSHH) and health and safety legislation.

 

3.3 Clinical governance

Traditionally clinical governance has been described using the seven pillars model. This early model has continued to be refined over the years to feature themes covering the following domains:

  • Clinical effectiveness and research.
  • Audit.
  • Risk management.
  • Education and training.
  • Service user, carer and public involvement.
  • Clinical information and IT.
  • Staffing and staff management.

Clinical governance has seen a significant shift in recent years, with increasing focus given to patient safety as its primary outcome. This has been brought about in response to adverse patient events within the NHS. The most recent response to events at Mid Staffordshire NHS Trust. The subsequent Francis report (2012)10 made a number of recommendations about the standards that should be met by organisations providing health and social care, particularly with regards to the culture of openness and the duty of candour. Each dental practice must be able to demonstrate a culture which encourages openness and transparency in the reporting of patient safety incidents and complaints, so that any learning resulting from root cause analysis can be shared in teams, and system improvements made when appropriate. In addition, all staff should understand their professional responsibilities to raise concerns about the quality of care they feel falls below acceptable standards without fear of personal reprisal. This used to be called ‘whistleblowing’ but has been superseded by the phrases ‘raising a concern’ or ‘freedom to speak up’ and new guidance is being developed by the Department of Health to support healthcare professionals in raising concerns when necessary.

 

Patient safety is now a routine component of governance frameworks in many healthcare settings, but is still underdeveloped in primary dental care. This is in part due to the complexity of overlapping dental regulation, the lack of a centralised reporting system and patient safety initiatives (such as checklists to prevent wrong site tooth extraction) being a relatively new concept in primary dental care, still requiring full scale implementation in practice. However, there is increasing research and policy interest in this area and it is likely patient safety reporting in primary dental care will become easier, better defined and more routine in years to come.

 

3.3.1 Clinical governance framework for primary care dental services

The seven pillars model helps to define the key minimum requirements and standards that all health social care providers are expected to provide. However, these are not all relevant to dentistry and so specific standards were developed in 2006: Primary Care Dental Services Clinical Governance Framework.11 These dental standards focus on 12 themes relevant to primary dental care. The standards and key actions and polices along with recommendation for supporting evidence can be found at: www.pcc-cic.org.uk.

 

3.4 FGDP(UK) guidance for dental practice - Key skills 

The FGDP(UK) has developed its own framework to highlight key areas of clinical governance that will help dentists at any stage of their career achieve a quality standard endorsed by the FGDP(UK), and demonstrate that their practice is compliant in these areas. The Key Skills format is also used widely as an integral part of the foundation training programme, and Key Skills in Primary Dental Care is highly recommended to support this training. The key skills are:

  • Medical emergencies.
  • Infection prevention and control.
  • Clinical record-keeping.
  • Radiography.
  • Legislation and good practice guidelines.
  • Team training.
  • Risk management and communication.

3.4.1 Examples 

This section covers in more detail related guidelines and requirements in each of the seven key skills areas. It is not intended to provide an exhaustive list of requirements in each area but to highlight key minimum safety and quality standards and to refer to other sources of information. It is important to remember that dental regulation is different in each part of the UK and therefore practices should refer to their local guidance in providing evidence of compliance with fundamental standards. For example in England, CQC inspectors report their findings in dental practice under five key questions:

  • Are they safe? (To ensure people are protected from abuse and avoidable harm).
  • Are they effective?
  • Are they caring?
  • Are they responsive to people’s needs?
  • Are they well led?

The BDA produce advice sheets to help practices identify what type of evidence is advisable to demonstrate compliance with fundamental standards in each of the UK nations (www.bda.org).

 

3.4.1.1 Medical emergencies

Medical emergencies can occur in dental practice at any time and dental practices have a duty of care to ensure that patient safety is prioritised in delivering care. The GDC states it is important to ensure that:

  • There are arrangements for at least two people to be available within the working environment to deal with medical emergencies when treatment is planned to take place. In exceptional circumstances the second person could be a receptionist or a person accompanying the patient.
  • All members of staff, including those not registered with the GDC, know their role if there is a medical emergency.
  • All members of staff who might be involved in dealing with a medical emergency are trained and prepared to do so at any time, and practice together regularly in a simulated emergency so they know exactly what to do.

The Medical emergencies in the dental practice section of the British National Formulary (BNF) provides guidelines on the management of the more common medical emergencies which may arise in the dental practice.

 

The Resuscitation Council (UK) no longer provides specific guidance on medical emergencies in the dental practice (formerly provided in their publication Medical emergencies and resuscitation standards for clinical practice and training for dental practitioners and dental care professionals in general dental practice). This was superseded in November 2013 by its publication Quality standards for cardiopulmonary resuscitation practice and training in primary dental care,12 in which the Resuscitation Council (UK) continues to provide helpful guidance on all aspects relating to cardiopulmonary resuscitation in the dental practice.

 

3.4.1.2 Infection prevention and control

All practices must maintain high standards in infection control and prevention and take the necessary steps to provide a clean and safe environment for dental care. The underlying principles of infection control are to apply standard precautions to minimise the risk of transmission of harmful micro-organisms regardless of the health status of the patient or healthcare worker. GDC guidance states that registrants must treat patients fairly and without discrimination, including on health grounds. Standard cross infection precautions include:

  • Hand hygiene.
  • Personal protective equipment.
  • Safe working with sharps.
  • Sterilisation and disinfection of dental instruments.
  • Surgery design and disinfection.
  • Dental unit waterlines.
  • Waste management.
  • Immunisations and screening.

Standards have been set out in Health Technical Memorandum (HTM) 01-05 published by the Department of Health in 2013.13 This established two specific benchmarks – essential quality requirements and best practice, although there is no timescale for implementation of best practice. HTM 01-05 is intended to raise the quality of decontamination work in primary care dental services by covering the decontamination of reusable instruments within dental facilities. An audit tool to help dental practices to self-assess their compliance with HTM 01-05 is available from the Department of Health and Social Care website.13 Scotland has its own series of infection control guidance documents published by the Scottish Dental Clinical Effectiveness Programme (SDCEP) available at www.sdcep.org.uk. Wales and Northern Ireland have their own editions of HTM 01-05 which both differ slightly from the original.

 

Legionella is of specific concern in dental practice if dental unit waterlines are not adequately managed. Legionella pneumophila lives in water systems and can survive in biofilm where it is protected from disinfection agents. All dental practices in the UK have a legal duty to identify and assess sources of risk and to have processes in place to monitor and record all precautions and control measures. The HSE guidance is available at: www.hse.gov.uk/legionnaires.

 

3.4.1.2.1 Further reading 

  • Department of Health. Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV: new healthcare workers.14
  • Health and Safety Executive. Health and Safety (Sharp Instruments in Healthcare) Regulations (2013) Guidance for employers and employees.15
  • Health and Safety Executive. Legionella and legionnaires disease.16

3.4.1.3 Clinical record keeping

Dental professionals are required to make and keep accurate dental records of care provided to patients, whether under NHS or private arrangements. The GDC imposes a professional obligation to create records to document dental treatment that is provided to patients. The GDC states in Standards for the dental team you must:

  • Make and keep contemporaneous, complete and accurate patient records.
  • Protect the confidentiality of patients’ information and only use it for the purposes for which it was given.
  • Only release a patient’s information without their permission in exceptional circumstances.
  • Ensure that patients can have access to their records.
  • Keep patients’ information secure at all times, whether your records are held on paper or electronically.

There are a number of guidelines and support tools to assist dental professionals in producing accurate, comprehensive and contemporaneous patient records. The dental indemnity providers offer expert advice and resources on clinical record-keeping, and the FGDP(UK) has produced good practice guidelines which provide a comprehensive review of the subject – Clinical examination and record-keeping.17

 

3.4.1.4 Radiography

Dental practices have a legal duty to minimise the risk to patients, staff, visitors, contractors and the environment from the effects of ionising radiation in accordance with approved codes of practice issued by the HSE and other statutory agencies. There are two sets of regulations in the UK governing the use of ionising radiation. The Ionising Radiations Regulations 2017 (IRR17) is principally concerned with the safety of workers and the general public but also addresses the equipment aspects of patient protection. The Ionising Radiation (Medical Exposure) Regulations 2018 (IR(ME)R 2018) is concerned with the safety of patients and defined new positions of responsibility; the employer, the referrer, the practitioner and the operator. Every practice must appoint a Radiation Protection Advisor (RPA) ,so expert advice is available on effective radiation safety and protection. Practices must also employ a set of local radiography rules specific to each machine which describe working arrangements and is usually administered by a Radiation Protection Supervisor (RPS), who is a member of the dental team. Radiation protection is included in the remit of the various dental regulators across the UK.

 

The techniques adopted in dental practice for the taking and processing of radiographs must ensure that they are of maximum diagnostic value, while at the same time as minimising the radiation dose. Further details can be found in the FGDP(UK) publication Selection Criteria for Dental Radiography.18

 

3.4.1.5 Legislation and good practice guidelines

It is important all dental professionals are aware of essential practice standards that provide a safe and suitable environment for staff, patients and members of the public who work in, or visit the practice. This includes legislation relating to practice premises, materials, medicines and equipment, hazardous substances and fire safety procedures. A practice must have sufficient space, heating, lighting, ventilation and facilities to provide a pleasant and comfortable environment for staff, patients and visitors and where possible the requirements of the Equality Act 2010 are met. If it is not possible to meet the requirements by making alterations to the premises, the practice should make suitable alternative arrangements for care to meet the patient’s needs. All equipment used in the practice must be serviced and maintained in accordance with manufacturer’s instructions and purchased from reputable sources to guarantee safety and technical standards meet UK legislation.

 

Effective practice management procedures and systems should be in place to provide business continuity in the event of an emergency situation such as flooding, fire or power failure which prevents normal services being delivered, with a plan developed for managing practice communications with staff, patients and the public in such an event. Security of the premises and policies and procedures to protect staff from occupational hazards as well as aggressive or violent behaviour are also important in providing a safe environment for everyone. The BDA provides comprehensive information to assist practices in meeting these requirements through advice, model polices and protocols, and changes in policy made by regulators (www.bda.org).

 

3.4.1.6 Team training

Governance systems are there to protect patients but they also depend on the performance of the entire dental team to ensure services are consistently delivered in a safe and effective way. The GDC recognise the importance of teamwork and state that ‘the quality of teamwork is closely linked to the quality of care the team provides’. Clinical leadership is important to demonstrate that services are well-led and are delivered in a governance structure that has clear lines of responsibility and accountability within the practice to ensure everyone is aware of their own role in the team, and how they contribute to the overall quality of the service. Developing members of the dental team through regular appraisal, training and professional development is a key component in achieving this, along with regular team meetings and training to create a culture that promotes delivery of high practice standards at all times. Broadening the skill mix in the practice team can also assist in delivering oral care in a more efficient and resilient way.

 

All practices must operate robust and systematic recruitment procedures to ensure anyone employed in practice is of good character, has the correct work permissions and registrations, and is competent and indemnified to perform the role. The practice must ensure induction, regular training and continuing professional development is available for all staff, and a system is in place for identifying and managing poor performance within an overall supported environment.

 

The Investors in People award has set standards for people management and can be a useful process for practices to undertake.

 

3.4.1.7 Risk management and communication

Identifying and managing risks in dental practice is an increasingly complex area covering a diverse range of topics. Risk assessment is a systematic examination of work activities to identify what could go wrong and cause harm, and whether adequate controls are in place. The BDA recommend practices should risk assess the following areas:

  • A general practice risk assessment (e.g. premises, equipment, security, etc).
  • Specific assessment of hazardous substances (COSHH).
  • Employees and patients with disabilities.
  • Display screen equipment use.
  • Fire risks and evacuation procedures.
  • Manual handling and occupational health.
  • Risk affecting new and expectant mothers.
  • Radiation risks.
  • Risk for those undertaking work experience or visiting the practice.

There are specific risks associated with using personal information and practices must comply with Information Governance approved codes of conduct covering areas such as data protection, confidentiality of patient information, Caldicott principles, records management and information security procedures. The Information Commissioner’s Office (ICO) (www.ico.org.uk) requires organisations, including dental practices, to demonstrate implementation of good practice, compliance with the law and year-on-year improvement plans.

 

All practices must have in place effective safeguarding systems to protect adults and children from improper treatment and abuse. This is an important fundamental standard and one all dental professionals should understand and know how to act upon should they have concerns. The practice safeguarding policy should indicate how to refer a matter to the local authority safeguarding team and where to go for advice. Safeguarding information should be available to patients and members of the public so they know who in the practice is responsible should they wish to raise a concern. Specific advice for dental professionals is available from national guidelines, such as HM Government Working together to safeguard children (2015) and specialist societies such as the British Society of Paediatric Dentistry and the dental indemnity companies.

 

Person-centred care is essential to providing services which meet patients’ needs. Practices must demonstrate robust patient and public involvement to satisfy regulators that care is delivered in partnership with patients, and that they have opportunities to feed back on areas of concern or where service improvements can be made. Person-centred care includes the need for consent, and dental professionals should only provide care to a patient that has consented to it. The professional view of consent is shifting to incorporate the patient as a joint decision-maker with active involvement in deciding upon appropriate care and treatment options, taking into consideration all the relevant information. Gillick competence is the principle used to judge capacity in a child under 16 years of age. Where a person under the age of 16 is not Gillick competent and therefore deemed to lack the capacity to consent, it can be given on their behalf by someone with parental responsibility, or by the Court. Where a patient over the age of 16 lacks the capacity to consent, the Mental Capacity Act 2005 (MCA) must be taken into consideration. Treating all patients fairly, and with dignity and respect, is a key principle of the NHS Constitution in England and practices must not discriminate in the way they deliver care to any person with any of the nine protected characteristics described in the Equality Act 2010.

 

Feedback may also be received in the practice through patient complaints, and all practices must have an effective and accessible complaints process that provides patients with easy access to the policies which clearly describe how patients concerns and complaints are listened and responded to. Patients must be told the process (which may differ depending on whether the complaint relates to NHS or private care), the timescales for managing their complaint and how they will be kept informed. Patients must also be provided with information on where to refer their complaint to should they be dissatisfied with the outcome provided by the practice.

 

All regulators expect practices to demonstrate how they continuously monitor the quality of the services they provide and document what quality improvement plans are in place. Monitoring quality may come from a variety of sources, such as patient and public feedback, adopting an evidence-based approach to patient care and treatment, implementing national guidance or measuring compliance with practice protocols and policies. This is usually done through clinical aduit - ‘a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and standards which leads to implementation of change’. Clinical audit is a professional obligation and every dental professional should be involved in audit activity. It is good practice to involve the entire dental team so there is a systematic approach to improving standards across the practice. Audit is a useful tool in measuring performance in a structured way and sustaining improvement (including through re-audit) by continuously identifying where positive changes can be made to processes, and then shared as learning opportunities for the dental team.

 

3.5 Other standards and guidelines

A number of organisations produce standards and guidelines of relevance to dental professionals and primary dental care. These include National Institute of Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), the British Dental Association (BDA), Dental Faculties of the Royal Surgical Colleges, Medicine and Healthcare Products Regulatory Agency (MHRA), Dental Appliance Manufacturers Audit Scheme (DAMAS), and dental indemnity providers. Brief details of some of these are described in sections 3.5.1-3.5.6.

 

3.5.1 British Dental Association (BDA)

The BDA’s advice sheets cover a wide range of topics. They are regularly updated to reflect latest evidence or best practice and cover key areas such as patient care, compliance, monitoring quality, legal obligations and employment. BDA members can access all of the advice sheets from the BDA website (www.bda.org).
 

In addition to advice sheets, the BDA can also offer members additional guidance and resources for dental practitioners, such as policy templates, evidence summaries and advice in meeting regulatory standards.

 

3.5.2 Dental Faculties of the Royal Surgical Colleges

The Royal Colleges are charities dedicated to promoting excellence in surgery including dental surgery. They offer educational courses and examinations in dental specialities as well as producing policy documents and their own clinical guidelines. They act as advisory bodies to other organisations such as the Department of Health and GDC, and increasingly use their expertise to produce position papers to influence dental policy-making.

 

3.5.3 International Organization for Standardization (IOS)

The International Organization for Standardization (ISO) has developed a number of systems in administration and business practice providing an international quality standard. They include the ISO-9000 series. They do not assess clinical processes or outcomes. However, the series of standards are applicable to other aspects of structure and process in dental practice and have been attained by a number of dental practices. More information on ISO-9000 can be found at: www.iso.org.

 

3.5.4 Medicine and Healthcare Products Regulatory Agency (MHRA)

The MHRA is the UK-wide regulator for ensuring medicines and medical devices are fit for use and are safe. The MHRA is responsible for the regulation of medicines and medical devices and equipment used in healthcare and the investigation of harmful incidents. There are specific requirements for dental practices that manufacture dental appliances to register with the MHRA under the Medical Devices Directive 93/42/EC (MDD) providing the business address of the practice and a description of the devices provided. In addition a ‘Statement of Manufacture’ for each device should be offered to each patient and a copy of the statement retained for the lifetime of the product.

 

It is recommended that dental practices sign up to MHRA’s drug and device alerts using the following link: www.gov.uk/drug-device-alerts/email-signup to receive important public health messages and other critical safety information. If dental practitioners encounter adverse drug reactions, these can be reported via the ‘yellow card’ system, either online or using the paper copy in the BNF. More information on the MHRA can be found at: www.mhra.gov.uk.

 

3.5.5 Dental Appliance Manufacturers Audit Scheme (DAMAS)

DAMAS is a quality management system designed specifically for the manufacturers of custom-made dental appliances and based on the principles of ISO. DAMAS is an inspection and quality system within the dental laboratory industry that provides a framework for an effective quality management system which enables dental laboratories to prove to their clients that they are operating within legislation.

 

DAMAS provides laboratories with a set of processes that ensure a systematic approach to the management of the organisation. The system ensures consistency and improvement of working practices, which in turn should provide products and services that meet customer's requirements. More information can be found at: www.damas.co.uk.

 

3.5.6 Dental indemnity providers

It is a mandatory requirement that all dental registered professionals have arrangements for indemnity insurance in place for patients to be fully compensated when appropriate. In addition to providing personal guidance and legal defence to members in need, they also offer education and training resources to mitigate the risks of complaints or litigation in practice, and offer guidance on meeting regulatory standards such as NHS standards and dental regulators. There are a range of providers and more information is available from them.

 

3.6 Standards in research (research governance)

It is increasingly recognised that primary dental care offers a rich environment for clinical research that has greater focus on the needs of dental professionals, patients and the public. The mission of the Health Research Authority (HRA) is to provide a health research system in which the NHS supports research of the highest quality. It is universally acknowledged that all scientific research should meet internationally agreed standards.

 

The UK Policy Framework for Health and Social Care Research (2017)19 outlines principles of good governance that apply to all research undertaken in health and social care within the UK. The framework is designed to ensure the safety, dignity and rights of research participants and to provide safeguards to also protect the research team. Its standards cover five domains:

  • Ethics.
  • Science.
  • Information.
  • Health, safety and employment.
  • Finance and intellectual property.

All health and social care organisations participating in research are required to have local implementation plans in place to ensure that the appropriate research governance standards have been met. This includes ensuring ethical approval is obtained from an NHS Research Ethics Committee for research involving the NHS, its patients and NHS employees (or contractors). There are now co-ordinated systems in place for NHS Research and Development reviews across the UK, and the Health Research Agency is developing a common approach to research approval across the UK nations.

 

The FGDP(UK) is active in promoting research in general dental practice and has a number of resources available on its website (www.fgdp.org.uk/research). This includes details of academic collaborators who can support research in dental practice and research information leaflets to provide dental teams with local sources of advice and guidance on oral healthcare research.

 

3.7 References

1.            FGDP(UK). Faculty of General Dental Practice (UK). Available at: www.fgdp.org.uk.

2.            General Dental Council (GDC). Standards for the dental team. London: GDC; 2013.

3.            British Dental Association. BDA good practice. Available at: https://bda.org/goodpractice.

4.            DAMAS. Dental Appliance Manufacturers Audit Scheme. Available at: www.damas.co.uk.

5.            Care Quality Commission (CQC). The fundamental standards. Available at: www.cqc.org.uk/what-we-do/how-we-do-our-job/fundamental-standards.

6.            Healthcare Inspectorate Wales. Homepage. Available at: http://hiw.org.uk.

7.            Healthcare Improvement Scotland. Homepage. Available at: www.healthcareimprovementscotland.org.

8.            Regulation and Quality Improvement Authority. Homepage. Available at: www.rqia.org.uk.

9.            Health and Safety Executive. RIDDOR - Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013. Available at: www.hse.gov.uk/riddor.

10.          Department of Health. Report of the Mid Staffordshire NHS Foundation Trust. London: Department of Health; 2012.

11.          Primary Care Contracting. Primary care dental services clinical governance framework. Department of Health; 2006.

12.          Resuscitation Council (UK). Quality standards for cardiopulmonary resuscitation practice and training. Available at: www.resus.org.uk/quality-standards/primary-dental-care-quality-standards....

13.          Department of Health. Decontamination in primary care dental practices (HTM 01-05). London: Department of Health; 2013. Available at: www.gov.uk/government/publications/decontamination-in-primary-care-denta....

14.          Department of Health. Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV: New healthcare workers. London: Department of Health; 2007.

15.          Health and Safety Executive. Health and Safety (Sharp Instruments in Healthcare) Regulations (2013) Guidance for employers and employees. Available at: www.hse.gov.uk/healthservices/needlesticks/resources.htm.

16.          Health and Safety Executive. Legionella and legionnaires disease. Available at: www.hse.gov.uk/legionnaires.

17.          Faculty of General Dental Practice (UK). Clinical examination and record-keeping. London: FGDP(UK); 2016.

18.          Faculty of General Dental Practice. Selection criteria for dental radiography. London: FGDP(UK); 2018.

19.          Health Research Authority. Policy framework for health and social care research. London: Health Research Authority; 2017.

 

Copyright © FGDP(UK) 2019. This work is distributed under the terms of the Creative Commons Attribution NonCommerical 4.0 International licence (CC-BY-NC). Notification of use is appreciated via email to FGDP@fgdp.org.uk