governance Flashcards
describe the CQC and what they do (4)
- independent regulator of health and social care in England
- monitor, inspect and regulate services - ensures minimum quality standards, safety outcomes
- reports and publishes findings
- concerned with premises, management, organisation policies, procedures, protocols, documents
describe the GDC and what they do (2)
- UK statutory regulator of all members of the dental team
- protects patients and regulates the dental team against published standards
describe the Dentists Act 1984 (6)
legislative framework for DCPs which gives the GDC powers to:
– grant registration only to those who meet requirements
– set standards for UK dental education and training providers
– set standards of conduct, performance and ethics for dental team
– investigate complaints against DCPs and take action where appropriate
– require DCPs to keep skills up to date (CPD)
what main 5 things does the CQC look at when they assess a practice/service?
- patient-centred care - effectiveness, communication, CPD
- consent - autonomy, informed
- pt safety - premises and infection control
- complaints system and response
- leadership, management, governance
what kinds of things regarding patient safety may be assessed by the CQC? (5)
- policies - safeguarding, raising concerns, underperforming
- decontamination (HTM 01-05)
- drugs within date (medical emergency, daily materials)
- registration of staff and working within competence, DBS checked
- clinical waste separation and collection
what kinds of things regarding leadership/management/governance may be assessed by the CQC? (5)
- specifically appointed leads (safeguarding, radiography, etc)
- fulfilling duty of candour
- being open and transparent (interview the newest team members)
- regular team meetings and audit
- updated policies to ensure safe practice
give a brief history on how NHS dentistry used to function and why that is no longer the case (5)
- established in 1948 with dental tx free at point of use
- fees introduced in 1952 due to high cost for providing care
- fee per item, any dentist able to provide NHS care if they wanted
- but concerns over drill and fill attitude and overtreatment, high costs for government
- now there is a set budget for NHS dentistry
describe how practices and associate dentists are commissioned by the NHS (5)
- a practice holds a contract with the Area Team to perform NHS PDC (certain number of dentists per town)
- target for amount of work per year and how much the practice will get paid for this = based on local treatment need, paid per month
- must achieve within 4% of goal otherwise reduced target next year
- 2% overperformance = clawback
- associate dentists agree with practice owner what % of the UDA value they receive
what are the UDA values of each band and what treatments are included? how much is the patient charged?
1 (1 UDA): £25.80
- examination, radiographs, prevention and PMPR (if clinically needed)
2a (3 UDA): £70.70
- fillings/extractions of 1-2 teeth
2b (5 UDA): £70.70
- non-molar endo (permanent teeth)
- fillings/extractions of ≥3 teeth
2c (7 UDA): £70.70
- molar endo (permanent teeth)
3 (12 UDA): £306.80
- crowns, dentures, bridges (lab work)
emergency (1.2 UDA): £25.80
- urgent assessment and specified urgent tx (pain relief, temporary filling, appliance repair)
who is exempt from paying NHS dental fees? (6)
- <18yo
- 18yo and in full time education
- pregnant or gave birth within last 12 months
- receiving low income benefits
- <20yo and a dependant on someone receiving low income benefits
- tx in NHS hospital by hospital dentist (but pay for dentures or bridges)
limitations of the old UDA model (up to 10)
financial:
- low remuneration for complex work
- unfair for patients with lower risk (same cost)
- FTAs = no money to dentist and no penalty to pt
unrealistic:
- bandings too simplified
- capacity issues (unable to reach targets)
pt-centred care:
- may encourage supervised neglect
- prevention is not rewarded
- target-driven
- limited referral pathways
- doesn’t allow for team-based approach
benefits of the old UDA system (3)
- provides access to relatively good quality care for many pts who would not otherwise be able to afford it
- stable source of regular income
- good pension scheme for NHS dentists (under review) and income protection if sick
what is included on the FP17 form? (5)
- provider
- pt details
- patient charge collected or if exempt
- number of UDAs performed
- treatment banding information
give all 9 GDC standards in order
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 work with colleagues in a way that is in patients’ best interests
7 maintain, develop and work within our professional knowledge and skills
8 raise concerns if patients are at risk
9 make sure our personal behaviour maintains confidence in us and the dental profession
what is GDC standard 1?
put patients’ interests first
what is GDC standard 2?
communicate effectively with patients
what is GDC standard 3?
obtain valid consent
what is GDC standard 4?
maintain and protect patients’ information
what is GDC standard 5?
have a clear and effective complaints procedure
what is GDC standard 6?
work with colleagues in a way that is in patients’ best interests
what is GDC standard 7?
maintain, develop and work within our professional knowledge and skills
what is GDC standard 8?
raise concerns if patients are at risk
what is GDC standard 9?
make sure our personal behaviour maintains confidence in us and the dental profession
define informed consent
- voluntary and continuing permission of the patient to receive a particular treatment
- based on adequate knowledge of the purpose, nature and likely effects and risks of that treatment, including its success and any alternatives
what are the 4 main components of informed consent?
- information
- autonomy
- capacity
- decision
(also time and respect)
what may be included in the information component of informed consent? (6)
- all treatment options with pros and cons and what they involve
- other options that you cannot provide yourself
- costs
- diagnosis and prognosis
- preventive measures for the future
- pre and post-operative instructions if appropriate
what does the autonomy component of informed consent mean?
- any decisions are taken freely, voluntarily and without coercion
(a reasonable choice to one person may not be reasonable to others)
what does the capacity component of informed consent mean and what factors influence this? (6)
- ability to make sound decisions and understand and process information given
- affected by:
– mental health/illness
– age
– consciousness
– complexity of decision
what is involved in the decision component of informed consent? (2)
- the patient must make a clear decision otherwise there is no valid consent
- this must be clearly documented, especially if the patient has not consented to the entire course of treatment
what is a material risk? (2)
- a risk that a reasonable person, if warned, would attach significance to
- a risk that a clinician, if aware of, would be likely to attach significance to
what kinds of situations would have potential barriers to shared decision making? (3)
- language barriers
- adults without capacity
- emergency situations and time pressure
at what age can patients consent to treatment and under which Act?
- from 16yo (considered to be adults at 18yo) - under the Family Law Reform Act 1969
(parent cannot revoke consent at this point)
factors to consider when assessing if a child is Gillick competent (5)
(<16yo)
- child’s age, maturity and mental capacity
- their understanding of the issue and what it involves and impact of their decision (pros, cons, long-term effects)
- how well they understand any advice or information given
- their understanding of any alternative options (if available)
- their ability to explain a rationale around their reasoning/decision
when can a Gillick-competent child’s decision be overruled?
if they refuse treatment which may lead to death or severe permanent harm
what is the Mental Capacity Act 2005? (3)
- law protecting and empowering vulnerable adults >16yo who cannot make all/some of their decisions
- outlines who can make decisions and in which situations and how they should go about this
- enables planning for a time when a pt may lose their capacity
explain the five key principles for mental capacity
1 presumption of capacity in all unless proven otherwise
2 support - one must be given all practicable help before anyone treats them as being unable to make their own decisions
3 “unwise” decisions - different values, beliefs and preferences
4 best interests - anything done for/on behalf of a person lacking capacity should be done in their best interests
5 less restrictive option - those making a decision for the one lacking capacity must consider options that interfere less with the person’s rights and freedoms of action (or if there is a need to decide/act at all)
how is mental capacity assessed? when might someone be deemed to lack capacity?
(the more serious the decision, the more formal the assessment)
1 is the person able to make the decision (with support if required)?
2 if they cannot, is there an impairment/disturbance in the functioning of their mind/brain?
3 is the person’s inability to make this decision due to the impairment/disturbance?
deemed unable to make the decision if they are unable to:
- understand information given to them
- retain information long enough to make the decision
- weigh up the information
- communicate their decision
what are the patient expectations relating to GDC standard 4? (4)
(maintain and protect patients’ information)
- records should be up to date, complete, clear, accurate, legible
- personal details kept confidential
- pts should be able to access their dental records
- records stored securely
describe the General Data Protection Regulation 2018 (3)
- legal framework defining what personal data is and how we must treat that information
- only keep data that is necessary and relevant and store this securely
- Information Commissioner’s Office must be informed if there has been a breach
why is it important to keep accurate pt notes/records? (4)
- ensuring continuity of care (between clinicians, yourself)
- legal - record discussions, consent, defence for complaints and litigation
- fulfilling regulatory requirements (NHS, GDC, CQC)
- support clinical audit and quality assurance
what should be included in pt records? (12)
- date
- operator
- up to date pt ID data
- relevant discussions, any consent given, decisions made
- contemporaneous record of clinical work (procedure, difficulties)
- MH
- any investigations
- treatment plans, price estimates
- appointment history (inc any FTAs)
- correspondence
- lab tickets
- exit notes (esp if any outstanding tx)
what should not be included in good clinical note taking? (4)
- excessive information with repetition
- uncommon acronyms
- financial details
- complaints details (bias)
what does the NHS require with regards to record keeping? (4)
- make notes on ANY treatment provided
- private treatment should be clearly stated with pt’s choice and price estimate
- pts who are exempt with evidence
- signed treatment plan
what does the CQC require with regards to record keeping? (2)
- the CQC registered person should ensure service users are protected against risks of unsafe/inappropriate care and treatment from lack of proper information about them
- records kept securely, retained for an appropriate period and securely destroyed when appropriate
what are some advantages of digital records over paper records? (3)
- faster to create, can use proforma to assist record keeping
- less physical room needed and will not physically deteriorate
- easier to transfer between clinicians and easier to read
what does “contemporaneous notes” mean?
created during the treatment or immediately afterwards
what needs to be included in the patient records regarding radiographs? (6)
- date
- exposure settings
- who prescribed and who performed the radiograph
- radiographic report
- diagnostic acceptability/grade
- justification
why are we using photographs increasingly in general practice? (5)
- record keeping
- communication - eg shade/shape to lab, with patient to show possible outcomes
- social media and advertisement
- case presentations, proof of work done
- evidence of pathology
what rights do patients have regarding their dental records? (4)
- right to access
- right to ask for factual inaccuracies to be rectified or deleted
- do not have the right to correct a clinical opinion that they do not agree with
- written consent is needed if the pt requests disclosure of their notes to a third party
how quickly must disclosures be made after a patient has requested?
without undue delay, within 40 days but the sooner the better
how much can be charged for sharing patient dental records? (3)
- depends on circumstances (unlikely to charge if dealing with a complaint)
- up to £10 for administration as long as the patient hasn’t been seen for 40 days
- up to £50 for copying handwritten notes
to whom can a dentist disclose a patient’s records apart from the patient? (4)
- third party with patient’s written consent
- police, court
- Inland Revenue
- disclosure under GDC regulations, or NHS regulations
(contact indemnity if any doubt)
what is the maximum period for which any records should be retained?
30 years
how long do UK patients have to register a complaint about their care or treatment?
3 years after becoming aware of an issue (often given longer)
what is the NHS Code of Practice minimum retention period for patient records?
- 11 years for adults
- 11 years for children or their 25th birthday (whichever is longer)
what are the patient expectations relating to GDC standard 8? (2)
(raise concerns if patients are at risk)
- act promptly to protect their safety if there are concerns about the health, performance or behaviour of a DCP or the environment where treatment is provided
- raise concerns about welfare or vulnerable patients
why might you contact Public Concern at Work?
if you are unsure about whether or not to raise a concern, or you would like advice
(may also consult defence union)
how can you raise a concern in practice? (2)
- via practice manager
- check practice reporting policy
(if uncomfortable then may contact indemnity organisation)
what is the appropriate sequence for escalating concerns in a practice as a FD?
1 practice manager, educational supervisor, senior colleague (in house)
2 local dental committee
3 NHS area team
4 GDC (regarding colleagues) or CQC (regarding pt safety)
how is “safeguarding” defined by the Care Act 2014?
“protecting an adult’s right to live in safety and free from abuse and neglect”
define “abuse”
“treating someone with cruelty or violence, especially regularly or repeatedly”
define “harm”
“physical or emotional injury which is deliberately inflicted”
define “neglect”
“ongoing failure to meet a person’s basic needs, such as warmth, food, clothing and shelter”
define a “vulnerable adult”
“a person over the age of 18 who may not be able to look after themselves, or unable to protect themselves from harm or exploitation”
what are the 6 principles of adult safeguarding?
- empowerment (person-led decisions, informed consent)
- prevention (take action before harm occurs)
- proportionality (least intrusive response appropriate to risk presented)
- protection (support and representation for those in greatest need)
- partnership (local solutions, working with communities)
- accountability (transparency in delivering safeguarding)
list the different types of abuse, harm and neglect (13)
- physical
- sexual
- psychological
- neglect and acts of omission
- exploitation and human trafficking
- financial or material
- discriminatory
- organisational or institutional
- radicalisation
- domestic
- female genital mutilation
- modern slavery
- self-neglect
what action might you take if you have a safeguarding concern in different situations? (5)
(priority is to protect individual at risk)
- always listen to pt and speak to safeguarding lead/trusted colleague
- immediate danger or serious crime has been committed –> police (999 or 101), ideally with consent
- potential for involvement of children or unborn baby –> safeguarding children referral
- other individuals at risk –> public interest disclosure permits safeguarding adults referral without consent
- always make thorough notes of conversations and any action taken
what is the most important thing to remember when handling any safeguarding issue?
you do not have to and should not manage it alone
do you need parental consent before sharing information with other agencies with regards to safeguarding?
no (but ideally you would get consent)
what is involved with GDC standard 5? (3)
(have a clear and effective complaints procedure)
- ensure there is an effective complaints procedure readily available and follow it
- respect pt’s right to complain - acknowledge, listen
- give prompt and constructive responses to any complaints
describe the difference between “simple” and “complex” treatments
- simple = clearly defined outcome, easily achievable, no adverse outcomes expected
- complex = may have several potential outcomes, path may change during treatment
define “commission”, “omission” and “duty of candour” in the context of complaints
- commission = action of committing a crime or offence
- omission = failing to fulfil a moral or legal obligation or leaving out information
- duty of candour = professional responsibility of HCPs to be open and honest with pts when something goes wrong with their treatment or care
how can duty of candour be applied when something goes wrong during treatment? (4)
- tell the patient or advocate when something goes wrong
- apologise to pt
- offer an appropriate remedy or support to put matters right if applicable/possible
- explain fully the short and long-term effects of what has happened
give some characteristics of practitioners with low claims experience (5)
- spending slightly longer with each patient at each visit
- patient has better knowledge of what was happening and why
- active listening skills
- warm friendly atmosphere
- humorous warm personality
give some general complaints handling standards (4)
- agreed written procedure for handling complaints in a practice, often with complaints officer
- standards of response should be set and monitored with audit
- every complaint should be logged
- desirable to tell patients these standards and procedures (leaflets, posters, etc)
describe how a complaint made via telephone would be handled (4)
- ideally same day response by complaints coordinator via practice telephone only
- give options for resolution/discussion = CC calls back at a certain time, in person meeting
- send written confirmation of complaint
- keep pt informed throughout, and give realistic time frames for responses
describe how a complaint made in writing would be handled (4)
- acknowledge any letter by return, enclosing a copy of the written complaints procedure (often by email)
- contact patient by telephone soon afterwards ideally
- give options for resolution/discussion = CC calls back at a certain time, in person meeting
- keep pt informed throughout, and give realistic time frames for responses
describe how a complaint made in person would be handled (4)
- initial response from first-contacted member of staff supported by complaints coordinator (also check you have correct pt contact info)
- contact pt within 48 hours if possible by phone or email
- give options for resolution/discussion = CC calls back at a certain time, in person meeting
- keep pt informed throughout, and give realistic time frames for responses
what is the REACH acronym for successfully responding to complaints?
- Recognition = everyone has the right to complain, even if you don’t think it’s valid
- Empathy = conducive to conversation, saying sorry
- Action = follow through on plans
- Compensation = financial, retreatment, refunds usually the best option
- Honesty = admit if you are in the wrong, do not forge/alter records
what is the GDC guidance for DCPs regarding complaints? (4)
- give pt a copy of complaints procedure when you acknowledge their complaint (inc timescales and stages involved)
- inform dental defence union
- send acknowledgement within 3 working days of receiving complaint (inform pt if you need time to investigate and timescale)
- respond no more than 10 working days after receiving complaint
what is the appropriate sequence for escalating complaints as a FD?
1 you and the patient
2 educational supervisor, complaints manager
3 NHS Ombudsman, Dental Complaints Service (private)
what is an ombudsman? (2)
- a person who has been appointed to look into complaints about companies and organisations
- independent, free and impartial
define “audit”
a way of improving quality of patient care, by looking at what we are doing and seeing if it can be done better
why bother doing audits? (2)
- looks at elements of practice rationally and objectively
- cyclic - ensures positive changes are embedded into practice (improving pt care)
describe the stages of an audit (5)
- topic selection - guidelines, significant events, etc
- pilot - ensures process works well
- first cycle and analysis - to measure current performance (may be retrospective)
- second cycle - measures performance following changes or to ensure standards are still being met
- audit report with method and discussion
(re-audit as needed)
what is involved in enhanced CPD for dentists (3)
- registrant reflects and creates a personal development plan with targets
- CPD undertaken is guided by PDP
- 100 hours of verifiable CPD over a five year cycle
what are the 4 parts of the activity and reflective log?
1 review (current position and learning needs for future)
2 prepare for action (what needs to be done to meet learning needs)
3 action (undertaking a range of learning activities)
4 outcomes (show how and what you have learned benefits you and others)
list the 4 GDC Indicative Outcomes in brief
1 effective communication
2 effective management and constructive leadership
3 maintenance and development of knowledge and skills within your field of practice
4 maintenance of skills, behaviours and attitudes which maintain pt confidence in you and the profession
how does social media fit into GDC standards?
4 maintain and protect pts’ information
- do not post any information/comments about pts on social networking or blogging sites
- no identifiable information without explicit consent
- maintain appropriate boundaries with patients
9 make sure our personal behaviour maintains confidence in us and the dental profession
- do not publish anything affecting confidence in you or profession unless part of raising a concern
what is clinical governance and what does it encompass?
- “a framework through which NHS organisations are accountable for continuous improvement of the quality of their services and safeguarding high standards, by creating an environment in which excellence in clinical care can flourish”, PIRATES:
- Patient and public involvement
- Information and IT
- Risk management
- Audits and peer review
- Training and education
- Effectiveness (clinical)
- Staff management
what are the 8 Caldicott principles
(relating to confidential information)
1 justify purpose(s) for use
2 use only when it is necessary
3 use the minimum necessary confidential information
4 access should be on a strict need-to-know basis
5 everyone with access should be aware of their responsibilities
6 comply with the law
7 the duty to share information for individual care is as important as the duty to protect patient confidentiality
8 inform patients and services users about how their confidential information is used and what choice they have
