NHS Focused Flashcards
What is the CQC?
The care quality commission is the regulator of health and adult social care in England. Their main role is to make sure that people are provided with safe services and encourage care services to improve. They register care providers, monitor and rate services and speak on issues in health and social care. The CQC assess many types of facilities such as hospitals, dental services and care homes, and is able to inspect and take action if things need to improve. The CQC has a vital role is ensuring that dental services comply with established guidelines and standards and that the public receive quality care.
What are AGPs?
AGP stands for aerosol generating procedure which is a common practice in dentistry. High speed equipment such as scalers produce dental aerosols which are made up of particles from the teeth and gums. This can then become air suspended in the clinical environment and can contain viruses and bacteria so can be harmful. If inhaled, they can reach the lungs causing coughs and throat infections. Since Covid 19 this has become an even bigger issue so dentists are required to wear personal protective equipment and have enhanced extraction for AGPs, to prevent the spread of the virus.
What is NICE?
the national institute for health and care excellence provide national guidance based on evidence to improve health and social care. They evaluate new health technologies for NHS use, considering clinical effectiveness and value for money and they also help practitioners deliver the best care. NICE has a big impact on dentistry as it provides specific guidelines for treatment, sets quality standards for dental care, offers guidance on public health initiatives eg dietary advice and ensures patients receive safe and effective treatment.
What is the GDC?
The general dental council regulates dental professionals in the uk. They register dental professionals and set standards for the dental team. Their main purpose is to protect patient safety and maintain public confidence in dental professions and it is illegal to practise dentistry until you have registered with the GDC. They also have 9 principles used to provide dentists with ethical guidance on how to treat patients.
What are the differences between NHS and private dentistry?
1) NHS dentistry is funded by the government, providing services at a lower cost to adults and free for children, elderly and those with exceptions. Treatment is typically guided by clinical need and is governed by national guidelines. Private dentistry is funded by patients themselves, allowing for a broader range of treatments and often more advanced procedures. Private clinics set their own prices.
2) NHS dentistry focuses more on essential treatments and preventative care. Some cosmetic treatments may not be available whereas private offers a range of treatments including cosmetic treatments.
3) NHS can have longer waiting times for appointments and treatments due to high demand and limited resources. Private typically has shorter waiting times and can accommodate urgent cases more quickly.
4) NHS has a more standardised approach when dealing with patients due to guidelines, budget constraints and the UDA system resulting in shorter appointment times but private tends to have a bit more flexibility and time allocated for each patient to make the overall experience more personalised.
What do you know about how the NHS charges for appointments?
For children and the elderly, nhs appointments are free. However for those who have to pay, treatments fit into 3 bands.
Band 1 treatments cost £26.80 which includes treatments like x-rays and marginal corrections .
Band 2 treatments cost £73.50 which includes treatments in band 1 and fillings, root canals, treating gum disease etc.
Band 3 costs £319.10 includes all band 1 and 2 treatments and other treatments such as bridges, crowns, dentures.
What is the role of a dental hygienist?
Dental hygienists help patients maintain their oral health by preventing and treating periodontal disease and promoting good oral health practice. They will show the patient good practices to keep the teeth and gums healthy at home. Hygienists focus on cleaning, scaling and polishing the teeth whereas dentists have a broader range of skills to treat and restore the gums and teeth.
What challenges does dentistry face within the NHS today?
1) The NHS has limited funding which affects the quality of the dental services available. Budget cuts can lead to reduced staff, limited resources and therefore fewer patients can be treated at a time. This means there are longer waiting lists for patients and adults struggle to get put onto the nhs system. Also patients may feel less satisfied with their appointments as dentists try to shorten treatment plans in order to gain greater value of UDAs, so the overall patient experience is worsened. NHS dentists are also under greater stress to hit their UDA targets so the mental health of NHS dentists is also worsening.
2) some underserved areas also may particularly struggle to find an NHS dentist leading to delayed treatment and worsening of oral health outcomes. Especially due to nhs staff shortages and dentists moving to the private sector due to the UDA system, this means that the underserved community have less access to nhs dentists. Those from wealthier backgrounds are less concerned by this issue as they can afford private treatments and resources such as fluoride toothpastes etc but those from poorer backgrounds don’t have access to these and therefore are more greatly affected by this issue causing a widening gap between those from different socioeconomic backgrounds.
3) due to the ageing populations, there is a growing demand for dental services. This alongside diet has caused an increase in the number of dental caries and emergency appointments that have to be booked. Yes these issues are trying to be reduced by using water fluoridation and sugar tax however, they are still a prominent problem. This demand puts extra pressure on the NHS and its resources. Patients are also becoming increasingly aware of cosmetic options due to increasing social media use and widening beauty standards so people are focusing on whiter and straighter teeth ,and therefore they may expect more from dental care which can create a gap between what is available through the nhs and what they desire.
4) the challenges facing the nhs affect both practitioners and patients so it is important to find solutions such as advocating for preventative care and working with other healthcare professionals to improve patient outcomes.
What is the sugar tax?
The sugar tax was introduced in 2018 with the aim to reduce the levels of obesity in the UK and to promote healthier dietary choices.
Drinks with more than 8g of sugar per 100ml would get taxed 24p. The revenue made from initiative was then put into programs aimed at promoting physical activity and healthy eating.
This would in turn reduce obesity levels, reduces the number of caries and reduce the number of sugar related diseases such as diabetes. However there are disadvantages as it affects jobs in the beverage industry and there are disparities between different socioeconomic backgrounds. People also feel that this puts the uk in a “nanny state” which refers to the government being too controlling in people’s personal lifestyle and choices. It is difficult to get informed consent off of everyone so some people have gone against it.
What is the traffic light system?
It is a clinical pathway that is aimed to focus more on preventative care for patients. The practitioner gives the patient an initial oral health assessment and then gives them a red, Amber or green rating, which informs them of their personalised prevention plan. Red= patient requires oral health intervention and needs to take more care of dental health. Amber= dental health could benefit from treatment, so patient is encouraged to enquire about different treatment options. Green= dental health is good and patient should keep doing what they’re doing. The ratings risks are discussed with the patient such as gum disease and is given a recall appointment depending in the severity of the rating.
What are the NHS values?
1) the first value is working together for patients. Members of the dental team work together demonstrating good teamwork skills to ensure the highest standard of dental care.
2) another value is respect and dignity. The NHS value every member of the team and recognise that each person has an important role. They also value patients and seek to understand their abilities and limits.
3) another value is commitment to quality of care. The NHS encourage feedback from patients, families, caters and staff in order to improve the care they provide. Dentists earn trust by consistently delivering high standard of care.
4) other values they have are compassion. This mainly involves being kind and understanding each person’s stress and anxiety.
5) the 5th value is improving lives which involves striving to improve health and well-being of patients
6) the last value is that everyone counts in order to maximise patient experience and treatment and every member of the team feels included. You have to make sure nobody is discriminated against or left out.
What do you think about patient’s access to care within the NHS system?
Equitable access is cruicial to ensure that all patients receive the dental care they need. Many patient when booking appointments with the NHS have long waiting times or even don’t have nhs clinics nearby which can delay treatment and worsen oral health. Also, many nhs practices are no longer taking new patients partially due to a backlog from Covid 19 but also due to the money dentists receive from the NHS is not enough to cover the service they provide. However there are some new initiatives being discussed to make NHS clinics more accessible to all. For example, nhs dentists will be given a “new patient” payment between 15-50 pounds to treat patients who have not seen a dentist in 2 years or longer. There is also the idea that underserved areas will have improved access through the use of dental vans. This is essential in allowing eveyone to have access to an NHS dentist and being able to maintain oral health. They also have said that dentists that open up pratices in areas with poor access to NHS care will be offered a £20,000 bonus to allow for more treatment to underserved areas.
What are some benefits of nhs services and what are some drawbacks?
Benefits- one of the primary benefits of NHS dental services is that it is more affordable than private treatments. This means that people from varying socioeconomic backgrounds can afford the dentist.
Another benefit is that the NHS offer a wide range of treatments including preventative and restorative treatments. This ensures patients receive holistic care for their dental needs. Another benefit is that NHS dental services are held to high standards ensuring that patients receive quality treatment. NHS values ensures each patient is prioritised and they have a safe treatment.
Drawbacks- one drawback is the long waiting times especially for non-urgent appointments. Patinets can have delays affecting their oral health. The NHS has budget limitations which can lead to reduced services at certain NHS dental practices impacting patient access. Some people perceive NHS dental services as being lower quality compared to private care, which can deter them from getting treatment. This perception can be caused by many things such as the amount of time allocated per patient or the environment of the practice.
How do dentists promote public health and prevent diseases?
1) one way dentists promote public health is by educating patients about oral hygiene. This includes teaching proper brushing and flossing techniques, the importance of regular check ups and the impact of diet.
2) dentists also provide preventative services such as regular fluoride treatments which can help reduce the risk of caries. This allows the patient to maintain better oral health and avoid more complex procedures later on. Dentists also conduct screenings such as X-rays to identify issues early.
3) many dentists also take part in community programmes such as educational workshops to provide dental care and education to underserved populations helping to improve access to oral health services and reduce disparities. They also advocate for public health policies such as supporting initiatives for water fluoridation and nutrition education.
What are the most common dental conditions treated under the NHS ?
One of the most prevalent dental issues are cavities. NHS dentists provide treatment such as fillings to restore affected teeth and prevent further decay. Gum disease is also a common condition in which scaling and root planing is offered. A common treatment especially in teenegaers is orthodontic treatments such as braces who meet the criteria. This helps promote dental alignment and overall oral health. Many patinets experience tooth aches and sensitivity which can be caused for various reasons eg enamel erosion. Dentists can diagnose the underlying cause and recommend appropriate treatments to alleviate pain. The NHS also places importance on early detection of oral cancer. Dentists conduct screenings to catch cancer early and educate patients about risk factors so they are educated.
Why are nhs dentists leaving to go private?
One of the main reasons dentists are pulling out of nhs dentistry and moving to private is due the UDA system. Dentists are paid for each unit of dental activity regardless of whether the treatment is straightforward or a series of complicated treatments. This means that a dentist that does 3 fillings on one person will be paid the same as a dentist who only does one filling on one person. This does not increase access to new patients and makes dentists want to chase a target rather than a sustainable model where you can focus on prevention and care of the patient. This not only leads to NHS Dentist appointments being much shorter and the overall patient experience being rushed but also put extra stress on nhs dentists. Private tends to offer greater money and the dentist can spend a greater amount of time on each patient and provide greater patient care which is one of the main goals as a dentist.
How has brexit affected uk dentistry?
The number of EU-trained dentists registering in the UK has halved since brexit. EU trained dentists used to make up a quarter of the workforce. This has reduced the number of nhs dentists available for appointments and has caused a lot of backlog.
Also due to brexit, more dental material that are imported such as amalgams are being tariffed so overall it ends up costing the provider more money. This means that prices for these treatments have risen and will continue to rise. People in the uk who are wealthier, tend not to focus on the nhs dental crisis as they have the opportunity to go private however Many underserved communities cannot already afford these treatments or have access to them in the first place widening the gap between wealth inequality.
Do you think that all dentists should be obliged to work in the NHS?
Working in an nhs practice greatly exposes newly qualified dentists to a diverse range of patients with varying clinical needs. This experience is invaluable for developing essential skills such as problem solving and efficiency. NHS dentists often work under high pressure and time constrained conditions which helps them refine their clinical abilities and become more adept to managing complex cases. Additionally, the diversity of patients often from different socio-economic backgrounds provides wide exposure to many dental conditions which may be limited in a private practice where the focus is more shifted to cosmetic procedures. NHS practice also allows dentists to build clinical confidence before specialising. Dentists have the opportunity to perform a broad range of treatments giving them a solid foundation before deciding where to specialise.
However one of the 4 pillars of medical ethics is autonomy and even though this mainly applies to patients, some may argue that forcing dentists to work in the nhs would infringe on their own professional autonomy. Such a requirement can lead to worse mental health and burn out ultimately reducing career fulfilment. Additionally, NHS practices offer fewer treatment options compared to private practices limiting the range of procedures dentists can perform and offer to their patients. This may hinder growth for those who want to specialise in cosmetic procedures as this is more common in private practices.
How has Covid 19 impacted dentistry?
Covid-19 has impacted the field of dentistry in many ways. Patients have arguably been affected the most as they hadnt had access to dental care. This means that some patients who had been reluctant to visit the dentist prior to the pandemic may now feel grateful for the chance to receive care again, so in some cases it has led to a positive change and patients being more proactive when it comes to their dental care. Teledentistry has also become more prominent as it allows patients to consult with dentists virtually which helps maintain patient care while reducing in person visits. Dentists have also adopted stricter infection control guidelines including enhanced sterilisation procedures, the use of personal protective equipment and air filtration systems to reduce airborne pathogens, which was thought to be a major area of concern during the pandemic due to contamination of mucous membranes and saliva.
However there have been many downsides to Covid 19. Many procedures and appointments were postponed leading to a backlog of patients needing care so there are longer wait times and it has become more difficult for adults to become registered under an nhs dentist, especially in underserved communities. The pandemic also affected the mental health of dentists due to increased stress levels with changes in pratice, financial uncertainty with the decrease in the number of patients and concerns for personal and patient safety. Many surveys have been conducted post pandemic and have found only 21% of practices returned to pre Covid 19 capacity demonstrating the vast impact the pandemic had on the field of dentistry.
Do you think all NHS appointments should be free?
In England, nhs appointments are only free for a select few including under 18 year olds and those receiving low income benefits. It’s well known that there is an oral health crisis with many patients going to A&E for dental problems.
Making dental treatment free could reduce this number meaning A&E departments would have more time and resources to devote to other cases. Even in non-emergency cases, free dental treatment would hopefully encourage individuals to attend routine check-ups which are crucial to spot dental health problems earlier on and treat them quickly which ultimately saves money as it avoids have complex treatments later on.
However, there are disadvantages to free NHS appointments. Firstly, the NHS is already underfunded by the government and so with no money coming in from the patients either, many NHS practices would not be able to keep running due to a lack of resources and staff. There could also be many other reasons people don’t attend their dentist appointments for example they don’t like near a nhs dental clinic or that have had negative experiences with the dentists in their past, so free dental appointments would not address the underlying causes of the oral health crisis. This is why I believe that dental treatment should not be made free on the NHS. I feel the problem would be better addressed through a public health campaign which could help tack issues with health inequalities and try to improve access to dental care in all areas, which would not only have a bigger impact in my opinion but also be cheaper to run.
What are some barriers to oral health?
1) access to dental care. Many dental deserts so not accessible to many people. Covid has also caused backlog and longer waiting times so difficult for adults to even be put on nhs register delaying treatment. UDA system more people moving to private.
2)we live in a multicultural country so we have people from all different backgrounds visiting the dentist. This means that the dentist is likely to encounter language barriers. Difficult to obtain valid consent. Translator could translate wrong and can lead to patient feeling embarrassed and could act as deterrent to them visiting the dentist so important to be non judgmental. Also different cultures have different beliefs for example certain religious individuals may request a female dentist only and this is becoming increasingly difficult with the long waiting times . certain backgrounds may believe in herbal medicines over what the dentist may give. It’s important to come up with alternative solutions so that individuals get proper treatment while their beliefs are respected.
3) there is also a lack of education and awareness about the importance of oral health and regular dental appointments. This means individuals do not understand how oral health can affect overall health and lead ti them thinking that dental appointments are not necessary. People may also be uneducated on how lifestyle choices like diet and smoking can affect their oral health as these are a leading cause for tooth decay in the country. Important to employ public health camp gains and workshops to educate youth.
4) Fear of the dentist is also a common reason for why people avoid the dentist. This may be due to things like fear of needles or previous negative experiences with dentists. It’s difficult to tackle issues like this as well because there is no one educating individuals on the importance of dental checkups and how the as a dentist’s primary role is to prioritise the well being of a patient.
What are the 9 GDC principles?
1) putting patients interests first.
2) communicate effectively with patients
3) obtain valid consent
4) have a clear and effective complaints procedure
5) work with colleagues in a way that is in patient’s best interests
6) maintain, develop and work within your professional knowledge and skills
7) maintain and protect patients’ information
8) raise concerns if patients are at risk
9) make sure your personal behaviour maintains patient’s confidence in you and the dental profession.
