The Care Quality Commissioner (CQC) have inspected a number of dental practices over the years. During these inspections they have collated some examples of notable practice, which they are sharing in order to allow other dental providers to improve and learn from them.
Examples of the notable practice, are presented under the CQC’s five key line of enquiry questions: Is it safe? Is it effective? Is it caring? Is it responsive? Is it well led?
This article will look at the CQC’s notable practice for is it effective? And look at other areas which the CQC have reported on, under this section, from previous inspections.
Is it effective?
The CQC will look at the following areas under the effective category:
- Assessing needs and delivering evidence-based treatment.
- Monitoring outcomes and comparing with similar services.
- Staff skills and knowledge.
- How staff, teams and services work together.
- Supporting people to live healthier lives.
- Consent to care and treatment.
The first three aspects of is it effective have been discussed in the previous article part 1.
How staff, teams and services work together
Team work we all know is vital to running a practice but there are so many demonstrable areas to show your compliance with this both with practice staff and colleagues outside the practice. Below are a few examples:
- Staff worked proactively with health professionals, for example, to improve the outcome for patients with long-term conditions such as diabetes, by providing oral health education and encouraging regular attendance at dental appointments. Staff also aimed to improve referral pathways to GPs to screen for diabetes for patients whose oral health was of concern. This is seen as notable practice by the CQC because of their commitment to working alongside other health care professionals to improve diabetes care.
- Other areas seen by the CQC has been when a hygienists had set up a referral pathway with the practice’s implantologist and implemented a pre-treatment planning assessment with the aim of improving patients’ oral hygiene prior to the assessment of the patient for placement of implants to try to avoid future problems with implants and to improve the outcome for the patient.
- Other practices have organised a variety of cost-free educational opportunities for their own staff and those from local practices, every two months with a strong emphasis on sharing of clinical expertise and knowledge, best practice and peer review to improve patient outcomes. The events counted towards dental professional’s continuing professional development and took a variety of formats, including workshops, lectures and hands-on. Attendees were encouraged to bring their own cases to discuss. The educational events related either to a specific area of dentistry, for example periodontal, (gum), disease, or to a specific group, for example, hygienists. Peer review meetings were organised by the practice every two months specifically for local hygienists and therapists to attend.
- Another practice demonstrated compliance in this area by utilising the services of a business skills coach to provide training for all staff in each role specific group, for example coaching for receptionists in customer care, every two months to improve all aspects of service delivery for patients. Several staff were members of their own professional associations and some had leadership roles in these. Staff told us this helped them keep up to date with the latest developments and best practice and they shared learning from this with the practice. The practice manager was currently the vice president of a practice managers' association and in this role intended to improve practice management in dental practices. Several staff had won industry awards, for example UK hygienist of the year 2015, and UK practice manager of the year 2015 etc.
Supporting people to live healthier lives
Promoting oral heath, recording campaigns and sessions are various ways in which other practices have previously shown compliance in this area. Here are a few of these examples:
- Staff have previously told the CQC that they promote and take part in national oral health initiatives, for example, mouth cancer action month and information about initiatives has been displayed in the practices and contained in their practice newsletters.
- Practices have held ‘Children’s days’ in every school holiday aimed at encouraging children to attend regularly for dental care and to improve the patients’ experience and health outcomes. The ‘days’ were open to existing patients of the practice and new patients. Staff dressed up and decorated the practice. Examinations and assessments were carried out and there was a strong emphasis on promoting good oral health and diet, and talking to the children and their parents. The practice aimed to provide a positive experience for children and build their confidence. Children received oral health education and instruction and visual displays were produced with information on, for example, sugary and fizzy drinks. Patients commented on CQC’s comment cards that the practice was extremely good with children and that the children’s days had a great fun atmosphere.
- Other practices adhere closely to guidance issued in the Department of Health publication Delivering better oral health: an evidence-based toolkit for prevention when providing preventive oral health care and advice to patients. This is used by dental teams for the prevention of dental disease in primary and secondary care settings. Tailored preventive dental advice and information was given to the patients, by practices, in order to improve health outcomes for them. This included dietary advice and advice on general dental hygiene procedures. Where appropriate fluoride treatments were prescribed. Adults and children attending the practice were advised during their consultation of steps to take to maintain good oral health. Tooth brushing techniques were explained to them in a way they understood. The dental care records we observed confirmed this. Information in leaflet form was available in the waiting room in relation to improving oral health and lifestyles, for example, smoking cessation.
Other examples of previously notable practice seen by the CQC include:
- Practices chose a community project each year with a focus on improving oral health outcomes for their own patients and for the local population. The current community project was oral health care for people living with dementia. The practice staff were training in the dementia tool kit which would enable them to become Dementia Champions.
- Another example was where one of the hygienists had recently implemented plans to improve oral health in nursing homes and hospitals.
Some of the residents of the homes were patients of the practice. The hygienist had organised a training course for nursing home staff to teach them how to look after the oral health of the residents and had also organised to provide a talk to end of life carers and nurses on oral health care in their patients. This would result in improved health outcomes for patients in terms of oral health and general health and well-being.
Consent to care and treatment
Proving that patients have given their consent to care can be challenging at the best of time, but contemporaneous dental records will help. There are various things you should ensure you record in your dental records. These include, but are not limited to:
- Consent forms signed by the patient or guardian showing the exact cost to the patient and what treatment is intended to be done.
- Evidence of discussions taking place, options given with costings and patients given time to think about their options.
- Translators present if necessary and their details recorded.
- Information presented to patients in a manner that they understand.
- Leaflets and induction loops, etc for patients who may need information in different ways.
- An understanding by staff and clinicians of the Mental Capacity Act 2005 (MCA). This provides a legal framework for acting and making decisions on behalf of adults who lack the capacity to make decisions for themselves.
- A copy of patients’ treatment plans in their records.
The practices should have as much information available for a practice inspection to show compliance as possible. This could be in the form of practice, polices, procedures, protocols (written and demonstrated by staff if possible). All the staff should be aware of these and be able to show their knowledge of them. All staff training logs and maintenance records should also be available and will help to show this.
The above given examples and others throughout this article, should not be the only procedures in place during the inspections. Each practice and their circumstances will be individual, so you should ensure that all possible methods of showing compliance to the CQC are demonstrated by your practice.
- How CQC regulates primary dental care services: Provider handbook, CQC, March 2015
- Dentists: Information for providers, CQC
- Key Lines of Enquiry for healthcare services, CQC, last updated June 2018
Use the following item in the Toolkit to put the ideas in the article into practice:
About the author
Dr Shilla Talati BDS graduated from Guys Hospital in 1999 and has been in general/private practice ever since. She was a partner MD of Dental Perfection in Coventry for several years, where she had a special interest in the management side of her dental practice. She has run several courses for the GDP in general practice and is now involved in practice management issues, including staff training, compliance monitoring, and staff motivation. To