Dental Law and Ethics

Paul Lambden

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315345598
• Edition: 1
• Topic: Medizin
• Subtopic: Medizinische Theorie, Praxis & Referenz

Radcliffe Primary Care series Work based learning is central to life long learning and most health professionals working in primary care are already formally or informally involved within this learning process. This book is a practical guide describing what work based learning is and outlining how it can be used as an effective learning system. Case studies throughout are taken from personal accounts of learning experiences from members of primary care teams. They demonstrate how work based learning can be made more effective and how this contributes to promoting change and service improvement. Work based Learning in Primary Care is essential reading for all members of the primary care team.

CHAPTER ONE

The General Dental Council

Margaret Seward

Quality and standards are at the very heart of the activities of a professional regulatory body and for the dental profession that body is the General Dental Council (GDC). It is often stated that professional self-regulation is a bargain or a contract between the profession and the state for the maintenance of the highest standards of care and for the protection of the public. Any such regulatory process is a privilege and in return there needs to be accountability, consistency and transparency in all its actions and activities. At the same time, any regulatory mechanism, which in this case is financed solely by the members of the profession through the payment of an annual fee, should also be seen as one which supports the highest ethical principles of the professional group which it represents.

Principles of regulation

While the primary focus of the statutory regulatory process is to protect the public there is no doubt that it does have other advantages. First, it enhances the status of the profession and second, it provides some assurance of the standards of the professionals in the working environment. This is achieved through either published ethical guidance or the inspection of undergraduate courses as provided by dental schools or faculties, ensuring the highest standards of educational provisions are met.

However, there remain certain common misunderstandings about professional regulation in general terms. It cannot and should not be used as a substitute for the well-established systems of civil redress. The actions normally taken by regulatory bodies are, to put it simply, to protect a member of the public, a patient, from a professional, a dentist, hygienist or therapist, who may either cause him/her harm or undertake treatment which falls short of the expected standards which would have been provided by their peers. The self-regulatory process is certainly not designed to award compensation to the affected parties and again, it is certainly not a substitute for a matter of concern, for example fraud, which clearly needs to be investigated by the police or criminal courts who then decide on the appropriate punishment or penalty.

It is important to remember that the GDC does not aim to punish dentists and when a dentist’s name is removed from the Dentists Register following an inquiry, this action is taken solely to protect the public. However, this is often wrongly seen as a punishment because the dentist, as a consequence of being ‘struck off’, is deprived of his or her livelihood.

Another common area of doubt relating to the activities of the GDC is in relation to employment matters. Effective management is for employees and employers to work out together.

Any professional regulatory system can only work satisfactorily and retain public confidence if the members of the profession adhere to the highest ethical principles. ‘Do as you would be done by’ when dealing with members of the public or, to be specific, patients is the sure maxim to gain success.

The Council and its composition

The General Dental Council was established in 1956 by a Dentists Act, so creating an independent profession. Before this time the General Medical Council held overall responsibility for dentistry, although the business was administered by the Dental Board of the United Kingdom which was established by the Dentists Act of 1921.

At the present time the General Dental Council operates in line with the current legislation which is contained within the 1984 Dentists Act.¹ Repeated efforts have been made by the profession since 1992 for changes to the primary legislation, but so far have not met with success. However, the Health Act 1999² included Order Making Powers, which it is hoped will facilitate the much-needed reforms to specific areas of current legislation. These, for example, could allow the introduction of mandatory recertification for all dentists, increase the number of lay people on the Council, permit the establishment of poor performance procedures and the statutory registration of all Professionals Complementary to Dentistry (PCD). This would mean that dental nurses and dental technicians would join the dental hygienists and dental therapists who are currently registered with the Council.

The mission of the GDC clearly states that it is the regulatory body of the dental profession; it protects the public by means of its statutory responsibilities for dental education, registration, professional conduct and health.

It also states that it supports dentists and dental auxiliaries (PCDs) in the practice of dentistry and encourages their continuing professional development.

The Council has 50 members who elect the President from amongst its number for a term of five years. The remaining 18 dentists on the Council come from four designated constituencies in the UK but they represent the whole profession: England, Isle of Man and the Channel Islands elects 14 members, Scotland elects two members, Wales and Northern Ireland one member each.

A further 17 members are nominated by the dental authorities who award the qualifying degrees and diplomas such as the universities with dental schools and the Surgical Royal Colleges which have dental faculties. There are six lay members appointed by the Privy Council and four Chief Dental Officers, again representing the four constituencies - England, Scotland, Wales and Northern Ireland. Maintaining the historical fink with the General Medical Council, three members are doctors who are also members of the GMC and are nominated to serve on the GDC. As a consequence of the 1984 Dentists Act, one dental auxiliary can sit on the full Council and is elected by the Dental Auxiliaries Committee of the GDC.

The term of office for all members is five years but the election of the dentists and the nomination of appointed members does not take place concurrently, so permitting stability and continuity of the Council’s work. On 1 October 1999, the President and 17 nominated members began a new five-year term of office and the most recent election of dentists and the one auxiliary member was held in May 2001. The successful candidates took office on 1 October 2001. There is a new electoral system in operation which replaced the former and complicated system of the single transferable vote (STV). In addition there has been a reorganisation of the constituencies to allow for national and regional candidates to be elected, so improving understanding of the activities of the statutory regulatory body among members of the profession and also encouraging them to participate in the quinquennial elections.

The major activities of the Council, that is registration, education, conduct and health and dental auxiliaries (PCDs), are conducted through committees on which members of the Council serve. The composition and procedures of each committee are determined by regulations and schedules contained within the Dentists Act 1984.

However, in order to permit more speedy consideration of single and important issues review groups are set up to prepare documents for consultation and report. Topics considered by review groups in the past few years have included general professional training, general anaesthesia and sedation, specialist registration, recertification, postgraduate visitations and a new international qualification.

Registration

Dentists who want to practise dentistry in the UK must have their name on the Dentists Register, for which they pay an annual amount of money called the ‘retention fee’. There is no provision in the Dentists Act to allow a reduced rate for either a part-time practitioner or someone who takes a career break from dentistry, but a practitioner over 65 can apply for the ‘retired practitioner’s rate’.

There are two categories of registration: full and temporary. Those entitled to full registration are graduates or licentiates of UK dental authorities, holders of recognised overseas diplomas, nationals of EU member states who are holders of recognised European diplomas and overseas dentists successful in the Council’s statutory examination or from universities abroad whose undergraduate course has been recognised by the GDC.

In fact, the arrangements for entry of graduates from overseas universities changed in 2001. The statutory examination has been replaced by a new examination called the International Qualifying Examination (IQE) which must be taken by all overseas graduates wishing to practise in the UK. This also applies to those dentists graduating after 2001 from previously recognised universities abroad, such as in Australia, South Africa and Malaysia. As a consequence the traditional visitations undertaken by the Council to overseas universities to inspect their dental courses will be discontinued.

The second category, temporary registration, is to allow dentists from overseas to work for a maximum period of four years in the UK in order to undertake teaching, research or postgraduate study for an additional degree or diploma. Those dentists who hold temporary registration can only work in a dental school or an NHS hospital or other institute in a post approved for training by one of the Surgical Royal Colleges of the UK or for research or teaching in a specified and approved position. A dentist with temporary registration is not permitted to work in a general dental practice.

Auxiliaries

All dental hygienists and dental therapists who possess a UK diploma in dental hygiene or dental therapy can ask to have their names entered on the Rolls of Dental Auxiliaries, which is published annually by the GDC. In common with dentists, each auxiliary has to pay a retention fee each year, although at a lower rate, and anyone who practises dentistry without being registered is working illegally and can be prosecuted. Hygienists or therapists qualified in the EU can gain entry to the UK Roll.

Specialists

Since 1998 recognised specialists in a distinctive branch of dentistry can apply for their name to be entered on the appropriate specialist list on the payment of an additional annual fee. This was provided for by the respective European and Primary Specialist Dental Regulations and the GDC’s own Domestic Regulations for Specialists passed in 1998. The specialists’ lists are currently in dental public health, endodontics, oral surgery, orthodontics, paediatric dentistry, periodontics, prosthodontics, restorative dentistry and surgical dentistry.

A unique document in connection with specialist training, called ‘the Accord’, was originated by the GDC in 1996. This agreement details the partnership between the GDC, the faculties of dental surgery, the specialist societies, the universities, the postgraduate dental deans and directors and the Joint Committee for Specialist Training in Dentistry.

The educational continuum

The Council ensures the highest standards of education throughout the lifetime of a dentist. Section (1)2 of the 1984 Dentists Act states: ‘It shall be the general concern of the Council to promote high standards of dental education at all its stages …’. This encompasses undergraduate vocational training, general professional training and continuing professional development. This is referred to as the continuum of dental education.

The First Five Years³ published by the Council, states the requirements of the undergraduate course and visitors are appointed by the GDC to ensure that the course of instruction at the dental school, as well as the qualifying examination, meet the expected standards. The satisfactory outcome of the dental undergraduate course is to produce a dentist who is able to practise independently without supervision.

The introduction of mandatory vocational training in 1995 for dentists who enter NHS dental practice provides the new graduate with a protected environment in which to work for one year with a senior practitioner who is appointed as a vocational trainer.

For a professional, lifelong learning is no longer an option but an obligation. In April 2000 a preparatory scheme for recertification of dentists on a five-year cycle was launched as a prelude to a compulsory scheme, which will be possible when the Dentists Act 1984 is amended by an Order Making Power contained in the Health Act 1999. The aim of recertification is to demonstrate that dentists whose names appear on the Dentists Register have undertaken regular continuing dental education, so showing a commitment to keep up to date in order to maintain competence.

Although the GDC has legal powers to visit and approve all postgraduate degrees, diplomas and courses, it has so far only exercised its right in relation to postgraduate degrees and diplomas from universities and Royal Colleges and has not sought to give approval to courses run by postgraduate deaneries or by commercial organisations.

The curricula for the various distinctive branches of specialist training are approved by the Council through its Specialist Training Advisory Committee, which has representatives in its membership from various professional bodies, as well as the three deans of the dental faculties of the Surgical Royal Colleges.

Curricula are also published by the GDC for the courses in dental therapy and dental hygiene.⁴ Training for the diplomas in this subject has traditionally taken place within university dental schools. However, recently training courses have been established outside these recognised venues and qualifying examinations have been established through the surgical Royal Colleges and their faculties. A dental hygienist works in all branches of dentistry but a dental therapist is only permitted to work in dental departments of NHS hospitals or in community dental clinics. Some schools for dental auxiliaries run a combined course so that a student qualifies after two and a half years as a therapist as well as a hygienist. All courses and examinations for auxiliaries are approved in the same way as the undergraduate courses for dentists, by appointing visitors from the GDC to assess the course and examination. Auxiliaries are now known as Professionals Complementary to Dentistry (PCD) and have a similar ethical obligation to keep up to date and maintain competence throughout their practising lifetime.

Professional standards

Section (1)2 of the 1984 Dentists Act states: ‘It shall be the concern of the Council to promote high standards of professional conduct among dentists …’ and this...