New GDC Standards Guidance 2013
Richard Mason CMIOSH

New Ethical Guidance for the dental profession was published during 2013 and come into force on the 30th September 2013. The new guidance has taken into account the ever developing environment in which we work and clarified new areas of ethical practice for the expanded range of dental registrants.

Dentistry is part of a rapidly changing UK culture driven by technology, economics and public expectations. In the earliest recorded accounts, dentistry is described as a healing art; today modern dentistry is an exact, high-tech science. Advances throughout the twentieth century changed the profession dramatically and created today's culture of dental care. Before becoming a self regulated profession dentistry had its share of amusing folk remedies, colourful quacks and cults. Now dentists must observe the highest ethical standards by placing patients' interests first and acting to protect them.

Dentistry was one of the first health care professions to focus on prevention, patient education and collaboration [between whom?] to create awareness of the causes of dental problems and enable patients to make lifestyle changes to prevent dental disease. Today, most General Medical Practitioners now offer their patients' regular health assessments and lifestyle checks, taking an approach tried and tested within the dental profession for decades.

The ethics standards of modern dentistry developed throughout the last century, guided by successive regulatory bodies. Most recently, the regulatory body in each country within the UK enacted the regulations of the Health and Social Care Act of 2008. Other milestones in the development of the dental profession include the establishment of the General Dental Council (GDC) in 1956. The GDC was formed to protect patients and regulate the dental team. It protects patients by promoting confidence in dental professionals through the enforcement of ethical standards of practice and conduct.

The adherence to a formally agreed set of values is a fundamental aspect of professionalism. Dental ethical guidance covers:

• The core ethical principles of practice
• Patient expectations
• What patients can expect from the dental team
• Standards
• What registrants must do to ensure patient expectations are met

To ensure the guidance is fit for purpose, the GDC instigated a consultation process at the end of 2012 during which all dental professionals and their representative bodies, as well as the general public were invited to put forward their views and concerns about:

• What standards should be set
• How registrants should meet the standards
• Practical applications for ethical principles for dentistry

The resulting new Standards continue to place patient needs firmly at the core of dental activity. Copies of the Standards have been distributed to all registrants. They can also be downloaded from the GDC website (https://www.gdc-uk.org/Dentalprofessionals/Standards). The new Standards set out the guidance using the following terms:

'Must' - where the duty is compulsory
'Should' - is used when the guidance is providing an explanation of how you will meet the overriding duty

Professional judgement is required in all situations and exceptional circumstances outside your control could affect whether, or how, you can comply with the guidance.

Applying the Standards

The real test of laws, regulations and standards lies in their practical application in response to events. For the following case studies identify the relevant Standards guidance and show how each case should be applied:

Case Study 1

Manjit had heard from a colleague at work that the Total Care Dental Practice was the best practice in the area and so she decided to book an appointment to see one of their dentists. At the time of booking she explained to the receptionist that she was 'hard of hearing' and asked if this was likely to be a problem. The receptionist assured her that this would not present any problems.

At her first appointment Manjit arrived in plenty of time so that her details could be recorded as this was not possible for her to do over the telephone - due to her hearing problems. Having given her details she took a seat and read a book whilst waiting to be called through to the treatment room.

After an hour she approached the desk to ask how much longer she would have to wait. She was told that they thought she must have had gone home, as when the nurse called her name no one had responded. At this point the receptionist informed her that she had now missed her appointment and would need to rebook.

Case Study 2

Ivy is 80 years of age. Over many years she has had extensive restorative work on her upper central incisors. These teeth were crowned 25 years ago and have always been unsettled, requiring an apicectomy 10 years ago.

Ivy turns up at the practice with pain and swelling and requests the immediate extraction of the problem teeth and their addition to her existing P/- Ivy is advised that before the teeth can be treated the infection must be settled with antibiotics. She is told that her treatment plan at that point would not be XLA, but another apicoectomy to prolong the life of the teeth supporting the existing denture.

Ivy consents to taking the antibiotics, but not to the prescribed apicectomy, saying she does not want more of the prolonged discomfort she has previously endured. The dentist insists that the only treatment plan he will prescribe is that of the apicectomy.

Case Study 3

Maggie has nursed with John for 10 years in a small group practice. Over the past year she has noticed deterioration in the standards of his work and in his attitude toward patients. From time-to- time he has arrived at work unwashed and smelling of whisky. Maggie is aware that John is currently going though divorce and has made allowances. However, today he started to work without his operating light on and she is concerned about escalating patient safety issues.

Safety Priorities highlight safety issues in the dental surgery - click here to watch a comical short film