Serving the Customer ­ Do Patient Feedback and Questionnaires Improve Quality?

This review article aims to analyse whether patient feedback and questionnaires improve quality of care. It is recognized that patients cannot assess the medical competence of the clinician, yet patient experience provides an insight into the process of care through the patients' eyes. Patient experience measures are more reliable for use to assess quality than patient satisfaction surveys. It is inappropriate to use patient satisfaction surveys as a basis for remuneration of dentists within the NHS. Patient Reported Outcome Measures (PROMs) have been a successful measure of patient experience in medicine and their introduction to dentistry needs to be considered. Clinical relevance: This article will enable clinicians to understand the importance of patient experience measures as a more reliable way of improving the quality of clinical care than patient satisfaction surveys.

NHS pilots in primary care--an insight into the future?

UNLABELLED: This article looks at the background to the current changes in primary care dentistry being piloted in England. It looks at the structure of the different elements being piloted, such as the oral health assessment, interim care appointments and care pathways. It also examines advanced care pathways and how complex care will be provided when clinically feasible and beneficial to the patient. The authors have worked in a type 1 pilot practice since September 2010. CLINICAL RELEVANCE: The NHS contract currently being piloted in England delivers care through care pathways and clinical risk assessments with prevention as an important building block for the delivery of services. There are new measures planned for measuring quality outcomes in primary care. This has implications for how services are delivered, who delivers them and how dentists will be remunerated in the future.

A general dental practitioner's responsibility for implants that have been placed by a different clinician.

A review of the management of implants in general practice in relation to the responsibility and liability for managing them when the dentist has not placed the implant themselves.

Implant maintenance in general dental practice: dento-legal considerations for the general dental practitioner.

Before implants are placed, the patient, as part of the consent process, should understand the risks of the treatment but also the importance of a lifelong maintenance programme. This is particularly important if the patient is at risk of periodontitis. There should be arrangements in place for the patient's ongoing care and general dental practitioners who look after the patient need to appreciate their duty of care in monitoring the implants. Excellent record-keeping and valid consent are important factors in delivering care and can also very much help assist a defence in the event of a civil claim or a regulatory investigation.

The Dental Practicality Index - to treat or not to treat.

The Dental Practicality Index (DPI) has been designed to describe, on a clinical level, the 'practicality' of restoring a tooth versus referring to secondary care or extraction.The systematic approach of DPI has been shown to improve decision-making and confidence in treatment planning when used by young dentists. In addition, there is good evidence demonstrating that it provides an accurate estimation of the outcome of treatment. The DPI enhances clinician-patient communication and ultimately the consent process.

Life after erasure: what are the factors determining restoration?

This article is based on a review of cases involving UK dental registrants, erased and restored to the General Dental Council Dental Registers, in order to consider what factors might influence restoration.

Ethical and Medico-Legal Considerations with Aesthetic Dentistry Involving the Aesthetic Zone.

The bedrock of delivering cosmetic dentistry remains good communication underpinned by a clear and transparent consent process. This article looks at this while exploring the ethical and risk management issues that have started to challenge the profession. While patients' demand for cosmetic dentistry has exploded, this article explores the ethical conundrums faced by these treatments against the backdrop of whether their happiness is affected by their image.

Clinical audit--process and outcome for improved clinical practice.

UNLABELLED: Audit is a key aspect of everyday clinical care and essential for the safe as well as efficient functioning of any clinical environment. This applies to clinical care both within primary practice and secondary care within a hospital environment. The undertaking of an audit allows the clinician to analyse his or her own clinical practice in relation to current guidance or 'gold standard' parameters to enable best practice within all aspects of patient care to be implemented. This paper aims to explore the origins and importance of clinical audit as well as the various processes involved in undertaking it successfully. CLINICAL RELEVANCE: This article will enable clinicians to understand the importance of audit and how to incorporate it into their everyday practice.

Implementing NICE Guidelines on Recall Intervals into General Practice.

The NICE guidelines require practitioners to ensure that each patient has a specific recall interval based on an oral health needs assessment. There appears to be a hesitancy in the profession to move away from the 'six-month recall'. In England and Wales, Primary Care Organizations (PCOs) monitor activity using quantitative data. One particular metric measures how many patients are seen by the practice within 3 months and also between 3 and 9 months from their last course of treatment. The purpose of this paper is to introduce a quick reference chart based on the NICE guidelines which, when used in combination with clinical judgement, can aid the clinician in selecting a tailored recall interval. This paper discusses the purpose and benefits for using the guidelines in relation to NHS contractual obligations.

PPE or not PPE - that is the question.

The world is in the middle of the COVID-19 pandemic and healthcare workers as well as dentists are having to make every difficult decision about their responsibilities in caring for their patients. Compounding this is the shortage of personal protective equipment (PPE), which makes patient-centred care ethically more challenging. Our first response to these ethical challenges should be to start with ourselves to make sure we are safe before we think about the patients. This is not the approach we would normally adopt when treating our patients outside of a pandemic.

Blue on blue.

This Opinion article looks at the surprising number of referrals to the General Dental Council (GDC) fitness-to-practise process by other colleagues. Whilst some of these are undoubtedly genuine referrals to protect the public, essentially whistleblowing, many others are used as weapons in inter-professional disagreements or as part of financial disputes. The GDC is unable to distinguish between these referrals on the basis of the complainant's motives. Registrants should think twice about using the GDC for this reason and the profession should offer alternative avenues to resolve these matters.

Periodontitis - A Silent Risk That Has Become Louder.

This article reviews the key aspects of reducing the litigation aspects of the management of periodontal diseases and in particular periodontitis. Litigation arising from gingivitis, the other type of periodontal disease, is very rare and is therefore not considered in this article. This paper considers diagnosis, record keeping, communication, management of periodontitis including non-engaging patients and referrals. It provides guidance to reduce risks and improve the care for patients.

Grey Matters: 2006 and all that.

The article is intended to put the current NHS dental contract in england into context and identify areas where there has been confusion about interpretation of certain clauses. the article describes these as grey areas and provides a rationale for logically interpreting these issues, such as urgent treatment, mixing NHS and private treatment and defining what a course of treatment is.
These are the views of the authors based on significant personal experience of the contract, both as practitioners and as dento-legal advisers.

The successful management of complaints--turning threats into opportunities.

UNLABELLED: This article identifies the drivers that influence a patient's decision to complain about his/her care and the multifactorial reasons for this. It explores the effects complaints have on dentists and their teams and how these reactions should not be underestimated, even when the complaint can be quite minor. The article goes on to give some generic advice about complaints handling with a brief overview of the NHS procedures in the new contract and finishes with some useful strategies to prevent complaints occurring in the first place. CLINICAL RELEVANCE: Dealing with complaints is an important and ever increasing part of dental practice. If handled well, the patient will continue his/her relationship with the practice and lessons will be learnt. These lessons can be both clinical and non-clinical but, in many cases, complaints can be prevented by effective communication skills.

Off the record.

UNLABELLED: Clinical dental records fulfil a variety of functions. Whilst there is no standard data set for dental records, it is essential that these are contemporaneous--that is, they are 'recorded at the time' A good written record should contain details of the patient's identification data, medical and dental history, clinical examination, diagnosis, treatment plan, reference to consent, and progress notes. This paper covers these aspects in detail, and provides information on how long records should be stored, and who may access clinical records. CLINICAL RELEVANCE: The recording of contemporaneous patient/treatment information is central to treatment planning and good patient care.

Endodontic Risk Management: A Dento-Legal Perspective.

This article provides an overview of some of the issues in the assessment and management of endodontic patients which may lead to dento-legal problems. It covers assessment, the appropriate use of radiographs, special tests and the importance of following the correct consent process. It outlines why record-keeping is particularly important, and looks at problems that occur, such as perforation, fractured instruments and hypochlorite accidents.