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Can I accept a request for work experience from a school pupil who is interested in a career in dentistry?

24 March 2015

It is not unusual to receive a request for work experience from a school pupil. Observing in a dental practice can enhance the pupil’s understanding of dentistry and can assist them in deciding whether or not dentistry is the career for them. Not only that, but some dental schools prefer applicants to have undertaken some type of relevant work experience.

So what does a practice owner have to consider before agreeing to such a request?

Health and safety

Under health and safety law, a work experience student is considered to be your employee. You treat them no differently to other young people you employ. A young person is defined as anyone under the age of 18.

As an employer you will already have carried out a risk assessment. Under Health and Safety law you must assess the risks to young people under the age of 18 before they start work experience and tell them what the risks are. Young workers may be particularly at risk from work place hazards because of their lack of awareness of existing potential risks, immaturity or inexperience.

Health and Safety legislation addresses the protection of young persons at work in detail, and you should consider your obligations in this regard. The Health and Safety Executive guide, Young people and work experience: A brief guide to health and safety for employers, contains helpful information about these obligations.

Assess the risk

Before the young person can start work experience, the practice owner must carry out a risk assessment to identify any specific risks which they might face. The assessment must take into account the following:

• The inexperience and immaturity of young persons.
• Their lack of awareness of risks to their health and safety.
• The fitting and layout of the practice and surgery.
• The nature, degree and duration of any exposure to biological, chemical or physical agents.
• The form, range, use and handling of work equipment.
• The way in which processes and activities are organised.
• Any health and safety training given.

You should keep a record of the main findings of the risk assessment. This is good practice and it is a legal requirement if you have five or more employees (including young people on work experience). The risk assessment and any control measures taken should be shared with the parents of the work experience student. See the Health and Safety Executive’s FAQs for more information.

Once the young person is ready to commence their work experience it is important that you check that they have undergone and understood training which covers, for example:

• The hazards and risks in the work place.
• The control measures put in place to protect their health and safety.
• A basic introduction to Health and Safety, for example, first aid and fire and evacuation procedures.

In addition to this you may wish to check that your employer’s liability insurance and public liability insurance cover includes work experience students.

Confidentiality

Confidentiality is crucial and a clear induction is of paramount importance, as is the need to check the young person understanding of the subject. Confidentiality extends not only to the patient’s treatment, but also to the fact that someone is a patient of the practice. This might include some of the young person’s peers or teachers!

Issues of confidentiality also extend to access to the dental records and to the appointment book and you would need to ensure that the student is fully aware of your confidentiality protocols.

It would certainly be appropriate to check with each individual patient that they are happy to have a work experience student observing their dental treatment, and to emphasise that the patient can change their mind at any time.

The Working Time Regulations 1998 apply to work experience students and you may wish to consult with the school concerning the hours which they wish the work experience student to attend your dental practice.

Can I have a go?

The days of work experience students mixing materials and assisting at the chairside are long gone! It is appropriate to manage the work experience student’s expectations so that they are fully aware of that their experience, whilst being very worthwhile, will be limited to observing.

Dental Protection 2015

Q. I have just condemned my DAC autoclave to the great decontamination suite in the sky and need a replacement. What could you recommend? I don't want another DAC, it was temperamental and broke down a lot but I think it was the only machine that lubricated and sterilised. Please let me know if you have a happy relationship with your hand piece decontamination equipment and what make it is.

A. We have had DAC's for a number of years. The old ones broke down a lot we even had the inside replace at the factory.

We could not find anything similar on the market. We purchased the newer version

2 years ago and it has been serviced twice and have not had any problems with it.

I think the fact that it has been serviced by a DAC trained engineer has helped greatly.

A. This is the hand piece steriliser I was recommended. 

The Assistina 3 x 3 by W&H. I bought from Henry Schein but I'm sure DD sell it too.

Feb 2014

Q.Who organises the DBS checks for the dentists and hygienists working at your practices? Do any of your dentists and/or hygienists use the update service? If so, do they set themselves up for this?

A.We use website, disclosure barring services and they have an online account where you credit the payment for an enhanced CRB and then your staff complete it at their own pace and at home themselves. They set up their own account although you can monitor.

You get results within a few days. Very efficient and easy to use.

We use them all them time or when needed.

A.I organise ALL of our 27 staff’s DBA checks

I use a company called Exess Ltd

They send you through the DBS forms (which you can choose on the form Standard or Enhanced)

You gather and check the staffs ID, i.e. passport, driving licence, utility bills and send a copy along with the DBS form to Excess

And they process and return

It is quick, efficient and we have used them for the past 4 years – with NO problems

A.We use Mencap, they are efficient, it’s all online easily trackable, would thoroughly recommend …£65,00 ish

August 2015

Q.We are looking into getting a washer/disinfector. I was told that we need a water softener as we have hard water in the area. As our decon room is not large enough we need to house the softener in another part of the building.  What this means is that ALL the water coming into the building goes through the water softener, and I am thinking is this necessary? Do I need soft water for the toilet flush? My concern is that larger volume of water will need extra salt and hence extra storage space will be needed. Also we would have to purchase a higher capacity softener which would be more expensive and will have the associated higher running cost.  

A.We have a w/d as well. We do not have a water softener. We use salt. This is in the instruction on how to use the W/D.

At first I purchased the salt from Eschmann. It was too expensive. Now I get the salt pellets from cash/carry. A bag is probably about £10 to £15.

August 2015

Q.I have been asked to create a policy/document for visiting tradesmen to the practice covering data protection? E.g.  IT consultant, the plumber, lab tec, etc. Does anyone have such a document they could forward me to help?

A.We have a visitor’s book that all tradesman sign in and out.  It has the date, time (in & out), company name and purpose of visit. At the front of the book we have printed – principals of confidentiality, data protection, code of practice, disclosure to third parties and practice rules, available for the tradesman to read.

A.You should have a contractor’s policy in place as they have to be aware of the practice H&S policy as you do of theirs 

*A third party confidentiality agreement template can be found in the template section

August 2015

Q.Our NHS contract is a fair size one. Would anyone have a spreadsheet or some form of keeping a running count of how many UDAs are completed by each associate, how many remain from target etc. Yearly target percentage? Basically keeping track of UDA targets for the whole year is what I am looking for. I really struggle with this so your help would be a life saver.

A. We use a dental package called Ismile and this does it all for us. Otherwise if you access the principles NHS portal you can get all the information from that.

A. I understand your frustration…it's taken me a couple of years to perfect, (but I managed to control my uda's last year to within 0.04% of its target??yeh!)  But I have a spreadsheet set up that I transfer the number of uda's sent in each claim package and then cross check what the BSA say I've done… That way I know if any claims go astray and what each dentist is achieving month by month. Do you use R4 or SOE software packages? If you do have either of these then I know that have the information you are after already installed within their program. You just need to tell their help desk to talk you through how to get at it.
 

August 2015

Q.I am recruiting a new registered nurse and would like to offer the short listed candidates a 'trial shift' I've never done this before. How would I pay a candidate for their time? Do they need to be on the payroll?

A.We have had a couple in the past and paid them for their time out of Petty Cash

We pay the same rate we would as if we were going to employ them, so whatever you are offering

A.This was also new to me with the Practice I joined a year ago, but all we do is offer a 1/2 day to observe and see what the job entails and have a chat after to see if they are still keen, we then say to them that we have another candidate for a trial and we will be in touch soon, but we do not pay them, we have done this for a receptionist, nurse, Hyg and not getting paid has never been an issue.

A.We offer this type of taster session for both our dental and orthodontic recruitment but we don't pay. We take it as a sign of mutual interest and have never had an issue with someone wanting to be paid. 

A.We do currently do this with all new employees, although do not offer pay, instead if the candidate is successful, we will give time back in lieu. I suppose it depends on how long the shift is really.

November 2015

Q.Does anyone know where we can get information on how to obtain a translator for a Romanian patient? I have contacted NHS England and they have told us we have to find our own interpreter and then they will reimburse costs.

A.We use CITAS interpreting services 

A.Languageline. It's a telephone interpretor service.

A.We’re in Sheffield & have used SCAIS interpreter service on 0845 124 8889.

A.info@essexinterpreting.com  or www.essexinterpreting.com

A. We use The Big word. Www.thebigword.comand they are excellent. 

A.Try Google translate app

A.I have a number for an interpreter = 0808 802 0202.  I have not used it in a while, so you need to check it is still valid.

A.We just Googled translation services in whichever is your local area, although we have never used this service you should have the detail available at reception as when cqc visit this could be a question they ask your reception staff, so all need to be aware of what to do and where to access.

A.Not sure if any help as we are in North Devon and it is several years since we used this service but I have attached the details.  We used them for a patient who was having sedation with us and they were very good. (Communications Support Guide for Patients can be found in the downloads section)

A.Depending on where your  practice is, there are a few organization in Cambridgeshire, try KnockHundred Translations 01544 388040 they may be able to help you.

A.This is who we use, we registered with them and they send you all the info and your access code.

It's free of charge as far as I'm aware.

A. Interpreter Services Can help with translation and interpreter services.

We can call them direct and they will invoice the Area Team if we use the service if it is for an NHS patient.

For a private patient the patient or the practice has to cover the costs.

Language Solutions Line 08001692879

Milton Keynes Council Community Language Services 01908253253

Signs in Vision (Sign Language Services) 077285792789

A. We have had issues involving translating and I have spoken to the company below. They can charge per minute! The name is language line.

May 2015

Q.We have a trainee dental nurse starting at the practice, I’ve spoken with our principal dentist indemnity providers regarding her cover, they have advised that she will not be covered under his supervision/policy and they do not provide indemnity for trainees.

I spoke with GDC and they have advised me that the practice needs to provide indemnity cover for the trainee but the indemnity providers are refusing to do this.

Has anyone experienced this problem or what indemnity providers do you use that cover your trainee staff?

A.I am sure that ALL trainees are covered under Medical Defence and Dental Defence

A.We have 3 partners at the practice, two of them are with Dental Protection and one with MUD.

Dental Protection will add the qualified nurses to their policies and we to have trainee nurses that have been added but they have said because they are not qualified and are working under supervision they are not fully covered but added for advice only. They are due to follow up with an email explaining what this actually means, which I can send you when we receive it.

I suppose the next port of call would be advice from the college the trainee is attending.

It seems strange that the GDC are saying they do need indemnity if they are not the GDC register as yet.

A.If the trainee isn't GDC registered they don't have to have indemnity, but the supervising registrant must, as they are responsible for the students work. This is stated on GDC website on section on employing trainees! 

A.We take our trainees from our local university and they are covered from their course provider.

A.We have had trainees for years and never come across this.

Provided they are in an accredited approved training course and you have liability insurance then that’s all the training provider checks. 

I would suggest you check with the training company what insurance should be in place, as i say never had a problem, they can nurse as on course.

A.I believe that in situations of this nature, the individual must purchase her own indemnity cover, which is what associates and hygienists must do.  Hope this helps.  Can be expensive for a trainee.

October 2015

Q.I wonder if anyone can help – some of our nurses are complaining about the temperature in the decontamination room at work.  It reached 28 degrees yesterday.  HTM0105 guidance suggests that best practice means no fans or open windows or air conditioning.  I wonder how other practices get around this issue.

A.I believe you can have air con or a fan as long as the air flow is in a 'dirty to clean' flow direction or even avoids that area at all.  We had an air con unit in our sterilisation area which was positioned in a way that the air flow was not going against the dirty to clean work flow and we never had any problems from our CQC or infection control advisors check.

A.I spoke to a Health and Safety at Peninsula Law Firm this morning and he said that although best practice (from an infection control point of view) would state no air conditioning, doors and windows closed and no fans, the risk is very minimal and the far greater risk is to staff working in the room.  The advice I was given was to fit air conditioning but ensure it was well maintained, all records were kept and it was serviced annually.  Having looked at HTM0105 I believe that the advice Natasha has given above, further makes this the best option.

A.We do have the window open but have had a special mesh fitted so nothing can get into the room, and we do have a fan in there.

A.We have experienced the same problem over the last few weeks…we have a dedicated Decon Technician who is currently covering some maternity too and therefore in for 5 full days, servicing 6 surgeries. It has not been pleasant for her.  

We had a guy service all our air con units last week and so we asked his advice. There is a type of unit that is compliant, and he has promised to send me more info. He did mention that it was extremely expensive though, for what would probably just be used during a couple of months per year. I will forward more info when I have it.

A.We had special air con installed by ‘ACRS of Evesham’ when we refitted our long, thin-shaped decon room – it inputs clean cool air at the ‘clean’ end of the room and takes it out at the ‘dirty’ end, via circular ceiling fittings (look like ceiling lights). There is a huge aircon system that had to be installed in the roof space above! I don’t know if it would be classed as best practice, but the dental company doing the re-fit (Promec Ltd) recommended it.

July 2015

Q.Can anyone help with how they plan/organise their staff rotas?

We are currently experiencing a little unrest with our team particularly with some of the team not wanting to move or change who they work with.

Given that we have 9 surgeries and they vary between orthodontic and general, we plan 1 month in advance and also feel it’s good to change around to increase skills/experience.

Any help from others who plan and organise a team would be valuable.
 

A.I work with a smaller team but have recently been through this with changes to all rotas and who works with who.

Obviously it really helps to have the team on board with the plans – do they all understand why you want to make changes.

Also can you suggest a trial period with a meeting in say two to three months time to review how everyone thinks the changes are working out – this will probably make people more willing to give it a try in the first place and most likely they will find it is not as bad as they expected – no one likes change eh! Give them plenty of notice if you can with the new rota and aim to make it as fair as possible.

If all else fails – maybe an incentive or reward for those willing to try and change.

You can of course go down the contract route – are they contracted to one particular way of working, will the changes affect their contract? If No, then really they have to give it a go at yours or the principles say so. If their contracts would be affected then more negotiation may be needed.

I honestly think, just persuading people to try to changes with no permanent decisions to be made until a review is usually the best way to get folk on board with ideas and plans.

A.I had the same issue, there is no magic formula where we can please everyone.

At my last practice (in Portugal), I made each nurse responsible for a surgery and that was where they worked no matter who the clinician or specialist was. They were solely responsible for keeping their surgery clean and fully stocked. This seemed to work the best for me and for them.

Currently I am running three practices, and after some trial and error, I have decided to create practice teams, both for receptionists and nurses.

I met will all the team individually and asked if they had any rota suggestions, taken all of their input on board and agreeing on some compromises, the new rota came out. One week they might have to work with someone that is not their favourite, but then the following week I will ensure that they are with the specialty they enjoy the most. (We have all the specialists here, so the work is varied).

I have always done the rota on a weekly basis, but with this in place I think I can safely release a monthly one, with set teams in place and set shifts, it should prove easier to do and less time consuming. So far it seems to be running better than before, but only time will tell, I guess.

A.Yes you are right, but this is not easy to do. What I do in my practice,

One dentist—one room—one nurse

You have to find out which dentist/nurse combination can work, then plan.

A.It would be good to understand a little more about the unrest as I sense it's a little more complicated than just a rota issue.

But, I've recently come across RotaCloud.com and found it very useful in managing a rota across different sites. It allows the rota to be seen by who you would like and also allows all employees to submit requests. As its cloud based it's easy to access and for people like me that on occasions find the additional of more software a little burdensome has proven quite simple to use.

Please be assured that I have no other connection or interest in RotaCloud. I came across them as I was searching for a way of making rotas simpler to manage for one of my client's.
 

A.We arrange the rota on a weekly basis, each dentist has 2 or 3 nurses (we call them main nurses) they mainly work with and they all rotate between the dentists, hygienists and scrub duties, some do reception work as well, they get quite a variation but generally would have 2-3 days working with the same dentist. If I ever need a nurse to work elsewhere it wouldn't be questioned they would just get on with this, it is their job after all, perhaps remind them of that.

Q.I have a couple of queries regarding staff immunisations, first of all regarding BCG. Do we need to have blood test results showing that we have all been immunised or is it sufficient to have a record of who has had it and when. Secondly regarding tetanus, I believe that boosters should be had 10 yearly – is it necessary for everyone to have boosters purely for working purposes, i.e. do we need to go to our GPs and have this if it is more than 10 years since we last had it and again do we need to be able to provide proof?

A.Regarding immunisation, the guidance suggests that you nominate a person within the practice to co-ordinate staff health and keep a written confidential record of immunisation schedules and antibody test results. Permission (written consent) must be first gained from the team members before requesting any confidential information from their GP. Put in place markers or an alerting system to help the practice keep their records contemporary and ensure that all members of the dental team are up to date with booster vaccinations.

Regarding the BCG vaccine, the guidance states that this vaccine is recommended for healthcare workers who may have close contact with infectious patients. So therefore this vaccine should be given to all staff involved in direct patient care. However the BCG vaccine is not routinely recommended for non-clinical staff in healthcare settings.

Guidance states that all staff who are involved in direct patient care should be up to date with their routine immunisations including tetanus.

That being the case, the proof of immunisation required, will vary from practice to practice depending on what the Practice Owner feels is adequate.

If you have any further queries please do not hesitate to contact me.  

Kind regards

William Reynolds

Legal Assistant

LCF Law

November 2015

Q.Can anyone help please with a sample of a letter to NHS patients that continue to fail appointment?

We have a Policy to cancel appointments given us 24 hour notice

I am sure that many Practices have the same problem. I understand there some practices that send a letter advising such patients of de registration.

A.Letters FTA1 and FTA2 can be found in the template section of the website

A.We use a two tier system, the first appointment, then a letter is sent

Re       Failed Dental Appointment

We note from our dental records that you failed to attend or failed to give the practice 24 hours notice for cancellation of your dental appointment on:-

Please telephone the surgery within the next seven days to rebook this appointment, if we do not hear from you within this time, we will take it that you no longer wish to continue with your current course of treatment.

Please note that it is our practice policy that if you fail to attend or fail to give 24 hours notice on more than one occasion, this practice will no longer accept you as a patient.

If they fail again, we then send out this letter

It has been used in our practice for about 10 years, we have the off patient argue the case, but most patients are acceptable

Re:      Failed Dental Appointments

We note from our dental records that you have again failed to attend or failed to give the practice 24 hours notice for cancellation of your dental appointment on more than one occasion.

We write to advise you that as you have failed to attend or failed to give 24 hours notice on more than one occasion, this practice will no longer accept you as a patient.

A. Private and Confidential

MR D Test

Address ————–

04 Feb 2015                                                                                                                                              Our Ref:

Dear  ——-

This is to inform you that due to missed appointments at this practice, we are unable to provide you further treatment.

Practice policy and guidance from the local Primary Care Trust is clearly displayed in the waiting area and on appointment cards

If you wish to find another local dentist, please call the team of patient Advice Liaison Services (PALS) on 0800 3899 092 or 0208 3833 322

Alternatively, there is a list of local NHS dentist with letter.

Yours truly,

A.We use these 3 letters

1st

Dear

We see from our records that you failed to attend the practice for your

……………………………. appointment on ……………………………….

We hope that you are well and this was simply an oversight.

Surgery time was, however, booked for your appointment. If you are unable to attend an appointment, we ask that you give us at least 24 hours’ notice. Because we did not know that you would not be attending, we were unable to offer your surgery time to another patient.

In accordance with National Health Service policy, there is no charge for wasted surgery time. However under these guidelines, if you miss a second appointment, you may not be entitled to further treatment here.

If you have any queries, please do not hesitate to contact us.

Yours sincerely

2^nd (last chance)

Dear

We see from our records that you failed to attend the practice for your

……………………………. appointment on ……………………………….We hope that you are well and this was simply an oversight.

Surgery time was, however, booked for your appointment. If you are unable to attend an appointment, we ask that you give us at least 24 hours’ notice. Because we did not know that you would not be attending, we were unable to offer your surgery time to another patient.

As we informed you after your previous missed appointment, the National Health Service policy states that after two failed appointments, patients may not be entitled to further treatment. Your dentist is prepared to give you one more warning, but please be aware, if you miss another appointment your registration at this practice will be terminated.

If you have any queries, please do not hesitate to contact us.

Yours sincerely

3^rd  (Strick off letter)

Dear

We see from our records you failed to attend your ……………………. appointment on …………………………………….

You were informed after your last missed appointment that under National Health guidelines there is no charge for wasted surgery time. However, now you have missed a third appointment, you are no longer entitled to treatment at this practice.

Therefore, you can obtain a list of alternative dentists from the NHS Choices website at www.nhs.uk.

Yours sincerely

November 2015

Q. I’ve been asked my Principals to become our CQC Registered Manager (currently my boss holds this title!).

Are you able to give me a few pointers as to what the legal implications of this could be for me & any advice you may have as to whether I should accept/decline this role?

A.With regards to the legal implications of becoming a registered manager, please see our advice in this regard.

Registered Manager Regulations and legal implications

As a registered manager there is a particular regulation that you will need to abide by to satisfy your role. The specific regulation in relation to a registered manager is the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 7

The intention of this regulation is to ensure that people who use services have their needs met because the regulated activity is managed by an appropriate person.

Under Regulation 7 the registered manager must show that she:

·      Is of good character. This would mean demonstrating character traits such as honesty, trustworthiness, reliability and respectfulness.

·      Is able to properly perform tasks that are intrinsic to their role.

·      Has the necessary qualifications, competence, skills and experience to manage the regulated activity.

·      Has supplied them with documents that confirm their suitability.

It is important to note that the CQC cannot prosecute for a breach of this regulation. In place of this the CQC can take regulatory action. Regulatory action is action taken by the regulator of health and social care services in England to address a registered person’s breach of a regulation.

The CQC has an enforcement policy and can use various civil enforcement powers to improve care standards. These powers stretch to suspending the registration of a registered manager for a specified period. This is a rarely used power.

Another power is to cancel registration altogether which is one of the most powerful sanctions that the CQC have.

These powers will only be used where the CQC believe that the people receiving the regulated dental services have suffered harm because a regulated person is failing to comply with legal requirements.

Therefore to summarise, the CQC cannot prosecute for a breach of this regulation but there are regulatory measures that can be taken such as suspension and cancellation.

Kind regards

William Reynolds
Legal Assistant
LCF Law

November 2015