Dental Nurse Recruitment 2015

Q.Just wondering if anyone in NW London area are finding it difficult to recruit for a dental nurse. 
 
I have advertised on gum tree and Indeed and there seems to be barely any response!!.

I have done this in the past and have never come across this situation.
 
Please let me know how you deal with your nurse recruitment needs. I would like to avoid using an agency if possible.  I have also contacted the local training college!

A.I am very surprised.  We have not had to hire a new nurse for about three years now.  In the past I found Gumtree to be very helpful.  Maybe it’s because we are getting close to holiday time.  I have heard the same complaint from other practices that they are finding it difficult to get trained qualified experienced nurses. 

A.I used BDJ and didn’t get a single response so I tried the universal job site (free) and had 19 apply. May be worth a try.

June 2015

Q.I and have recently appointed a new dental nurse, does anyone have a model contracts you could send me.

A.We use the BDA standard template and adjust it to our own practice needs, then we get the BDA to check it – to ensure it is legally required.

A.We use a template from CODE.

A.Contracts are best being overseen by a legal team.

A.We use the BDA contract, along with a job description and offer letter (which both state they form part of the contract).

A.Here is a template of the contract we use, this has been checked by an employment lawyer as being ok. The template can be found in the templates section.

August 2015

Q. I am interested in knowing if all practices follow the procedures below for cross infection control.  If you do have you been obliged to allow in your day additional time or staff for these procedures to be carried out.  If you do not allow additional time, how long does it usually take to complete the procedure?  I would be eternally grateful for any feedback. I am desperate.

Cross Infection Control

Procedure

At the beginning of the day after putting on uniform wash hands with soap and water following  the procedures outlined in the hand washing guide.

Put instruments and handpieces in a box which is some moisture, but not overly wet.  Put the cover on the box.

Remove mask and gloves.  Do not put masks or gloves in your uniform pocket.  Be sure that they are placed in the clinical waste bin.

Carefully transport the instruments to the decontamination room

Upon entering the decontamination room wash hands again with either soap or hand disinfectant following the procedures outlined in the hand washing hygiene guide.

Put on face mask, eye protection (goggles or visor), If you wear the visor, you still have to wear the mask,  apron, gloves and heavy duty (black) gloves.

Take the lid off of the instrument box. Place instruments in the disinfection solution.  HAND PIECES DO NOT GO INTO THIS SOLUTION.  The instruments may stay in the solution for a random period of time.

Remove instruments from the disinfectant solution and place in the ultra sonic bath for a minimum period of ten minutes.

While the instruments are in the ultrasonic bath run clear plain water into the blue plastic bowl which should be located above the sink.

Place the instruments into clean blue bowl filled with warm water.  Rinse them and inspect them one by one under magnifying light before you place them on metal autoclave tray.  If you find dirty instruments at this stage you must place them back in  the ultrasonic bath or clean them manually in the metal sink with water temperature below 45 degreesC using appropriate disinfectant and long handle brush.  Scrub them under water to avoid splashing.

Handpieces do not follow this procedure

They must first be wiped with disinfectant and oiled before going through the auto clave process

Place instruments in the autoclave. On the required cycle.

When cycle has finished remove instruments from the autoclave.

Wash the now empty box with water and spray with disinfectant.  This box should be transported back to the surgery with lid on and empty. Disinfect the blue bowl by spraying.  Wash and disinfect gloves with spray.  Wash brushes in hot water and store upright on the clip provided.

Remove PPE in this order. Gloves, plastic apron, face mask, eye protection. Wash hands again either with soap or disinfectant.

A. We employ 2 decontamination nurses to ensure the unit is fully covered, and the nurses can concentrate on their job.

A. We broadly follow this procedure but have employed an additional nurse as scrubs nurse in the decontamination room!

A.I have had to employ a person to run the decontamination room, it doesn’t work if you have your nurses doing it in between patients there isn’t enough time.  I don’t know how many surgeries you have we have roughly 7 so with all the guidelines etc we took the decision to man it.  We don’t use a qualified nurse as this is not cost effective but employed a person who works the room and as long as they are fully covered with Hep B etc and are learnt what to do then this will be the most cost effective way.

A.We have a member of staff working within the decon room every session (barring staff shortages when everyone chips in), so all these jobs are done within the session, it works very well for us, we are very busy and couldn’t manage without an allocated person

A.With the changes to cross infection control and the subsequent timing issues, we have now contracted a start time 30 mins prior to the start of the practice opening times, to give us all an opportunity to get set-up without too much stress.  We do the same at the end of the morning session we close at 12.30pm to give 30 minutes or so for the end of session procedures.  (It gives me a chance to bother the dentists with admin!!!).  Of course, we do the same at the end of the afternoon session which ends around 5.30pm allowing 30 minutes clean-up (end of day admin as well).  If you would you like a copy of my infection control policy/hand cleaning policy etc., just let me know.

We have a designated member of staff working in the decon room full time – not sure how you’d be expected to work this into your daily routine and maintain seeing the same amount of pts?

A. Yes all of this apart from the soaking.

We have a central decon room for the processing as to do this in surgery between each patient would have taken up a lot of surgery time.  I believe that it is still the case that a patient should not be in the room for certain sections of the decontamination process so again this lengthens the turn around time between patients.

I am under the impression that now the guidance has moved away from “Soaking the instruments” as this can cause prions to harden to the instruments.  The spraying option with a specific product is the preferred method of use before the instruments go into the ultrasonic bath.

Once the patient has been treated the nurse should place the dirty items safely in the box and then change her gloves and wipe down the surgery.

Is one of your dentists a BDA member?  If they are you may have a source of telephone contact to the BDA for advice.  This would be recommended.  Are you or one of your nurses indemnified? If so you will have access to advice via this route too.

Do you have an NHS contract?  If so it will not just be what the HTM01-05 dictates but also NICE guidelines and any quirks by the PCT will be applicable.

A.Every day one of the nurses is the assigned decontamination nurse and all our nurses are given an extra (paid) 20 minutes at the start of the day to ensure cross infection procedures are carried out and surgeries prepared for the day’s patients.

A.We pay the girls 15 mins in the morning overtime for setting up, and also if needed 15 mins at end of day overtime to do end of day duties, bearing in mind they usually have 30 mins after the dentist has left to complete all tasks, and it seems to be working. All end of day jobs are listed for them, so they just need to tick off and sign when done.

It might be an idea just to provide each surgery an extra secure lidded box to transport clean instruments, they are not very expensive. We label our tubs, CLEAN/ DIRTY.

A.Our practice has 3 surgeries running at one time and we have a designated nurse to carry out all the decontamination procedures.

A.We do not have a decontamination room at the moment but I would envisage employing a member of staff to work in there as we will not block off time in the dentists book for this. I think it is more economical to employ someone else and run 3 full surgeries and on a rota basis have someone to cover all these extra duties.

A.I am practice manager in a large NHS Surgery.

We found the only viable solution was to employ an extra nurse to enable us to have a full time ‘scrub nurse’.  Each nurse takes a turn to do this which means all the staff have a really good knowledge of the infection control routine.

Our procedures differ slightly to yours but are tailored to our practice.

October 2013

Q.What matrix everyone is using for their CQC policies and evidence outcomes at the moment as we currently have a 2 draw filing cabinet with first draw being policies and procedures and second draw being evidence and its sectioned into outcomes, just after the new outcomes and sections- hope that makes sense, I have attached what I am currently using so it makes more sense.

A.Thank you very much for sharing this. We have something similar but without listing it in a sectioned way to outcomes.

We have a metal cupboard housing all of the polices with a laminated list of the p&p’s taped to the inside of the cabinet. On that list is the updates – we write those on & update the computer version. Our outcomes can then be traced to and by our updates/audits etc. We keep all of these on a shared drive on our computer for all staff to update their own particular section. The whole team has their individual responsibilities for these which we mix up from time to time to ensure all staff are competent within all sections

Your way of doing it has given me some good ideas, this is a useful subject for us all to discuss.

A.Surely as long as you have the policies and evidence readily available to answer any question asked by the CQC it doesn't really matter how it is stored.

Being in Denplan I used their publication for Denplan members of "An inspector calls volume 11 from 1 April 2015". I then just referred to previous compliance file and indicate that “previous outcomes are cross referenced to current changed regulations and then annotated accordingly.

I have found the Denplan information re CQC to be really excellent from the start.

August 2015

Q. I am looking for some help with our COSHH Risk Assessments.  Can anyone recommend a good COSHH management solution to help me control our COSHH risk assessments?   I would also like to hear from anyone with tips or advice for carrying out these risk assessments, and where I can get the relevant information for all substances.   Any help or advice would be appreciated.

A.Do you order from Henry Schein at all? They have all there COSHH information online that you can print off.

A.Dental directory has all data sheets on website

A.Your dental supplier should be able to give you all the relevant info and will probably have a program with them all on.

A.We are members of CODE Confederation of Dental Employers they advise of any changes in compliance etc. and have various ways they can help. They’ve been long established and I can recommend them.

A.We use CODE icomply, it does include all the CQC requirements as well as COSHH but helps to make the whole process much more manageable.

Almost all product information can be found on the internet if you search under the product names, if you have lost the leaflets. The BACD also has some useful product safety information sheets.

July 2015

Q.I was wondering if anyone could help me on a query I have, Christmas Day this year falls on a Friday and Boxing Day is the Saturday. The Friday is a bank holiday and the bank holiday is the Monday of the following week in lieu of Boxing Day.

For team members who work 6 days a week which includes Saturdays…what do you class as bank holiday the Saturday or the Monday?

As a practice we will be closed the Friday Saturday and the Monday so do staff members have all 3 days as paid leave or would they have to use a day’s holiday?

A. I think officially the Monday is the Bank Holiday however I would say one day will be holiday whichever way you look at it, however as it is a practice decision to close maybe a compromise could be made.

A. All three days, if you are closed, should be considered bank holiday for those who are usually scheduled to work on the Saturday.  These three days should be counted as part of their holiday package.

A.Do your staff have Bank Holidays and Practice Closure holidays included in their holiday entitlements?

If they do then 1 day for the Saturday would be deducted

If they do not they would be invited to take it unpaid?

I always ensure my rota states a year in advance all Bank and Public Holidays and Practice Closures.

All my staff have Bank and Public Holidays and Practice Closures (on the days they normally work) deducted off of their holiday entitlement.

A.It's a double edged sword situation because of the Saturday, either the staff lose out or the employer does. Personally if it was my practice I would say all three days off with pay, it is Christmas and I think staff morale would be pretty poor if I made them come in on the Saturday.

A.In answer to your query – in order to be fair to all staff members we would consider the Saturday as a normal working day, and it would therefore come out their holiday entitlement.

A.We always pay all the Christmas holiday, whatever the Bank Holiday arrangements. If the practice is closed then it's paid leave, and doesn't require staff to lose a day's holiday.

A.I’m not an expert but if holiday entitlement includes bank holidays does it make a difference. You’ll be closed and it will count as part of holiday entitlement I’d have thought?

A. The staff should have the 3 days as paid leave

A.As far as I understand the Saturday is classed as a normal working day as the Monday is the bank holiday. Therefore they would use a day’s holiday if not working the Saturday if that makes sense?

A. We pay for all 3 days.

A.I would say that all of those days are paid bank holidays.

June 2015
 

Q. Can you ask other members if they have to have an asbestos certificate, or an energy efficiency certificate? During all the various inspections we’ve had over the last 25 years, no-one has ever asked for one, but one of the partners is having a valuation done and the company is insisting we need one!

A.The only time I've been asked for an asbestos certificate was when I asked workmen to replace our ceiling tiles in one of the surgeries. Small fragments of the tiles were sent for analysis. We had to wait for results before work could commence.

Don't know anything about energy efficiency certificates in regards to dental practices.

A.We have an asbestos certificate – this was required by our insurers a few years ago. We had to have a asbestos survey and inspection carried out. From memory it cost a few hundred pounds.

No energy efficiency certificate but that sounds similar to what you have to do with domestic properties now.

A.I own 5 practices and a lot of rentals

We have to have an Asbestos Certificate done and an Energy Efficiency Certificate for ALL of them

I think once you have them done, they last for a certain period of time

If Asbestos is found to be in the property at all – and sometimes it is, then it’s a case of getting in the correct people for removal and disposal

A.We have both in the practices. Never been asked for them though.

A.Re the EPC look here. If it is has been done before it may be available to download using this link. If not this site also allows one to search for someone who can come and carry out this survey. From what I understand and EPC is now compulsory.

https://www.epcregister.com/reportSearchAddressByPostcode.html

Regarding the asbestos… From my experience, if the property in questions has Asbestos then the seller will need to get a certificate to say it is safe and that is has been labelled. There is no avoiding it.

A.We have an energy certificate as we needed one when we had an expansion, however it does cost a few hundred pounds to carry out, and has come in handy for other information and compliance for energy to be able to show it..

Each business has individual needs so it’s not something you can share is the only downside.

No asbestos certificate as our building was purpose built in the last 10 years.

A.We recently had an asbestos assessment done by a company called Bison. 

They inspected accessible areas and did a report, ours was prompted by British Gas engineers saying that they weren't supposed to do any work until they'd seen our asbestos risk assessment. 

It cost about £250 but I haven't had a chance to fully review it yet. I may be able to forward it to you as an example for you to see if it's what you're needing. 

A.Our practice changed hands last September, we had to have an asbestos certificate but, not an energy certificate. I expect each company is different. 

A.Yes we have a EPC (Energy Performance Certificate)
They are valid for 10 years

A.yes we do. If you are a landlord you have to provide one.
If you are a new build then you don't need the asbestos certificate.

May 2015

The intention of this regulation is to ensure that providers are open and transparent with people who use services and other ‘relevant persons’ (people acting lawfully on their behalf) in general in relation to care and treatment. It also sets out some specific requirements that providers must follow when things go wrong with care and treatment, including informing people about the incident, providing reasonable support, providing truthful information and an apology when things go wrong. 

The regulation applies to registered persons when they are carrying on a regulated activity. 

CQC can prosecute for a breach of parts 20(2)(a) and 20(3) of this regulation and can move directly to prosecution without first serving a Warning Notice.

Providers must

·        Promote openness and honesty

·        Take action against bullying and harassment

·        Investigate breeches of Duty of Candour

·        Ensure the team members understand Duty of Candour

·        Encourage team members tobe open and honest with patients and apologise when things go wrong.

·        Offer support to team members who are involved in a notifiable safety incident which include patient death, severe harm, moderate harm

The five key questions linked to Regulation 20

·        Is the service safe?

·        Is the service effective

·        Is the service responsive

·        Is the service well –led

Outcomes relating to Regulation 20

·        Outcome 1 – Respecting and Involving Patients

·        Outcome 4 – Care and Welfare

·        Outcome 6 – Co-operation with Other Providers

·        Outcome 7 – Safeguarding

·        Outcome 8 – Cleanliness and Infection Control

·        Outcome 9 – Medicines

·        Outcome 10 – Safety and Reliability of Premises

·        Outcome 11 – Safety and Reliability of Equipment

·        Outcome 12 – Requirements Relating to Workers

·        Outcome 13 – Staffing

·        Outcome 14 – Supporting Workers

·        Outcome 16 – Quality of service provision

·        Outcome 17 – Complaints

·        Outcome 21 – Records

Policies and procedure supporting Regulation 20 can be found in all Regulations.

General Patient Records – 8 years after conclusion of treatment

Children & Young People – Until the patient's 25th birthday. Or if the patient was 17 at conclusion of treatment, until their 26th birthday or 8 years after the patient's death if sooner.

Maternity – 25 years after the birth of the child, including still births

Clinical Trials – 15 years after completion of treatment

Litigation – Records should be reviewed 10 years after the file is closed. Once litigiation has been notified (or a formal complaint received) images should be stored until 10 years after the file has been closed

Mental Health – 20 years after no further treatment considered necessary or 8 years after death

Oncology – see Oncology records

Question:

I wondered if you could recommend an x-ray machine repairer to us please. We have a Yakang x-ray machine which requires servicing/ and or repairing. We are based in Norfolk.

Answer:

I suggest you get in touch with Stephen Green & Associates – he is our RPA and is located close to you I believe so he may be able to help, his number is 01508578618 or 078112823963

Answer:

Claudius Ash service & repair our x-ray machines. Telephone number 0800 090909 or sales@claudiusash.co.uk

There is a one off call out charge £125.00 + VAT thereafter £62.00 per hour + VAT

Answer:

Dental Buying Group look after ours. They are based in Cheshire but have engineers in other areas. 01606 861950 for general enquiries, 0870 7377113 for engineering.

Answer:

This is a number we used for repair but it was a few years ago, hope it helps. We are in Northampton. Gary Stock 07850401271, 01226208810 office.

March 2012

Question:

Can you advise how often you get your X Ray Machines inspected and serviced, and which company you use in your practice?

Answer:

We use DBG who are very good and reliable.  They service all equipment and supply materials and other services.  We have our equipment tested/serviced annually.  

Answer:

Annually & Plandent (aka Claudius Ash)

Answer:

Our machines are serviced & inspected on an annual basis by DBG.

Answer:

We receive a test patch every three years from the Health Protection Agency.  Once a year, as part of our maintenance package we have an electrical safety check from Anglian Dental

Answer:

We use Dental Buying Group and they come annually.  There needs to be a critical exam (which takes longer) every 3 years.

I know that often the local hospital radiography departments offer this service too and I believe Henry Schien and Dental Directory do too.
If you have the make of the x-ray machine you could call the UK distributor (as I doubt it will be made in the UK!) and ask for a list of preferred service engineers

Answer:

We have our x-ray equipment serviced annually by Image x-rays (Phil Tonge) 07838178926. Very good and reliable.

We also have a 3 yearly Equipment Performance Report (by Public Health England formerly NRPB)

Answer:

We have our machines serviced once a year by Plandent who supplied them to us. We also have a radiation survey every three years to comply with legislation Plandent does one & dental buying group the other

Answer:

We get them serviced annually and inspected (critical assessment) every 3 years.

We use a company called Image X-rays 07838178926.

Never had any trouble with them

Answer:

Once a year maintenance checks. Done by our RPA – Stephen Green and Associates

Answer:

Legally you have to have them checked, serviced and inspected every 3 years. We use the DBG, and they subcontract to IRS who are our legal advisors.

Any issues with your equipment or any new equipment in the meantime must be reported to them.

July 2014

Question:

I have started to come across a growing problem with staff trying to use unpaid time attached to holiday request when they have use their allocation.

I have taken advice on unpaid time off from a professional body and been advised to have a policy for unpaid time off, and that it is a separate entity to lawful holiday entitlement.

Does anyone have such a policy or suggestions, I am aware it is discretionary leave

Answer:

We make it quite clear, that unpaid time off will only be given in emergency situations and not for holiday purposes.  We have difficulty in allocating staff to replace staff on holiday, and we have no room to allow for additional time off.   We also encourage staff to space their holiday time throughout the year, in this way they do not come up short.   

Answer:

Unpaid time off can often be a head ache. However it is difficult to have a policy for unpaid time off as unpaid times off should be included in many of the other policies which a dental practice should have such as jury service, public duty, medical appointments, maternity leave, time off for dependants, parental leave.

I would advise that the employees are sent a memo stating that in the past it has often been the case that unpaid time off has been tagged onto annual leave. However, as of the 1^st February, employees will no longer be able to request unpaid time off in these circumstances. Unpaid time off is only granted by the Practice in extenuating circumstances and is at the Practice Owner/Manager’s discretion.

Answer:

It will also need to be linked to the discretionary / social / personal development support the organisation offers. Eg I am doing an MBA where some learners are fully funded to be here by their companies, because if what they will bring back to the organisation. Some organisations have a strong sense of corporate social responsibility (which I think we should encourage more in dentistry) and will release staff for community or charitable work. 

Answer:

We allow unpaid leave, although in their contracts it says at the co-principles discretion, which means they don't have an automatic right to it. We have found that if we are overstaffed though it helps us out, because we are paying them less, so as long as you can staff it, there's no reason to object.

Answer:

Unpaid leave: two weeks per year pro-rata may be permitted (i.e.10 days). A written request for any unpaid leave should be submitted to the Practice Principle/ Manager for approval at least four weeks in advance of the proposed leave. If appropriate cover is not available unpaid leave may be refused.  Unpaid leave cannot be permitted during the Christmas Period

January 2014

Question:

Does have anyone have a tattoo policy? We are considering offering a position to a young lady but she has a tattoo on her wrist.

Answer:

Our policy is simply if you have a visible tattoo ie, arms, neck, then it should be covered with a plaster whilst working. There are several girls in our employ who have visible tattoos and have no issue with covering them up.

Answer:

I don't have a tattoo policy however this is under consultation as we speak.

One of the key factors here is that of ensuring we do not discriminate on the grounds of what by some is considered as body art and by others as cultural acceptance in particular when henna tattoos are worn as a celebratory adornment.

It could be challenged that they are one of the same.

Answer:

I think it depends on the comfort level of your patients and practitioners.  We hired someone with one tattoo about a year ago.  She now has several and they are getting to be quite invasive.  Some patients are very uncomfortable to be looking up at the nurse and all of her tattoos.  We now fear that it she might be considering having some on her face.

Answer:

I manage a high end private practice In Henley on Thames

2 of our nurses have tattoos on their wrists.

We do not have tattoo policy, I do not feel that it affects their work in any shape or form or how the practice is seen. 

The girls are all well-presented, good at their work and highly competent.

Answer:

We don't have a long policy, but we have a statement that everyone has signed linked to the contract, which states any body piercings, body art or extravagant hairstyles and jewellery are not to be on show due to the nature of the job, and all staff signed it. We haven't encountered any issues.      

October 2014

Question:

Would anybody of a two surgery practice care to share how much rent they are paying as our landlord is looking to increase ours to £11K.

Answer:

We pay £26,833 for a six surgery

Answer:

We used to have a 3 surgery practice and we were being charged £1000 per month 6 years ago

Answer:

We pay £8500 for single surgery

May 2014

Question:

At the present time, we store our clean uniforms in our toilet.  They are in a cupboard with each practitioner having their own shelve.  We have been told that for infection control this is not acceptable because when the staff use the toilet, the spray from the toilet being flushed will land on the uniforms.

Would it be acceptable to put doors on the cupboard?  I find this to be easier than trying to find a space in our staff room for these uniforms.  I would appreciate any help that anyone can offer.

Answer:

When I did legionella training it was said to close the toilet lid when flushing this should resolve your problem. 

From today's reports make sure you don't have a hand dryer use paper towels.

November 2014

Question:

One of our Dental Nurses seems to have a problem with personal hygiene.  Some members of staff have remarked on it especially after using the facilities after her, and it is certainly noticeable in the surgery she works in especially when it is warm and so some patients must also be aware of it, but it was highlighted yesterday when she took her home leggings off and hung them on a radiator to dry having got drenched on her way to work.  The smell emanating from her clothes was very unpleasant and pervaded the corridor and one of the Partners remarked on it. 

The best way I can describe the smell is by comparing it to the fishy smell that autoclaves release when the canisters in the RO system need changing. 

Has anyone else had to deal with such a situation?  Any advice would be gratefully received.

Answer:

I know this is a very tricky subject to address. However I would approach it head on as it needs to be addressed. I would have a quiet word with the nurse in my offer and ask her if she had any problems at home- i.e. has boiler/washing machine broken etc.  As there may be a problem at home. If once discovered that there isn't I would then go on to discuss the problem about her personal hygiene.

This must be addressed, but with upmost care and sensitivity .It also may be a medical problem. As a practice manager it is our job to address it.

Answer:

I took the person to one side and discussed washing uniforms every day at 60 degrees at home. You can make it a discussion individually or as a group to not necessarily single this person out. I said to this person very diplomatically that on occasion there was an odour and you wanted to approach her before anyone else did so she feels the problem is discussed before it blows up into something un-necessary.

It is very hard to do but they will appreciate it if you handle it with care and consideration.

Answer:

There is only one way, TELL HER! You can be gentle and suggest maybe her washing machine not functioning properly or maybe the deodorant doesn't cope with the stressful effects of being a dental nurse but YOU HAVE TO TELL HER!!

I have been there twice, they don't like to be told and find it hard to believe but it is the only way.

Answer:

I understand where you are coming from, we have had the same, but not as bad. However, there is a condition, not sure if it is kidneys or liver, where the sufferer gives off a fishy smell, they are not necessarily aware of the condition and are definitely not aware of the smell.

We just said to all nurses as a start to be aware of personal hygiene, and that did cure it, if it didn’t we were going to tackle her head on, it would have been the only way. However, if she is suffering from this condition, she is probably not aware, and really not sure how you can handle that, as it can only be helped by seeing a GP and then medication.

Answer:

I would personally get the Practice Manager or whomever is in charge to ask her for an informal meeting.

At the meeting I would discuss the importance of cleanliness and highlight these points to her.

I once had a nurse who had a similar problem, but no one would speak with her, so I did, it turns out her mum was terminally ill and she was using all her spare time to care for her, not caring for herself – which unless I had asked her we would never had known her underlying problems.

This was resolved as she had no money for toiletries as all her monies were being used on bus fare etc., she was not only exhausted but really making herself ill.

I would have a word with her, she may not even be aware of the smell or indeed her personal hygiene routine, she may need some guidance.

I have in my 22 years of being a practice manager and 8 years as a PA had to inform about 3 staff 1 was a dental surgeon – if no one says anything it can get worse and result in staff bullying and making unnecessary comments behind their backs.

Hope you get on ok.

If not get her a full personal hygiene set for her secret Santa present ! With a private note in their – she will never know who sent it

Personally I would prefer to be told directly – and maybe given a little time off to correct this

Answer:

I have had deal with a similar situation in the past. It was most embarrassing, but the only way to deal with it is to just have a discrete word with her and maybe have de-odorant in the staff room and bathroom area. I always keep air freshener in both places as well.

It may be that she is a very valued member of the team and you don't want to lose her.

Answer:

I've had to have the talk with my old Principal dentist because of body odour and bad breath. I was just honest about it and he was very embarrassed by it as was I. 

Answer:

I would suggest that you first off have a dress code and hygiene policy – this will state what you expect from your staff in terms of clean uniform, cleans hands / nails and also a high level of personal hygiene.

If you can incorporate a form of feedback into your appraisals – google 360 degree feedback – this could help as anonymously others could comment on positive and negative aspects of working with each other.

Otherwise if action is needed imminently – I would check contracts with regards to dress codes or hygiene and have an informal meeting to begin with (still recorded) – explaining the concerns in the practice and hope that a gentle polite nudge might help.

Answer:

I had a similar situation many years ago with a nurse who used to walk to work and was inclined to be a bit sweaty – I took her aside and spoke to her and she was almost grateful that I had spoken to her before anyone made a comment! 

I would suggest you deal with your situation with care as there is a female medical condition which gives the symptom of a ‘fishy smell’ – she may be aware of the problem already.

Answer:

Yes I had to deal with this situation when I worked in practice as a senior dental nurse, at that time we didn’t have a practice manager.

I quite simply asked the person if we could have a chat about something that I had noticed putting the emphasis on me as opposed to others who had raised the issue. Due to the nature of the smell which was clearly associated with feminine personal hygiene I was honest in pointing out that I couldn’t help but notice she may have a health related problem which needed to be addressed. 

My approach was sensitive and understanding and I asked if she had any medical problems which she wanted to talk about as I was concerned for her health and well-being, I emphasised she didn’t have to talk to me and if she preferred to talk to someone else I would suggest she talk to her GP or the practice nurse.

She was willing to discuss her problem with me which highlighted other issues in her personal life relating to lack of stability at home, inadequate laundry facilities and other issues associated with the possibility of becoming homeless due to family problems. I was able to signpost her to services where she could get help with the social problems this boosted her morale substantially. In turn this motivated her to addressing the feminine personal hygiene issues.

In summary all this person needed was the issue being pointed out to her in the first place, without skirting round it, and someone to talk to about the other problems in her life.

November 2014

Question:

Do you use any a staff absence computer programmes to monitor holidays and sick leave? Something more sophisticated than pen/paper or an excel document? If so what is it called and would you recommend it.

Answer:

We use a software called Moneysoft Payroll Manager for both our payroll and staff holiday management. You can also use it to send your PAYE notices online to the HMRC.  It's very easy to use and you can download a free one month trial version from their website. (You can find it via Google) annual licence costs less than £60.

Answer:

I use NatWest mentor services for all my personnel they provide everything they are fantastic

Answer:

If you use sage for payroll they now have a really easy way of recording holidays and any kind of absence which help you monitor throughout the year, it also informs you for all GOV guidelines, updates on holiday/absence (all statutory payments) and you can also input your own holiday schemes. I’m using sage 50 at the moment it can be expensive but well worth it especially if you are looking after a big practice.  

Answer:

You can use the government’s own website to calculate who is due what. 

Holidays – https://www.gov.uk/calculate-your-holiday-entitlement

Sickness – https://www.gov.uk/calculate-statutory-sick-pay

I still keep track manually.

Answer:

I used to work at a large GP Practice and we used ISIS which was a user-friendly package.

August 2014

Question:

We are thinking of setting up a CCTV camera in reception/waiting room area (only) at our practice.

I just wondered if anyone knows what the protocol for setting up a CCTV at dental practice is. Are there certain guidelines we need to be aware off? Do we need to make patients aware that premises are CCTV monitored? How do we do that?

And in general is this something that may make our patients/staff feel uneasy? Does anyone have any experience in this situation? As a safeguarding precaution, are we allowed to have CCTV cameras in surgeries (clinical areas)?

Answer:

As far as I know CCTV is not allowed in the surgeries. Waiting areas and reception are fine but you need to display signs that CCTV monitoring is in progress. Not sure if you need a special licence though.

March 2014

Question:

We seem to have loads of paperwork at our practice as we ask patients to sign an estimate to confirm they have seen the price of the treatment needed and that they consent to treatment.  We then file one copy of this and give one to the patient.  This is done for EVERY appointment so that we know patients know the cost of their treatment.  This seems a bit of an overkill to me and the filing is mounting up!  I wonder what other practices do and how they get round this issue – any details would be appreciated!

Answer:

We also give a paper estimate to every patient and ask them to sign it, but we then scan their signed copy attach it to their electronic record and give the paper copy original back to the patient. This allows us to keep a signed copy but without the filing.

We use SoE Exact so it is very easy to attach scanned documents to the patients’ record – not sure what system you use but hope this helps?

Answer:

That’s the same with us. We keep an ongoing file and at the end of each month go through this and any work not taken up is the chased. At the end of two months we then box this up and put away. I guess eventually you either have to move or destroy paperwork. It’s as you say overkill.

Answer:

We cut down on the filing by scanning the signed estimate on to the patient’s notes, therefore the patient takes the paper estimate and we still have a copy by not a paper one to file.

Answer:

At our practice we indeed get the patients first estimate signed, we then scan onto the patients file on the computer ( we have Kodak R4 system that allows us to do this) We only get patient to sign another copy if treatment changes along the treatment path, this copy would again get scanned on. After paperwork scanned on the original is shredded. If patient needs another copy we can print off scanned documents.

Answer:

All our patient paperwork (except the blue PR form) is on our system software, we use electronic signature pads and get our patients to sign electronically. This is then saved onto the patient’s record and there no need for paper filing.

You can print or email them for the patient and can refer back to these at any time, the only paperwork we store is PR form and paper medical histories to back up our electronic version.

We use SFD (Systems for Dentists) but I’m sure that any software system can incorporate this onto your system.

Answer:

I know how much paperwork is involved but for legal reasons we have to let the patients sign treatment plans and consent forms. However, we print only one copy each, let the patients sign, scan it to our system (we use R4) and return the forms to the patients straight away so they have copy for themselves.

Answer:

We also have a lot of paperwork, and to reduce the amount of time spent filing; we now file all FP17pr and estimates/consent in batches by date. So at the end of each week we bundle fp17prs and file i.e. 10th – 14th Feb and the same with estimates/consent. We then know from patients records which date they were signed and where to look for them if we ever need to retrieve. This system has totally cut out filing at the practice.

February 2014

Question:

We are considering paying our staff a basic wage with performances enchantments linked to UDA targets and private income. Does anybody else do this and now do they find the results.

Answer:

We would welcome any feedback from any practice that does this or may have done this in the past.

Answer:

I would check with your Indemnity providers and also the BDA

As we did consider this some time ago, and was advised against it

As if 1 dental surgeon and nurse performs well and another dental surgeon is off sick and the other nurse does not get a bonus, then it is deemed as unfair!

Answer:

We pay a commission to our Treatment Co-ordinator for every new patient start treatment she achieves – happy to share the bones of this with the practice concerned.

In addition we pay a small year-end bonus for performance related achievement to each member of the employed team.

January 2014

Question:

Do you have any provision for your staff regarding occupational health? If so, what sort of organisation do you use, what is offered and what / how do you pay – per item, a retainer or how does it work? I would also be interested to see how many practices don't provide this, or is it generally the done thing?

Answer:

This provision is available to us through NHS England, free of charge. I would suggest you contact them to see if the same in your area.

Answer:

We don’t use occupation health as there is no funding and it works out really expensive.  We have been advised and follow the protocols for needle stick injuries etc. to be referred straight to A&E, which we have done and the service provided was fine.

Answer:

We have all staff members registered with Occupational Health at Dronfield. It costs £69 per employee per year, and our bosses pay for it.

Answer:

Yes we provide a full OH service via the PCTs (NHS England now) provider for our area. We have a small NHS contract so we have access to it.  It is free for us.

We have also made links with our local GP and the local travel centre…. this is our back-up plan in case the NHS route goes pear shaped.

We have used the travel centre once for Hep B Vaccine (very quick so person could start hands on instead of waiting for the OH visit).  Each visit cost us about £45 they needed 4 visits in all.

Answer:

I think the provision no matter whether it is NHS or PVT is crucial in case you end up with a sharps injury or for your H&S provision?

Answer:

We are a mixed NHS/Private practice and therefore Grampian occupational health will only cover needle stick injuries free of charge, all other services such as Hep B vaccinations, and any screening is charged for. 

Answer:

As a mixed practice, we have the option of NHS occupational health facility.

Answer:

We use the occupational health dept at our local hospital, this in our case is Macclesfield general. They do injections for new staff and hep b boosters .Tb, no charge as working within NHS also they can offer counselling if need be regarding hep b

Answer:

For over 10 years we have used our local Occupational Health Team for screening new employees and carrying out Hep B vaccinations. It’s only in the past year or so that it’s become a chargeable procedure. All treatment carried out is charged per course of treatment, per person, and we are invoiced accordingly.

Answer:

Quite a lot of GP practices offer this service so worth speaking to a larger practice nearby.

We have implant centres dotted around the UK so it can be area specific.

In all cases it is charged on a “pay as you go” basis rather than charging for the facility.

As far as CQC are concerned EVERY dental practice should already have this in place!

Answer:

We are a private referral clinic and as such cannot access any of the NHS such as the local Ace.

I have a private contract with the local hospital health and wellbeing for which I can send for inoculations, needle stick injuries, counselling and physical therapy for back neck etc.

These services are on a pay as we go type contract and form part of our CQC responsibilities for staff health and wellbeing.

There should be some form of reduced cost or access if you have an NHS contract for services locally.

Answer:

We pay per item and use our local hospitals OH resources.

Have used them for inoculations, medical assessments for long term absence, etc.

Answer:

We have enjoyed their services free of charge up until now… However apparently this may be changing from April, although no one seems to know anything at the moment. Not sure if that helps at all.

January 2014

Question:

Does anyone know how long we have to keep the old FP17s before destroying them please as they take up much needed archiving space?

Answer:

Its normally 11yrs but if you have Exact software you can scan them into the patients file and shred them which is the procedure we do at our clinic. No space or filing required which is time consuming.

Answer:

I rang to find this out myself – 2 years

Answer:

I’m not sure but have you considered scanning them in so save space?

Answer:

2 yrs

Answer:

We were told 11 years by dental defence union but have now been advised to ring the local PCT as well

Answer:

I would assume if the patient details are on them 11 years or until the pt is 25 years old whichever is the longer!!

Answer:

.I spoke to the BSA regarding this last week and their guidelines are 2 years,however they did advise me to ask my local LDC to clarify with them as well.I have done this but havent heard back yet!

Answer:

A minimum of 11years

January 2013

Question:

Please can you help with advice on how long we need to keep FP17DC forms and print out from Washer disinfector and autoclave?

Answer:

I thought it was 11 years unless stored on the computer, then its forever??

Answer:

From the IPS infection control audit – this is three years – we usually keep ours for up to four years just to be sure. 

Answer:

Forms if they have patient info on them then should be kept with patient records. 

Autoclave and washer disinfector print outs have always been three years. (It may have changed to 2 not sure) but we still keep for 3 years

July 2014

Question:

Medical Emergency Procedure’ we have 2 dentists, they are both in 4 days a week and I feel they should attend any emergencies and the nurses stay with their patients, but who is to be the leader….are most PM’s leaders and who do they delegate to when they are not their as I am only there 5 hrs a day.

Answer:

Whilst the whole team undertake medical emergency training, all our Dentists and Orthodontists play lead on a medical emergency (depending where it happens/which surgery)

The nurse will act as assistant or runner, depending on what is needed.

Surely the dentist should take the lead with all team members in support.

In your annual medical emergency training this must be discussed and everyone know where the drugs kit etc. is kept and the protocol for evacuating the practice in order for their paramedics to do their job on arrival.

Who wants to be in court to say they were in charge and not competent to administer adrenaline?  while a dentist was on the premises .

Answer:

Usually the PM will take the responsibility of arranging Medical Emergency Procedures.  We allow one afternoon a year when we have a professional come along and run through all the emergency procedures whilst checking our equipment and showing and reshowing how to use it.  The practice receives a certificate as well as everybody who attends.  I am happy to recommend him to you and his details are below.  I cannot recommend him highly enough:

Mr Phillip Howarth
020 7806 4020

Answer:

I would make it a policy that the receptionist call ambulance if needed and co-ordinate patients 1 dentist and 1 nurse attend to the patient and request additional help if required

As a practice manager if you are in attendance at the time I would take the lead and make sure that the staff are doing everything correctly and make sure it is all documented

We have a large practice and there was a really bad accident outside our practice last summer, a girl aged 11 ran out in front of a car – you heard the thud of her – all of the 13 staff worked so efficiently – luckily we had 3 ambulances 2 fire engines and the air ambulance, one member of staff went to the doctors opposite and the doctor did not have a clue

If it wasn’t for the quick thinking of our principal taking charge of the child she would have died, together we were co-ordinated and we're extremely proud of the staff even if they were just holding up a sheet to stop the onlookers

May 2014

Question:

We are considering offering credit facilities through a Dental Finance Company for our patients. Does anyone have any experience of this, ones to recommend or ones to avoid?

Answer:

Use Medenta, they are the best on the market for dental finance.  If you are considering payment plans like Denplan, I would recommend DPAS for membership schemes.

Answer:

We offer our patients a 12 month interest free loan facility through Denplan Enhance for treatment plans over £1,000

Answer:

We use Medenta, the training was excellent and it’s an easy system to use. As they charge a % we increased our patient fees to cover this (we hadn’t actually increased the fees in a few years, so timing was great).

Answer:

We use and have done so for a number of years Denplan and Braemar, between the two we have a few different options for patients and the practice.

Just worth a mention (you are probably already aware) you need to be registered with the FCA (Financial Conduct Authority) this organisation has replaced the OFT (Office of Fair Trading).

The patients like the facility and we use it probably a dozen time a year.

Answer:

We use to use two plans.  Denplan has a finance scheme and so does Braemar Finance, you must also obtain a license with The Office of Fair Trading, Consumer Credit Licensing.  There is a fee for this, I think it is approximately £500 per annum, but I am not sure.  Though, when you advertise this option to patients, you state that it is interest free, but in reality you pay the difference to the Finance Company. 

Another option which we now use are posted dated cheques.  This has worked out very well and you do not need a licence.

Our experience was that anyone who actually needed this credit, did not receive it.  We did not have even one approved application.

Answer:

Medenta are really good (now part of Practice Plan Ltd) although our PP regional manager told us last week that due to the reshaping of the FSA this year, no new credit licences (your principal dentist/practice will need one) will be available at the moment, to any company.

Perhaps give them a ring about it? Tel: 01691 684175

Answer:

We have Denplan at our practice and they have a 0% finance facility which we use and it is excellent, it is run in conjunction with Hitachi Bank.

Answer:

We use 2, Medenta & Finance 4 patients. Both good, but we like finance 4 patients as we can have lower amounts and the patient fills in the credit application form

david@finance4group.com

July 2014

Question:

Do you have any templates for advising staff on how to respond to a patient who is making racist comments about a member of staff?

Answer:

We had a similar thing but a patient making comments about other patients in the waiting room.

We took the patient to one side and told them that the behaviour was not acceptable then sent them this in a letter also.

As the patient did do this again we completed her treatment then sent her a letter saying she was know de-registered from the practice (we are a mixed practice).

Under the NHS patients that are abusive to staff can have treatment withheld.

*Bulling and harassment policy can be found in the Templates section

July 2014

Question:

Has anyone worked through the CQC Provider Compliance Assessment? If you have can you give me some guidance and advice please? Don't really know where to start!

Answer:

November 2014 the CQC are going to review their dental strategy and outcomes.  Can I check with you that you have a practice manual and audit files already prepared.  If not, I would recommend that you create the audit files in the present outcome formats and the practice manual differently for various groups.  I.e. Practice organisation, staff, patients, health and safety etc.  Personally, I would just make sure you have the manual and audits set up, after that you could be able to find compliance more comfortable.  

August 2014

Question:

What does your Cookie Policy on your website contain as we really do not know what we should be putting in it?

Answer:

COOKIES

Our goal is to maintain your trust and confidence when browsing our website.

What are cookies?

When people use our website we keep track of what they do. This may involve keeping a log of activity on our web servers and, where necessary placing cookies on your computer. A cookie is a small piece of information, like a number or short piece of text, which your browser can store on behalf of a website.

How to delete cookies from your PC

The instructions below are offered as a guide to the most widely used browsers, but the details may be subject to your own browser settings.

Please note that by deleting our cookies or disabling future cookies, parts of the website will not work.

Internet Explorer 9

Click the 'Tools' button. Point to 'Safety' and then click 'delete browsing history'. Select the 'cookies' box, then click 'delete'.

Internet Explorer 8

Click 'Safety' on the Command bar. Select 'Delete Browsing History'. Select the option for cookies and click 'Delete'.

Internet Explorer 7

Select Tools, 'delete browsing history', then select 'Delete cookies'.

Chrome

Click on the 'Tools' menu and select 'Options'. Click the 'Under the bonnet' tab, locate the 'Privacy' section and click the 'Clear browsing data' button. Select 'Delete cookies and other site data' to delete all cookies from the list (alternatively, you can remove all cookies created within a specific time period by selecting the period you want from the dropdown list).

Firefox

Select 'Tools' then 'Options'. Select 'Privacy' and in the 'Cookies' panel, click on 'Show cookies'. You can then either select a cookie and 'Remove cookie', or select 'Remove All Cookies'.

Safari

Choose preferences, select 'Security' then 'Show cookies'. Select the cookies to be deleted from the list and select 'delete'.

The cookies we use and how we use them

Some of the cookies we use are essential for parts of the site to operate and have already been set. You may delete and block all cookies from this site, but parts of the site will not work.

We want you to know that by using this website, you are agreeing to the use of these cookies. These cookies do not capture or contain any personally identifiable information.

August 2014

Question:

How do you approach the sensitive subject of an individual’s weight and the maximum load on the dental chair? Has anyone had experience of equipment being damaged because of this issue and if so has the practice had to bear the cost of repair/replacement?

Answer:

We recently received a referral form from our CCG to refer anyone in this category, although it is very difficult, and I don't think we would feel comfortable asking someone’s weight, or offering to refer them!

Answer:

We have had same problem and since developed protocols for bariatric patients with evidence based research and legal approval.
1) The EU maximum weight limit for use with a dental chair is 22 stone, or about 140kg. This is with the mechanism moving (ie the back), if static and chair turned off can go to 24 stone. Chairs are often made to exceed this but this is an EU ruling and we have found that if we have an issue and have allowed someone over that weight we have breached EU law and as such are liable.
2) There are very good evidence based flow charts from West Midlands and Fife PCT's on dental bariatric care. Both have an outcome of anyone over 22st needs to be referred to a bariatric dental specialist centre for the patient’s best care.
3) Insurance wise you are not covered if you use the chair with a weight limit above 22st and as such no public liability, staff indemnity etc. It will be seen as negligence as you are using a using equipment outside of its prescribed use, and most importantly it will breach health and safety regulations for your patients.
 
It is a massive issue and one that is desperately under aware of.
 
Answer:

We have a policy as I said, we have a sign at reception and in the waiting room notifying patients of the limit and for their health and safety they need to inform us much as they would any other medical condition. It should not be an embarrassing question to ask as it is a medical problem and if you address it as such patients understand.  

Answer:

We ask for the patients’ weight on our medical history form.  We also take referrals as we have a bariatric chair as part of our special needs service.  Our dentist are advised if they have anyone over the weight the chair can ‘cope’ with not to move the chair in case of collapse.  The patients must be explained the reason of the consequences that may happen if they are treated on a chair that does not carry their weight, best delay treatment than have a claim made against you should they injure themselves.  Your local commissioner should know who has a bariatric chair in the local area and how you can refer to them.

Answer:

In NHS Grampian we have the facility to refer a bariatric patient to ARI for treatment as they have specially adapted surgeries to cater for these patients.  Perhaps your local referral hospital will have the same service, worth investigating as it would make the experience much easier for the patient as well.

August 2014

Question:

I am upgrading my telephone system and I need to come up with a script for the auto attended (press 1 for… press 2.. etc.) and also a script for a promotional message to be played when the patient is hold. Would anyone be willing to share their script with me please to give me an idea of what to put on my new phone system?

Answer

Ours says press 1 for making, altering appts/payments, press 2 for practice manager, press 3 for pt care co-ordinator. The manager and co-ordinator have their own voicemails recorded in case they are not there. We do not have holding music/promotional info just every now and again says you are currently in a queue the receptionist knows you are waiting please continue to hold. The cost of putting anything more on was working out too much.

Answer:

I recorded the following for my Practice…

Thank you for calling (practice name)

For all NHS appointment enquiries please press 1. For all private patient enquiries please press 2. For information about our products and services or to speak with the practice manager please press 3.

Answer:

Happy to share our messages for our dental and orthodontic practices

Dental Hold

Hold Message 1

We’re passionate about preventative dental care that’s why we strongly recommend regular routine check-ups and hygiene visits.  Our Dental Care Plan is aimed at helping you maintain great oral health with affordable monthly payments so don’t hesitate, ask a member of our team about it today!

Hold Message 2

If you’re looking to put the sparkle back into your smile, ask us about tooth whitening treatments. We have some great offers to tempt you with.  Just ask any member of our team for more information.

Orthodontic Hold

Hold Message 1

Asmembers of the British Dental Association Good Practice Scheme, we’re committed to providing quality care to nationally recognized standards. Patient care and satisfaction is at the heart of everything we do but don’t just take our word for it, come and see for yourself and let us know how we’re doing. Patient feedback is encouraged – ask any member of the team for a survey at your next visit or drop us a line on our website contact pages. We’d love to hear from you!

Hold Message 2

As a specialist orthodontic practice, we offer a wide range of the most advanced tooth straightening treatments for all ages and to suit your lifestyle, personality and pocket. With interest free finance let us help you get you the smile you’ve always dreamed of. Talk to us today about your dream smile.

Opening Greeting

Thank you for calling Teeth in line. Please hold whilst we connect you. If no lines available to the surgery play the following message:

We are sorry to keep you waiting, we are currently assisting patients and we are trying our best to be with you as soon as we can

Position In The Queue

Your current position in the queue is…..Thank you for your patience at this busy time

Maximum Calls In Queue Message

Please do accept our apologies, the surgery is currently experiencing very high call volumes. Please try calling back a little later. Thank you.

Greeting Day Menu

You are now connected to Teeth in Line. A member of the reception team will be with you shortly.

Greeting Out of Hours

The Practice is now closed. For urgent dental advice please hang up and dial 1-1-1. Calls to NHS 111 are free from both landlines and mobiles. If you would like to leave a message please press 1.

Greeting Training Day

The Practice is currently closed for Training. For urgent dental assistance, please hang up and dial 1-1-1. Calls to NHS 111 are free from both landlines and mobiles.If you would like to leave a message please press 1.

Greeting Bank Holiday

The Practice is closed for the Bank Holiday. For urgent dental advice please hang up and dial 1-1-1. Calls to NHS 111 are free from both landlines and mobiles. If you would like to leave a message please press 1.

Lunch

The practice is now closed for lunch and will reopen at 2pm. If you would like to leave a message please press 1.

System Q Message

Thank you for holding, all our reception staff are currently dealing with other patients. Please continue to hold or alternatively if you would like to leave a message please press 1

August 2014

Question:

What ratio of percentage do you pay an associate i.e. 40%/60% and also the ratio of the deduction that they make in connection with lab bills. Any feedback is greatly appreciated.

Answer:

We do 50% on lab fees and UDA value

Answer:

We pay 50% and deduct the lab bills. Seems to work quite well

Answer:

We pay our associates 45% and 50% of lab bills/ Botox etc, any more than this and you are losing money, unless you are passing CQC, (and related costs) and credit card costs direct to the associate.

Answer:

I take off the labs from the gross along with everything else and then pay 45% to our associate.

Answer:

45% of gross 50% lab

Answer:

We pay 50% and the lab bills come off the gross amount first

Answer:

We are a NHS practice in Scotland.

Our associates get 50% and pay 50% of all lab bills. They also have a pro rata deduction for use of the hygienist. Any non-NHS work has a 50% split also.

This is something we need to look at as the profit margin within the practice is being squeezed with rising costs and fees which are not keeping up.

December 2014