Clinical Practice in the UK

Patients

Patients in the UK are generally well informed about their rights both within the NHS and private sector. You must understand your responsibilities as a healthcare professional.

In the UK there is considerable legislation regarding the treatment of patients. You need to be aware that for even routine procedures you must first obtain informed consent. It is important that you fully understand the regulations regarding the consent for treatment in the UK as they may differ significantly from those in the country where you trained or recently worked.

Teamwork

In the UK men and women are treated equally and there is no place for discrimination in the workplace. There is a strong emphasis on team work in the NHS and you will come into contact with staff from other professional groups, for example dental nurses, technicians, therapists, hygienists who can help you with the management of patients. It is your responsibility to know what treatments can be provided by each group and what supervision is required.

Employment

• The NHS employs many different healthcare staff including general dental practitioners and salaried dentists in the community dental service, Dental Hospitals and General hospitals.
• Private practice: you can provide dental treatment as a private practitioner both in primary care and also in a specialist practice. Please note that in the UK there are regulations about who can call themselves a specialist. The GDC holds lists of dentists who are specialists in different dental subjects.
• You could provide NHS or private dental treatment if you were employed by one of the dental corporate bodies.
• More specialised care is provided by NHS Trusts. This care is provided in hospitals. NHS Trusts employ consultants, associate specialists, staff grades, nurses etc. In teaching hospitals, many consultant staff will be involved in undergraduate and postgraduate dental student teaching and will hold an honorary university appointment.
• Universities in the UK employ dentists to teach undergraduate and postgraduate students. In addition it is possible to have a career in dental research. Many senior clinical academics hold honorary consultant contracts. Training for this type of senior clinical academic posts can be very lengthy as there is a necessity to have honorary registrar training in a specialty in addition to acquiring a higher research degree.
• The armed forces: more information can be found on the Defence Dental Agency's website.

Local Education and Training Boards (LETBs)

In England there are 13 LETBs which are responsible for the training and education of all NHS medical and dental staff in their area.

Dental Commissioning Board (DCB)

In April 2013 the DCB took commissioning responsibility away from primary care trusts (PCTs) for all NHS dental services: primary, community and secondary, including dental out of hours and urgent care. NHS dental services   provided in high street dental practices, community dental services, and dental services at general hospitals and dental hospitals are now commissioned by the local DCB.NHS dental services are based on the local oral health needs assessment which will be developed by public health teams in local authorities and will help determine the needs of local populations. In England, dentists must have their name on the performers list of NHS England in order to provide NHS primary care dental services.

Payment in NHS primary care dentistry

Local DCBs contract with general dental practices to provide dental services. The dental activities provided by a dental practice are collectively called, Units of Dental Activity (UDA) or Units of Orthodontic Activity (UOA). Each year, NHS dental practices will contract for a pre-determined number of UDAs. Payment is made up of the value of the UDAs and the patient’s contribution. Some patients are exempt from paying NHS charges for dentistry. For patients who are not exempt the NHS dental charges are divided into three bands. The bands are based on the type of treatment each patient requires. For example:

• Band 1 course of treatment
  Applies to a dental examination, diagnosis (including radiographs), prevention advice, a scale and polish if needed, and application of fluoride varnish or fissure sealant.
• Band 2 course of treatment
  This covers everything listed in Band 1 above, plus any further treatment such as fillings, endodontics or removal of teeth.
• Band 3 course of treatment
  This includes everything listed in Bands 1 and 2 above, plus crowns and fixed and removable appliances.

Ethics

The General Dental Council has issued new ethical guidelines which are applicable to all dentists in the UK. It is your responsibility to ensure that you are familiar with this new ethical framework. This guidance applies to all members of the dental team.

There are nine core ethical principles:

1. Put patients’ interests first.
2. Communicate effectively with patients.
3. Obtain valid consent.
4. Maintain and protect patients’ information.
5. Have a clear and effective complaints procedure.
6. Work with colleagues in a way that is in patients’ best interests.
7. Maintain, develop and work within our professional knowledge and skills.
8. Raise concerns if patients are at risk.
9. Make sure our personal behaviour maintains confidence in us and the dental profession.

Further information can be found on the GDC website.