Employment in the UK
Before you start working as a dentist in the UK, it is your responsibility to prepare yourself as you must fully understand the regulations regarding working as a healthcare professional.
The General Dental Council (GDC) has issued 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 six core principles:
- Put patients' interests first and act to protect them.
- Respect patients' dignity and choices.
- Protect the confidentiality of patient information.
- Co-operate with other members of the dental team and other healthcare colleagues in the interests of patients.
- Maintain your professional knowledge and competence.
- Be trustworthy.
Further information can be found on the GDC website.
In the UK, it is mandatory for dentists to have professional indemnity insurance.
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. This includes legislation regarding all aspects of health and safety and work including for example: cross infection control, ionising radiation regulations, mandatory immunisation of all dental workers against Hepatitis B, disposal of clinical and hazardous waste, single use equipment and CPD for all dental workers.
In the UK there is considerable legislation regarding the treatment of patients. It is important that you take time to fully explain to your patients any procedures that you may be planning.
You need to be aware that for an even routine procedure 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 and worked. Remember that at any stage patients change their mind about whether to have a particular treatment or procedure. It is your responsibility to ensure that they fully understand the implications, risks and benefits of any treatment you suggest. It is important that your English language abilities are of sufficient standard to explain any treatment. Many problems which generate complaints arise from poor communication with patients.
There is a strong emphasis on teamwork in the NHS and will come into contact with staff from other professional groups, for example nurses, technicians, therapists and hygienists who can help you with the management of patients. All these groups of Dental Care Professionals (DCPs) are regulated by the GDC. It is your responsibility to know what can be provided by each group and what supervision, or requirement for your presence or your written treatment plan is required. All members of the dental team are required to undertake continuing professional development. There is a mandatory requirement for CPD on an annual basis which is regulated and monitored by the GDC.
Whether you are an employee or employer at your dental surgery / office you are subject to UK employment law where men and women are treated equally and there is no place for discrimination.
Primary Care can be offered in the private of NHS sectors or through dental insurance schemes. It is the first level of health care and includes many medical and dental practices. General dental practitioners also have contracts with the PCTs.
Private practice: You can provide dental treatment as a private practitioner both in primary care and also as a specialist.
You could be employed by one of the dental corporate bodies offering general dental services.
Secondary / Tertiary Care
More specialised care is provided by NHS hospital / foundation or acute trusts. Patients are referred from primary care to hospitals for specialist treatment that is more appropriately provided in a hospital setting. NHS hospitals / foundation or acute trusts employ consultants, associate specialists, staff grades, specialty dentists, nurses etc. In dental teaching hospitals, many consultant staff will be involved in undergraduate and postgraduate dental student teaching and will hold an honorary university appointment. Consultants are responsible for training foundation trainees, Dental Core Trainees (DCTs) and Specialist Registrars (SpRs).
The specialties recognised by the GDC include: oral surgery, endodontics, orthodontics, periodontics, restorative dentistry, prosthodontics, dental public health, oral medicine, paediatrics, oral microbiology, oral pathology, oral and maxillofacial radiology and special care dentistry. Some of these specialties are practiced in hospitals and some also in a specialist practice.
In the UK maxillofacial surgery is a specialty of medicine and not dentistry.
Universities in the UK employ dentists to teach undergraduate and postgraduate students. Supervising dentists are experienced dental practitioners who have worked in primary care in the UK for several years and may have been trainers in primary care. Senior clinical academics have extensive experience in research or teaching and are employed by a university but also 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 specialist registrar training in addition to acquiring a higher research degree.
The Armed Forces
Dentists are employed by the armed forces to treat service personnel. The dental officer is responsible for the maintenance of dental health which is an important part of the overall medical fitness required for all servicemen and women. More information can be found on the Defence Medical Services’ website.
Some dentists are employed by hospitals, community dental services, or dental corporates.
Dental Commissioning Boards (DCBs)
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. In England, dentists must have their name on the performers list of NHS England in order to provide NHS primary care dental services.
Local Education and Training Boards (LETBs)
In England there are regional LETBs which are responsible for the training and education of all health and public health workers in their various regions. In Scotland and Northern Ireland this role is carried out by NHS Education for Scotland and Northern Ireland Medical and Dental Training Agency respectively. The Wales Deanery carries out this work in Wales.
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.
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:
- Put patients’ interests first.
- Communicate effectively with patients.
- Obtain valid consent.
- Maintain and protect patients’ information.
- Have a clear and effective complaints procedure.
- Work with colleagues in a way that is in patients’ best interests.
- Maintain, develop and work within our professional knowledge and skills.
- Raise concerns if patients are at risk.
- Make sure our personal behaviour maintains confidence in us and the dental profession.
Further information can be found on the GDC website.