Even if you have no more than a passing interest in Formula 1 racing you will realise that whilst the attention invariably focuses on the driver of the car, their success is only possible because of the effort from the supporting team.
After all, the driver tends not to jump out of the car in the pits to do his own refuelling!
Similarly, many patients will describe their interaction with a dental practice as 'going to see the dentist' or having a 'dental appointment'. How many of them, I wonder, ever consider the team of individuals who are involved in the delivery of their care?
Are you a team player?
It is not uncommon for job descriptions to express a preference for the applicant being a 'team player'. Much has been written in psychology texts with regards to personality types and a number of tests have been designed to determine personality such as the one created by Myers and Briggs. These assessments are useful in providing an indication of individual preferences in relation to working arrangements.
Some people understandably find themselves described or indeed refer to themselves as a 'control freak'. Another way of considering this trait would be to recognise an individual's inability (or fear) to delegate, in some cases, for even the simplest of tasks.
In failing to delegate treatment to a dental care professional the general dental practitioner is not benefiting from the services of the highly motivated and skilled resource in the form of dental therapists. As a result the dentist in question will have less time to deploy elsewhere in the practice.
The dental hygienist
It is probably fair to say that the majority of dentists would not claim to be as proficient as the average hygienist when performing tasks such as root planning and polishing. This is hardly surprising since hygienists spend a lot of their time developing these skills.
Unfortunately Dental Protection also sees many cases which involve claims for periodontal neglect over an extended period of patient care. Had there been a proper diagnosis of periodontal problems coupled with appropriate referrals to the dental hygienist, it is likely that many of these claims could have been avoided or even better, prevented.
The dental therapist
A recent survey undertaken by a dental therapy student found that the understanding amongst general dental practitioners of the dental therapist's role was extremely poor. There was a broad misconception that this group of registrants could only restore the primary dentition. Nor was it universally recognised that their training enables dental therapists to restore permanent teeth, extract primary teeth and give local anaesthetic. Similarly there was evidence that many dentists assumed that dental therapists could only be employed in the salaried service and not in general practice.
Prescription and referral
It is still mandatory for a patient to undergo a full mouth inspection by a dentist before any aspect of the treatment plan can be delegated by prescription to be treated by either a hygienist or a therapist.
Historically the patient would be required to see the dentist again prior to, say, having another course of scaling. However the most recent guidance from the General Dental Council allows some flexibility in the period of validity for the prescription dependent on the needs of the individual patient. Whilst the reassessment date still needs to be set by the dentist the recall period can now be decided by the dental care professional.
Underlying concern
Dental Protection indemnifies all registered members of the dental team and so we have a unique opportunity within this organisation to develop a deep understanding of the many issues that arise within the profession. Members will sometimes contact Dental Protection wanting to know if they should whistleblow to the GDC in respect of a dentist about whom they have concerns. This could be as a result of the patient potentially being at risk due to the health, behaviour or clinical performance of the individual concerned. Members who contact DPL on such matters are frequently concerned that they could find themselves in trouble if they do not report a perceived concern regarding colleagues.
Patient safety is of paramount importance and their best interests should be served by all registrants at all times.
Fortunately, the incidence of genuine concerns warranting a referral to the GDC is low.
Recently qualified dentists have been equipped with the latest thinking in training and there can sometimes be a disparity between their picture of what a dental surgery should be and the reality of their first practice. In the unlikely event that the recently qualified dentists feels that the problem needs to be investigated, Dental Protection would normally recommend that any such issues are dealt with on a local basis as a first step. Raising concerns with the senior manager or clinician can be a useful avenue to explore in this respect.
Including you
There is nothing to prevent the new dentist who joins a practice from being the subject of scrutiny by the existing team members.
We all work in different ways and have different levels of confidence. Dental Protection is aware that some DCPs are uncertain about what constitutes a reasonable spectrum of professional behaviour, and rather than being criticised for not mentioning their concern, they opt for the safer option of reporting their concern without any discussion.
Sometimes it turns out that they have simply misjudged the unfamiliar pattern of working of the new member of staff. To prevent this happening it is very sensible to spend time introducing yourself to the DCPs in your new practice and empowering them to ask you about anything they don't understand or which seems unusual to them. In this way you are unlikely to be surprised by an unexpected return to the pits at the GDC.
Joe Ingham is a dento-legal adviser who also works as a tutor at the School of Hygiene and Therapy at The Eastman.