Inspectors will consider this topic of lone working when they review the safe key question.
There are two aspects to lone working:
- having someone else on the premises so there is support in a medical emergency and,
- whether you need chairside support from a dental nurse when treating patients.
When we judge whether or not lone working is safe we consider:
- the view of the General Dental Council (GDC) Professional guidelines: General Dental Council 'Standards for the Dental Team 'Principle Six: Work with colleagues in a way that is in patients’ best interests.'
- the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, regulation 18 (staffing) and regulation 12 (safe care and treatment).
Treating patients alone on the premises
GDC Standard 6.2: You must be appropriately supported when treating patients.
The purpose of this requirement is so someone is with you if there is a medical emergency. This is covered in standard 6.2.2 and 6.2.3. The only exceptions to this mandatory requirement are outlined in 6.2.2:
- Treating patients in an out of hours emergency
- Providing treatment as part of a public health programme
- There are exceptional circumstances.
GDC outlines ‘exceptional circumstances’ as those which are unavoidable, not routine and could not have been foreseen. Absences due to annual leave or training are not exceptional circumstances.
Standard 6.2.3 states that if there are exceptional circumstances which mean you cannot work with an appropriately trained member of the dental team when treating a patient in a dental setting, you must assess the possible risk to the patient of continuing treatment.
We would be concerned if our inspectors found dental care professionals working alone on the premises which are not covered by the exceptional circumstances stated in the GDC standards
Treating patients alone without chairside support
GDC standard 6.2: You must be appropriately supported when treating patients and
GDC standard 6.2.1: You must not provide treatment if you feel that the circumstances make it unsafe for the patients.
Whilst all dental care professionals must be appropriately supported, the GDC does not necessarily require all dental care professionals to have direct access to chairside support at all times. Dental care professionals should assess the circumstances and make a clinical judgement about the level of support appropriate to treat the patient safely. However, they would need to justify their actions to the GDC if their decision was called into question in a fitness to practise hearing.
If our inspectors found a dental care professional to be working alone without chairside support from a dental nurse, we would expect to see that a risk assessment had taken place. This needs to take into account how support or assistance would be provided in a medical emergency; for either the patient or dental care professional. This relates to the key line of enquiry S4 in the safe question: “How are risks to individual people who use the services assessed, and their safety monitored and maintained?"