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Dental mythbuster 27: Well-led?
One of the five key questions we look at on our inspections is how well-led primary care dental practices are.
Our inspections in 2017/18 show most breaches of the regulations are under the well-led key question. Of 1,336 practices inspected during this period:
- 10% resulted in either requirement or enforcement action under the well-led key question
- in comparison, only 2% had any action taken under safe; while the effective, caring and responsive key questions saw very few or no breaches at all.
The regulations relating to the well-led key question are:
- regulation 17: good governance
- regulation 19: fit and proper persons employed
- regulation 5: fit and proper persons: directors
The GDC standards for the dental team state:
‘you must demonstrate effective management and leadership skills if you manage a team.’
Good leadership affects how the whole practice is run and, in turn, the experiences of patients. An empowered practice manager with delegated responsibility can make a valuable contribution, although many small practices are well-led without a manager.
We focus on how leadership, management and governance:
- assures high-quality care
- supports learning and innovation, for example, through audit and peer review
- promotes an open and fair culture.
‘Leaders’ in a practice can be:
- the principal dentist
- nominated individual
- others in management positions, for example, the practice manager
Our key lines of enquiry
In our health assessment framework there are eight key lines of enquiry (KLOE) relating to the well-led key question. In dentistry we do not rate providers. We use these KLOEs and inspection prompts to help us come to a judgment about whether the provider is meeting the regulations in the Health and Social Care Act.
Although we reserve the right to consider all prompts within the inspection framework, our inspectors will use their professional judgement to tailor the questions asked at each inspection to the individual practice. Providing the practice meets the requirements of the regulations, we would consider them to be well-led. This means that a dental practice does not need to provide documented evidence against every inspection prompt to meet the relevant regulations.
Does my practice strategy need to be written down?
No. You can have a written strategy, and some corporate providers do this routinely, but it is not essential. A practice must be able to explain their plans for the future to the inspection team. This should include how they would implement any necessary service improvements. A strategy may be to continue to operate as usual and not make any changes – this is acceptable if the practice is operating satisfactorily.
Do I need a written policy on modern day slavery (MDS)?
No. Inspectors might ask about MDS to assess a practice’s approach to safeguarding, but a written policy is not essential.
A written policy for safeguarding and/or MDS can help support knowledge and reduce risks so the practice runs safely and effectively. A written policy is not required to meet the regulations, inspectors assess the knowledge of staff.
Written policies are one source of evidence that inspectors consider. So not having a written policy would not automatically impact on our judgement of the quality of care offered.
Are the Deprivation of Liberties Safeguards (DoLS) relevant to me as a dental practitioner?
Yes. The Deprivation of Liberty Safeguards (DoLS) were introduced as an amendment to the Mental Capacity Act (MCA) and came into force in April 2009. The DoLS are additional safeguards to protect the rights of people who are deprived of their liberty in their own best interests to protect their health and safety.
DoLS are used in hospitals and care homes, so their significance might not be immediately obvious to the dental profession. Yet practices need to understand the safeguards and the implications when someone who is subject to a DoLS order moves in and out of their care.
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There is substantial evidence that culture – ‘the way we do things around here’ – and leadership can support services to deliver high-quality compassionate care. The well-led key question is therefore an important element of our assessment framework.
- Last updated:
- 12 December 2018