Archived: Dentoral Dental Practice - Leicester

We carried out an announced comprehensive inspection on 25 January 2016 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations.

Background

Dentoral Dental Practice is located close to the centre of Leicester. There are good public transport links to Leicester and to the outskirts of the City. Car parking is limited to on street only as the practice does not have parking facilities.

The practice provides mainly NHS dental services and a small amount of private dental services. It treats both adults and children. The practice serves a population of approximately 4,000. There are a greater number of local residents with an Asian ethnic background and higher levels of deprivation within the area.

There are four dentists working in the practice including the principal dentist. Two of the dentists were on long term leave when we inspected the practice. There are also four dental nurses employed. The practice does not currently have a hygienist but we were told by the practice that that they were seeking to recruit one.

In addition, the practice has a practice manager (who is also qualified as a dental nurse) and a receptionist to provide support to the dental team.

The practice opening hours are: Mondays, Tuesdays, Thursdays and Fridays 9:30am to 5:30pm and Wednesdays 9:30am to 12:30pm.

We received feedback from 13 patients. All feedback included positive comments about the practice. Some comments supported that the practice was responsive because patients would be seen quickly if required. We did not receive negative comments about the practice from patients we spoke with.

Our key findings were:

• The practice had a system for recording and analysing significant events and complaints and sharing learning with staff. However, we found limited examples to demonstrate the robustness of those systems in place.
• Staff had received safeguarding and whistleblowing training and knew the procedures to follow to raise any concerns.
• There were sufficient numbers of suitably qualified staff to meet patients’ needs.
• Staff had been trained to handle emergencies and appropriate equipment and medicines were readily available. However, we found that the practice did not have an AED (automated external defibrillator) in place. The practice manager informed us that they had made a decision to place an order for an AED prior to our inspection and we were provided with evidence of the order details.
• Infection control procedures were in place and the practice followed national guidance.
• There was limited assurance that patients’ care and treatment was planned and delivered in line with evidence based guidelines, and current best practice.This was because the one dentist present on the day of the inspection was unaware of current best practice guidelines.
• We examined documents maintained by the primary dentists who operated at this practice. We found these documents examined were limited in respect of information held regarding patient care and treatment. We were not assured that patients received clear explanations about their proposed treatment, costs, options and risks or that they were involved in making decisions about it.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met patients’ needs whether they wanted to be seen urgently or for more routine appointments.
• There was evidence that staff worked as a team and this approach had a positive outcome in some areas. There were a number of areas where robust leadership was required. This included compliance with best practice guidance and statutory standards.
• Whilst some governance systems were in place, there was limited assurance regarding clinical and non-clinical audits to monitor the quality of services.

There were areas where the provider could make improvements and should:

• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.
• Review the practice’s protocols for completion of dental care records giving due regard to guidance provided by the Faculty of General Dental Practice (FGDP) regarding clinical examinations and record keeping.
• Introduce protocols regarding the prescribing and recording of antibiotic medicines in consideration of guidance provided by the Faculty of General Dental Practice in respect of antimicrobial prescribing.
• Review its audit protocols to ensure audits of various aspects of the service, such as radiography and dental care records are undertaken at regular intervals to help improve the quality of service. Practice should also ensure, that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.
• Review and incorporate guidance issued by the Department of Health regarding the delivery of better oral health.
• Review the practices recruitment policy giving due regard to Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all new staff.
• To respond to the local needs of their population group by raising awareness in practice literature of the impact of lifestyle choices on patients’ health, eg smoking cessation and dietary factors.