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I’m now at least an inch shorter than last week, having walked for hours around the Dentistry Show at the NEC, Birmingham. My legs still ache, and a spot of medicinal malt whisky has only taken the edge off a throbbing soreness on the soles of my feet. Was it worth it?
Generally, it was a fairly predictable collection of stands all trying to sell us the latest, and unaffordable, technology. However, I did spend a long time at the Care Quality Commission (CQC) stall and talked to some people who were surprisingly helpful and friendly. What they said actually makes sense and has put things in perspective. They maintained that despite the fanfare around the new Fundamental Standards, nothing much has actually changed!
A simplified view
There are not a lot of new standards, as such, just a simplified way of looking at things. All the current QCS Policies and Procedures will provide support for the ongoing care and evidence that standards are being maintained. The Inspection Procedures have become more investigative and deeper in nature, but fewer of us will actually attract an inspection.
They reminded me that there are only two additions to the old standards and these are in order to meet the latest regulations - Regulation 5: Fit and proper persons and Regulation 20: Duty of candour.
Who is a ‘fit and proper person’?
This test applies to those people who are directors of dental services, or hold similar positions, such as partners and owners. Here are some of the details as outlined by the CQC.
First of all, they have to be of ‘good character’. It is difficult to outline every character trait that an individual should have, however, among them the CQC would expect to find values of honesty, trust and respect. Individuals should not have been complicit with significant care failures, and none of the definitions of unfitness should apply to that individual. These include the appearance of the individual on barred lists of the Safeguarding Vulnerable Groups Act 2006, and/or any decisions made by any professional regulatory bodies that have resulted in removal from their registers. The CQC will have regard to information on when convictions, bankruptcies or similar matters are to be considered ‘spent’.
Individuals should have a caring and compassionate nature. ‘Caring’ is one of CQC’s key questions against which they rate, and they expect this attribute to be at the core of those delivering healthcare. During inspections they explore whether staff are caring towards people receiving services and whether people are treated with compassion. One way of doing this is by asking people receiving services how they feel when they are being treated or spoken to by staff in that service, and asking staff how senior leaders set the tone and culture of the organisation in this respect.
They have fleshed out what ‘serious misconduct’ might mean, and suggest this could include assault, fraud, theft, breaches of health and safety regulations, intoxication while on duty, any breach of confidentiality, disobedience of lawful and reasonable instruction, and disrespect in the workplace.
As stated in the guidance, a director must not have been responsible for, been privy to, contributed to or facilitated any serious misconduct or mismanagement in carrying on a regulated activity. Individuals should not have been complicit with significant care failures.
‘Duty of Candour’
The new Duty of Candour is concerned with being open and honest with patients when something goes wrong. It is discussed in terms of ‘serious’ or ‘notifiable’ incidents, which doesn’t actually help us a lot because these are few and far between in dental practice . However the same principles apply whenever anything does not go according to plan!
Patients need to be told about something within a reasonable amount of time. Although not defined in the regulation, it is taken that the notification must be within at most 10 working days of the incident, and sooner where possible. Records should be complete, legible, accurate and up-to-date. Every effort must be made to ensure records are updated without any delays. Clear, honest and effective communication with patients, their families or carers should be demonstrated.
- Openness - enabling concerns and complaints to be raised freely without fear, and questions asked to be answered.
- Transparency – allowing the truth about performance and outcomes to be shared with staff, patients, the public and regulators.
- Candour - any patient harmed by the provision of a healthcare service is informed of the fact and an appropriate remedy offered, regardless of whether a complaint has been made or a question asked about it.
Fundamental or Essential – all the same!
So, just to repeat the ‘don`t panic’ message, there is not much change except for the new regulations concerns the Fit and Proper Persons Act and the Duty of Candour. Although the new inspection processes are more thorough, most inspections will be preceded by a list of evidence that will be required at least a fortnight before the inspection date.
Keep Calm and Carry on Practicing!
Dr John Shapter – QCS Expert Dental Contributor