Item 7ACouncil

23 June 2004

Standards for Dental ProfessionalsNew core standards guidance and supplementary guidance

Purpose of paper For action.

Mission statement/business plan To set and promote high standards across the dental team.

Issues 1. To approve a final draft of core standards guidance to replace Maintaining Standards.

2. To approve supplementary guidance on consent and confidentiality to be sent out for public consultation.

Recommendations Please see paragraph 34.

Authorship and origins of paper Frances Garratt, Standards Committee Secretary, following Committee discussion.

Presentation to Council Sally Irvine, Standards Committee Chair.

Further information Frances Garratt020 7887 3847fgarratt@gdc-uk.orgorRobin Newman020 7887 3801rnewman@gdc-uk.org

Introduction

1. Council publicly consulted on draft standards guidance to replace Maintaining Standards towards the end of 2003. The new draft guidance had a working title of Standards for Dental Practice. The responses to the consultation were summarised in the Standards Committee’s report to Council of March 2004.

2. The consultation followed a review of Maintaining Standards, which concluded that1:

a. The primary objective of the Council’s ethical guidance should be to act as a guide for individual practitioners on the principles of ethical practice;

b. The guidance should establish the framework of principles and values within which a dental professional should operate and provide guidance on how to make decisions within that framework;

c. The guidance should be addressed to individual practitioners but will also serve to explain the ethical framework of dental care to patients and healthcare providers;

d. Ethical guidance should be addressed to the whole dental team on the basis that the same ethical principles will apply to all members of the team, even though how they apply them will differ according to their roles and circumstances;

e. Ethical guidance should not include detailed technical guidance nor should it operate as a rule book;

f. If there is a need for the Council to issue detailed guidance on specific complex issues, this should be produced separately from the ethical guidance. This could be done either in different publications or as an annex to the ethical guidance.

g. The guidance should be clear and understandable for practitioners and members of the public alike.

h. The guidance will continue to be the main vehicle for the Council to express its views on the standards expected of dental professionals. An important secondary use of the ethical guidance will be to inform decision-making at the various stages of fitness to practise procedures, by illustrating the principles promoted by the Council.

Discussion

Standards for Dental Professionals

3. The Standards Committee has revised the draft guidance in the light of responses to the consultation and Committee discussion. The final draft is at Annex 1.These revisions include a change of title to Standards for Dental Professionals, to better reflect the fact that the guidance applies to all members of the dental team, whatever their working environment, and is focussed on the professional responsibility of the individual.

1 These conclusions were endorsed by Council in November 2002.

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4. The advice of the Council’s diversity and equal opportunities consultant has been sought and incorporated in relation to the paragraphs dealing with those issues.

General anaesthesia and conscious sedation

5. The Council currently gives detailed guidance on general anaesthesia and conscious sedation in Maintaining Standards. The inclusion of Council guidance on general anaesthesia arose out of major public concern following patient deaths after general anaesthesia for dental treatment, and an absence at the time of authoritative guidance available to the dental profession as a whole from other sources. Detailed guidance on the use of sedation followed.

6. The inclusion of this guidance is inconsistent with the general approach taken in Maintaining Standards, which does not include detailed clinical or technical guidance on other issues.

7. This was recognised by the General Anaesthesia and Conscious Sedation Working Group, which was charged with producing and reviewing the Maintaining Standards guidance on general anaesthesia and conscious sedation between 1998 and 2001. It was envisaged by this group that it should be possible to remove most of the Council’s guidance on sedation once a Standing Dental Advisory Committee (SDAC) report of an expert group, entitled Conscious Sedation in the provision of dental care, had been published. It was felt that the SDAC guidance would be a more appropriate mechanism for providing clinical advice to dental professionals, given that the Council is not constituted to give detailed technical guidance of this kind.

8. In the light of the historical significance of the Council’s guidance on general anaesthesia and conscious sedation, and the fact that these issues are major patient safety concerns, the Standards Committee decided that, exceptionally, it would make reference to general anaesthesia and conscious sedation in Standards for Dental Professionals. It agreed to do this by including a short statement as an annex to the new core standards guidance.

Website provision of list of other sources of advice

9. Maintaining Standards contains a limited bibliography, which makes reference to other organisations which provide guidance to dental professionals, certain pieces of legislation, and specific guidance produced by other bodies.

10.The Committee did not consider it practical to include a bibliography in the body of Standards for Dental Professionals. Doing so would create difficulties in keeping the information up-to-date in hard copy and, presentationally, would potentially detract from the purpose and content of the core guidance.

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11.However, the Committee agreed that it would be useful to produce a list of a range of sources of information and guidance for dental professionals and the public on the Council’s website.

12. It would be desirable to limit the information provided to sources of advice and guidance, rather than to refer to specific pieces of guidance or legislation. This was in recognition of the fact that such a list could not – and should not -attempt to be exhaustive, given the individual professional’s responsibility to keep informed of laws, regulations, contemporary standards and authoritative guidance affecting his/her work.

13.Reference would be made in Standards for Dental Professionals to the list being available on the website, or by telephoning or emailing the Council.

Supplementary guidance

14.One of the conclusions of the Maintaining Standards review was that, if there were a need for the Council to issue detailed guidance on specific, complex issues, this should be produced separately from the main guidance.

15.The Committee considered criteria for deciding on whether or not further, more detailed guidance on an issue was required, and also agreed some general principles to be applied to all standards guidance produced by the Council.

General principles

16.Following on from the principle established by the Maintaining Standards review that the Council should not produce detailed technical guidance or a rule book, the Committee agreed that the Council should also avoid:

a. Giving legal advice - the responsibility of dental professionals to make sure they comply with relevant laws and regulations is made clear in the new guidance Standards for Dental Professionals. The Council is not an appropriate authority for giving legal advice to dental professionals.

b. Endorsement of third party guidance - issues of responsibility, accountability and quality assurance arise for the Council in considering any arrangements involving the endorsement of third party guidance. Endorsement would defeat many of the objectives behind the Council not issuing specific guidance itself. For example, the Council could be drawn into disputes about the contents of third party advice it had endorsed, and responding to requests for interpretation of that advice.

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Criteria for supplementary guidance

17.Having established these general principles, the Committee agreed that in considering whether or not to provide guidance supplementary to Standards for Dental Professionals on an issue, the Council should take into account:

a. The Council’s statutory functions and mission statement e.g. would the Council be failing in its public protection function if it did not produce guidance on a particular issue?

b. Whether the issue has come up frequently in complaints or fitness to practise proceedings, indicating a potentially widespread problem;

c. Whether there is a demand for guidance from the profession and/or the public (to be determined from sources such as data held about the nature and frequency of enquiries to the Council);

d. Whether sufficient guidance is available to the profession as a whole from other authoritative sources, which practitioners could reasonably be expected to take into account if adhering to the principle “follow contemporary standards”. Is there a gap in the guidance available which the Council should fill?

e. Whether the Council has a different perspective on the subject to that of the bodies which have provided guidance and which it would wish to express? (e.g. defence organisations produce comprehensive guidance on many subjects but these are from the perspective of protecting the professional, rather than the public, interest);

f. Public accessibility to existing guidance;

g. Whether there are any political issues to take into account;

h. Whether the advice the Council could reasonably provide, given its statutory functions and mission statement, would be genuinely useful to the profession and/or the public.

18.Taking these factors into account, the Committee decided that the Council should produce supplementary guidance on consent, confidentiality and the dental team.

19. In relation to consent and confidentiality, the Committee felt that these issues were critical to public trust. Although the Council has not previously issued guidance on these subjects, it was felt that due to the changing nature of the relationship between patients and healthcare professionals, it would now be appropriate to do so.

20.However, the Committee agreed to limit these guidances to the ethical issues around patient consent and confidentiality of patient information, since the

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Council is not constituted to give legal advice. Draft guidances on confidentiality and consent are attached at Annex 2 and Annex 3.

21. Issues around the production and timetabling of guidance for the dental team are dealt with separately at Item 7B.

Moving from Maintaining Standards to the new guidance

22.The Committee also concluded that special care would be needed to manage the process of moving from the existing guidance to the new guidance. In particular, registrants would need to understand that the absence in the new guidance of some of the more detailed information currently contained in Maintaining Standards should not be taken as meaning that the Council had ceased to be concerned about those matters. It would be necessary to consider how best to explain to registrants the new approach.

Next steps

23.The new standards guidance as a whole needs to be in place in advance of the opening of the new PCD register.

24. In order to meet the timetable for publication of the guidance, the next steps suggested by the Committee are as follows.

Following the Council meeting:

To send the final draft of the core guidance to the Plain English Campaign for approval (please see paragraphs 25-27 for further details of this process).

To send the draft guidance on confidentiality and consent out for public consultation.

To report to Council in December on the consultation responses and to submit final drafts of the guidance documents on consent and confidentiality for approval, onward submission to the Plain English Campaign for approval, and publication.

To publish Standards for Dental Professionals and supplementary guidance on confidentiality and consent, and send copies to existing registrants, in January. (New registrants will receive the guidance on joining the register.)

Plain English campaign approval

25. It is Council policy to send all corporate publications to the Plain English Campaign for approval prior to publication.

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26.The Plain English Campaign will, subject to any amendments it suggests being accepted, award each of the standards documents with a “crystal mark”.

27.Council is asked to note that once changes have been made by the Plain English Campaign and the crystal mark awarded, a contractual requirement of the relationship with the Campaign is that no further changes are made to the document without reapplying to the Campaign for approval and issue of a new crystal mark.

Diversity implications

28.All standards guidance produced should be accessible to the profession and the public. The website list of other sources of information and advice should also be accessible both to dental professionals and the public, and should reflect the devolved administrations where appropriate.

29.As previously stated, the advice of the Council’s diversity and equal opportunities consultant has been sought and incorporated into the paragraphs of Standards for Dental Professionals which deal with diversity issues.

Communications implications

30.The Standards Committee has developed a publicity campaign proposal (to be submitted to the Corporate Relations Working Group), setting out a comprehensive strategy to communicate the implementation of the new guidance to dental professionals.

31.The focus of the campaign will be to ensure that registrants and prospective registrants are aware of the new guidance, understand the approach to the guidance and their individual responsibility as professionals, and the fact that the guidance replaces Maintaining Standards and represents the Council’s definitive statement on standards.

32.Registrants and prospective registrants will also need to understand the relationship between standards and the new fitness to practise arrangements.

Resource implications

33.Budgetary provision has been made for publication of the new guidance. Additional budgetary provision has been requested to enable a comprehensive communications strategy to be implemented.

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Recommendations

34.Council is recommended by the Standards Committee to:

a. Approve the final draft of Standards for Dental Professionals at Annex 1, for submission to the Plain English Campaign for approval and subsequent publication.

b. Agree the draft guidance on confidentiality at Annex 2 to be sent out for public consultation.

c. Agree the draft guidance on consent at Annex 3 to be sent out for public consultation.

d. Note that the publication of these documents will be supported by a comprehensive communications strategy.

e. Note the intention to publish Standards for Dental Professionals and supplementary guidance on confidentiality and consent, in January, and the necessity of publishing all the new standards guidance in advance of the opening of the new PCD register.

f. Note the terms on which Plain English Campaign crystal marks are awarded.

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Annex 1

Final draft of core standards guidance

Standardsfor

Dental Professionals

[insert publication date] General Dental Council

www.gdc-uk.org

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About this booklet

This booklet identifies the principles which should guide your work as a dental professional. It underpins all other guidance issued by the General Dental Council (GDC).

The principles should inform all aspects and stages of your professional education and practice. You should apply the principles appropriately to any work in which you are involved as a dental professional, whether or not you routinely treat patients.

Clinical standards in dentistry are constantly evolving. The GDC does not issue clinical guidelines or statements on clinical standards, with the exception of the policy statement on general anaesthesia and conscious sedation at the annex to this booklet.

As a dental professional you are responsible for making sure that

you are familiar with and understand

current standards which affect your work relevant guidelines issued by bodies other than the GDC and

available sources of evidence underpinning current standards

you apply your up to date knowledge and skills ethically.

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The principles of practice in dentistry

As a dental professional, you are responsible for:

1. Putting patients’ interests first and acting to protect them

2. Respecting patients’ dignity and choices

3. Protecting the confidentiality of patients’ information

4. Co-operating with other members of the dental team and other healthcare colleagues in the interests of patients

5. Maintaining your professional knowledge and competence

6. Being trustworthy

Applying these principles

It is your responsibility to apply these principles to your daily work, exercising your judgement in the light of the principles.

You have a professional responsibility to be prepared to justify your actions and you may be called upon to do so. You must be willing and able to demonstrate that

you are aware of this booklet and you have upheld the principles which it explains

If you cannot give a satisfactory account of your behaviour or practice in line with the principles explained in this booklet, your registration will be at risk.

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1. Put patients’ interests first and act to protect them

1.1 Put patients’ interests before your own or those of any colleague, organisation or business.

1.2 Apply these principles when handling queries and complaints from patients and in all other aspects of non-clinical professional service.

1.3 Work within the scope of your knowledge, professional competence and your physical capabilities. Refer patients for a second opinion and for further advice or treatment when it is necessary to do so and/or at the patient’s request.

1.4 Make and keep accurate, complete and contemporaneous patient records, including a medical history. Make sure that patients have easy access to their records.

1.5 Give patients who make a complaint about any aspect of the care or treatment they have received a timely and helpful response. Do not allow a patient’s complaint to adversely affect the care or treatment you provide or arrange for that patient. Co-operate fully with any complaints procedure which applies to your work and with any formal inquiry into the treatment of a patient.

1.6 Maintain appropriate membership of a defence organisation or ensure that you are otherwise indemnified against claims at all times, including past periods of practice.

1.7 If you believe that patients might be at risk because of your health, behaviour or professional performance, or those of a colleague, or by any aspect of the clinical environment, it is your responsibility to take action. Obtain advice from appropriate colleagues, a professional body or your defence organisation. If at any time you are uncertain how to proceed, contact the GDC.

1.8 Never ask for, nor accept, any inducement, gift, or hospitality, or make or accept any referral, which may affect, or appear to affect, your professional judgement.

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1.9 Do not make any claims which could mislead patients.

2. Respect patients’ dignity and choices

2.1 Treat patients with respect and courtesy, in recognition of their dignity and rights as individuals.

2.2 Recognise and promote patients’ responsibility for making decisions about their bodies, their priorities and their care, making sure you do not take any steps without consent. [There will be a reference here to supplementary guidance on the ethical considerations in consent.]

2.3 Treat patients fairly and in accordance with the law. Promote equality of opportunity for all patients. Do not discriminate against patients or groups of patients according to their gender, age, race, ethnic origin, nationality, special needs or disability, sexuality, health, lifestyle, beliefs or any other irrelevant consideration.

2.4 Listen to patients and give them the information they need, in a way they can use, to enable them to make decisions. This will include establishing and maintaining effective communication with patients, explaining options (including risks and benefits), and giving full information on proposed treatment and costs to them.

2.5 Maintain appropriate boundaries in the relationships you have with patients. Do not abuse those relationships.

3. Protect the confidentiality of patients’ information

3.1 Treat information about patients as confidential and only use it for the purposes for which it is given.

3.2 Prevent accidental disclosure or unauthorised access to confidential information by keeping information secure at all times.

3.3 In exceptional circumstances, disclosure of confidential patient information without consent may be justified in the public or patient’s interest. Seek appropriate advice before disclosing

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information on this basis. [There will be a reference here to separate guidance on confidentiality].

4. Co-operate with other members of the dental team and other healthcare colleagues in the interests of patients

4.1 Work co-operatively with other team members and colleagues and respect their role in the care of patients.

4.2 Treat all team members and other colleagues fairly and in accordance with the law. Do not discriminate against them.

4.3 Communicate effectively and share your knowledge and skill with other team members and colleagues as necessary in the interests of patients. In all dealings with other team members and colleagues, make the interests of patients your first priority. [There will be a reference here to supplementary guidance on dental team working]

5. Maintain your professional knowledge and competence

5.1 Recognise that your primary qualification was the first stage in your professional education. Develop and update your knowledge and skills throughout your working life.

5.2 Keep your knowledge, skills and professional performance under continuous review; reflect upon them; identify and understand your limitations as well as your strengths.

5.3 Make yourself aware of current best practice in the fields in which you work. Provide a good standard of care based on available contemporary evidence and authoritative guidance.

5.4 Make yourself aware of laws and regulations which affect your work, premises, equipment and business, and comply with them.

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6. Be trustworthy

6.1 Justify the trust placed in you by patients, the public and your colleagues by acting honestly and fairly in all your personal and professional dealings.

6.2 Apply these principles to clinical and professional relationships and also to any business or educational activities in which you are involved.

6.3 Maintain appropriate standards of personal behaviour in all walks of life, so that patients’ confidence in you, and public confidence in the dental profession, are enhanced.

Guidance supplementary to this booklet

In addition to this booklet, the GDC has produced supplementary guidance booklets on:

Patient ConsentConfidentiality of patient information; andTeam Working

[titles of the above documents yet to be agreed]These booklets, and additional copies of this booklet, can be downloaded from our website or you can telephone or email us for copies using the contact details below.

Other sources of advice

You can find a list of a range of further sources of information and advice for dental professionals and the public on our website at www.gdc-uk.org. Or, you can telephone us for a copy of the list on 020 7887 3800 or email us on ProfessionalStandards@gdc-uk.org

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Annex

GDC statement on providing dental treatment under general anaesthesia and conscious sedation

Dental treatment under general anaesthesia should only be undertaken when absolutely necessary only take place in a hospital setting with critical care

facilities. General anaesthesia may only be administered by an individual

who is on the specialist register of the General Medical Council as

an anaesthetist; or a trainee working under supervision as part of a Royal

College of Anaesthetists’ approved training programme; or a non-consultant career grade anaesthetist with an NHS

appointment under the supervision of a named consultant anaesthetist, who must be a member of the same NHS anaesthetic department where the non-consultant career grade anaesthetist is employed.

The anaesthetist should be supported by an individual specifically trained and experienced in the necessary skills to assist in monitoring the patient’s condition and in any emergency.

The GDC supports the recommendations contained in the Department of Health (England) publication A Conscious Decision – a review of the use of general anaesthesia and conscious sedation in primary dental care (July 2000) and associated letters of advice from Chief Dental Officers in England, Northern Ireland, Scotland and Wales.

The GDC also supports the guidance contained in Conscious Sedation in the provision of dental care (November 2003), a Standing Dental Advisory Committee report of an expert group on sedation for dentistry, commissioned by the Department of Health. The GDC expects dental professionals to follow this guidance.

[publication date]

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Annex 2

Draft of supplementary guidance on principles of confidentiality

Our core standards guidance Standards for Dental Professionals sets out six key principles which you should apply to all aspects of your work as a dental professional.

It is your responsibility to apply the principles to your daily work, exercising your judgement in the light of the principles.

The guidance states:

“Protect the confidentiality of patients’ information”

Treat information about patients as confidential and only use it for the purpose for which it is given

Prevent accidental disclosure or unauthorised access to confidential information by keeping information secure at all times

In exceptional circumstances, disclosure of confidential patient information without consent may be justified in the public or patient’s interest. Seek appropriate advice before disclosing information on this basis.

You have both an ethical and a legal duty to keep patient information confidential. This guidance deals with the ethical issues around protecting the confidentiality of patients’ information.

We do not give legal advice. As Standards for Dental Professionals explains, you are responsible for making yourself aware of laws and regulations which affect your work, premises, equipment and business, and complying with them. If you are in doubt on the legal issues around protecting and providing patient information, ask an appropriate source – for example, your defence organisation - for advice.

Duty of confidentiality

Patients are entitled to expect that you will protect the confidentiality of information you hold about them.

Confidentiality is central to the relationship of trust between you and your patient.

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The duty of confidentiality applies:

to all members of the dental team.

to all information about the patient which you learn in your professional capacity and from which the patient can be identified. This includes, for example, recognisable patient images such as photographs.

The duty of confidentiality applies even after a patient dies.

If it is necessary to disclose patient information:

Seek the patient’s consent to do so wherever possible. Read our guidance Principles of Patient Consent for advice on obtaining consent

Make sure that you only disclose the minimum information necessary for the purpose

Be prepared to justify your decisions and any action you take

Disclosure with the patient’s consent

Make sure that you explain to patients the circumstances in which information about them might be shared with others involved in their health care.

Give patients the opportunity to withhold permission for you to share information about them.

Where a patient allows you to share information about them, make sure the patient understands:

what you will be disclosing

the reasons you will be disclosing it

the likely consequences of the disclosure

If you have permission to disclose information, make sure anyone you share that information with understands that the information is confidential.

If you are given patient information to enable you to provide care for a patient you have a legal duty to keep the information confidential.

You may be asked to provide patient information by third parties, for example, to assist teaching or research, or you may yourself wish to

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use patient information for the purposes of teaching or research. If so, make sure you apply the principles in this guidance by

seeking the patient’s consent, whether or not you judge that the patient can be identified from the disclosure

making sure the patient understands exactly what they are consenting to and how the information will be used

making sure that you only disclose the minimum information necessary for the purpose.

If it is not necessary for the patient to be identified from the disclosure, anonymise the data you disclose so that the patient cannot be identified.

Preventing accidental disclosure

Make sure that you protect the confidential information you are responsible for when you receive it, store it, transmit it or dispose of it.

Store records securely and don’t leave them lying around or on screen where they might be seen by other patients, unauthorised health care staff or members of the public.

Don’t talk about patients where you can be overheard

Disclosure in the ‘public interest’

You may judge that you should share confidential information without consent in the public interest. This might happen where the patient puts their health and safety or other peoples’ health and safety at serious risk.

If you think it is in the public interest for you to share confidential information, before you act, and where practicable, do everything you can to persuade the patient to disclose the information themselves, or to give you permission to disclose the information.

If you cannot persuade the patient to do this, or it is not practicable to do so, take advice from an appropriate source, such as your defence organisation, before you disclose the information.

Disclosure required by court order

A court may order you to disclose patient information without consent. If so:

Take legal advice from an appropriate source such as a defence organisation before you disclose the information.

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Only disclose the minimum information necessary to the proceedings.

In any circumstance where you decide to disclose confidential information, be prepared to explain and justify your decision and any action you take.

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Annex 3

Draft of supplementary guidance on principles of patient consent

About this booklet

Our core standards guidance Standards for Dental Professionals sets out six key principles which you should apply to all aspects of your work as a dental professional.

It is your responsibility to apply the principles to your daily work, exercising your judgement in the light of the principles.

The guidance states:

“Respect patients’ dignity and choices”

Treat patients with respect and courtesy, in recognition of their dignity and rights as individuals.

Recognise and promote patients’ responsibility for making decisions about their bodies, their priorities and their care, making sure you do not take any steps without consent.

It is a general legal and ethical principle that valid consent must be obtained before starting treatment or physical investigation, or providing personal care, for a patient. This principle reflects the right of patients to determine what happens to their own bodies, and is a fundamental part of good practice.

Patients have a right to choose whether or not to accept your advice or treatment. This guidance expands on the ethical principles of obtaining patient consent which you should apply to your work.

We do not give legal advice. As Standards for Dental Professionals explains, you are responsible for making yourself aware of laws and regulations which affect your work, premises, equipment and business, and complying with them. If you are in doubt on the legal issues around obtaining patient consent, ask an appropriate source – for example, your defence organisation – for advice.

Ethical issues in obtaining patient consent

You should give patients the information they want and need, in a way they can use, so that they are able to make informed decisions about their care.

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Giving and obtaining consent is a process, not a one-off event. It should be part of an ongoing dialogue between you and the patient.

For consent to be valid, the patient must have received sufficient information to make the decision.

Take steps to find out what your patients want to know as well as telling them what you think they need to know. Examples of information which patients should know or may want to know include:

Why you think a proposed treatment is necessary

Risks and benefits of proposed treatment

What might happen if the treatment is not carried out

Any alternative forms of treatment available, and their risks and benefits

Details of anticipated treatment costs

Explaining costs

In respect of costs, you should always make clear to the patient:

the nature of the contract and in particular whether the patient is being accepted for treatment under the NHS or privately

the charge for an initial consultation and the probable cost of subsequent treatment

Where treatment is likely to be extensive, give the patient a written treatment plan and estimate.

If, having agreed an estimate with the patient, you think that you will need to modify the treatment plan, make sure you obtain the patient’s consent to any further treatment and additional cost; and give the patient an amended written treatment plan and estimate.

Informed consent

Giving a patient clear information to enable them to take a decision may involve using written material, visual or other aids to best explain aspects of treatment.

Try to meet particular communications needs such as hearing difficulties or language barriers, for example, by suggesting that the patient brings a friend

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who can sign or interpret if there are hearing or language difficulties, or providing a hearing ‘loop’.

Satisfy yourself that the patient has understood the information you have given them.

Consider whether they would like more information before making a decision; and whether they would like more time before making a decision.

Respond honestly and fully to any questions the patient has.

Involve other members of the dental team in discussion with the patient, where appropriate. They may have valuable knowledge about the patient’s background and particular concerns.

Do not pressurise the patient to accept your advice. The decision must be that of the patient.

Patients have a right to refuse consent to investigation or treatment. If they do so, they also have a right to expect that doing so will not negatively affect their relationship with you.

Once given, a patient may withdraw consent at any time, including during the performance of a procedure.

Make sure that, once consent has been obtained, the patient is given a clear route for reviewing the decision with the person providing the treatment.

Make sure you are clear as to the scope of the authority the patient has given you. For example, whether the patient consents to all or only part of a proposed treatment plan.

Who obtains consent

If you are the member of the dental team providing the treatment it is your responsibility to discuss it with the patient and obtain consent as you will have a comprehensive understanding of the procedure or treatment, how it is carried out and any risks attached to it. If it is not practicable for you to obtain consent, you may delegate these tasks provided you ensure that the person to whom you delegate:

is suitably trained and qualified;

has sufficient knowledge of the proposed treatment;

understands the risks involved; and

follows the principles explained in this booklet.

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If you delegate the responsibility of obtaining consent, you will remain responsible for making sure, before you start any treatment, that the patient has been given sufficient time and information to make an informed decision, and has given consent to the procedure or investigation.

Capacity to give consent

Every adult has the right to make his/her own decisions and must be assumed to have capacity to do so, unless demonstrated otherwise. Where there is any doubt, assess the capacity of the patient to give informed consent by considering whether or not the patient understands and can weigh up the information necessary to make the decision in question.

Consult your defence organisation or a professional body for up-to-date advice on:

how to deal with an adult patient who you think lacks capacity to give informed consent.

the law in relation to the capacity of children to give informed consent.

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