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Welwyn Garden City Foundation Training Scheme for

General Dental Practice

Scheme Handbook 2014 – 2015

QEII Hospital Postgraduate Education Centre

Health Education East of England Dental Foundation Training

Welwyn Garden City Dental Foundation Training Scheme – Handbook 2014– 2015 1

elcome to the Welwyn Garden City Dental Foundation Training Scheme. This Handbook is to provide you with information

about the Scheme and how DFT functions. It is meant to be used in conjunction with the programmes which will be issued for each of the three terms, Autumn, Spring and Summer.

In the handbook there is a section about Health Education East of England and the people who make up the Foundation Training organisation. There is a section about venues for study days and also information about the ‘nuts and bolts’ of DFT organisation.

This year of DFT is a very valuable one during which you have the chance to gain wonderful experience in the provision of excellent dental care within a general dental practice setting. You will learn many things, and you will find yourself in many challenging situations. However, it is also meant to be fun.

Those who have undertaken DFT before you have found it to be a tremendous experience and they are always sad when they realise that their year is ending. You are at the start of your year and all is ahead of you. Let us work together to make it an excellent year for you.

Welwyn Garden City Dental Foundation Training Scheme – Handbook 2014 – 2015 2

Director of Dental education

Head of School of Dentistry

Mr. Alex Baxter BDS, MMEdSci, FDS RCPS (Glasg),

FDS (Rst Dent), RCPS

Regional Advisor in General Dental Practice

Dr. Peter Cranfield PhD, BDS, DIC, DGDP(UK)

Dental Education Coordinator

Ms. Elizabeth Hope

: [email protected]

Regional Vocational Training Administrator

Miss Elisabeth Graddage

: [email protected]

East of England Deanery

Other VT Schemes and Advisors in East of England Basildon Bedford Essex Coast Ipswich Norfolk

Mr. Graham Bishop Dr. Peter Cranfield Ms Hannah Woolnough Mr. Jason Stokes Mr. Andy FurnissBarming Dental Healthcare Ctre, 372 Tonbridge Road Maidstone, Kent. ME16 8TR ( 01622 728159

The Mews, 22 Bancroft, Hitchin, Herts. SG5 1JW ( 01462 434323

Parkview Dental Centre 49 Fonnereau Road Ipswich IP1 3JN ( 01473 254873

10 - 12 Cathedral Street, Norwich NR1 1LX ( 01603 628 963

57 Southlands, Swaffham, Norfolk. PE37 7PF ( 01760 721385

Postgraduate Dental Education Health Education East of England 2-4 Victoria House | Capital Park | Fulbourn | Cambridge | CB21 5XB

(01223 597 613

mailto:[email protected]



Peterborough

Mr. Andy Furniss Mr. Uday Patel 10 Market Square, Sandy, Beds. SG19 1HU ( 01767 681100

QE II Postgraduate Education Centre Howlands, Welwyn Garden City, Herts. AL7 4HQ ( 01707 224566

Welwyn Garden City Vocational Training Scheme Vocational Training Advisor

Elinor Japp, BDS, MA(Ed) FHEA

22 London Street,Godmanchester,

Huntingdon, Cambs. PE29 2HU

( Home: 01480 436485

Mobile: 07730 532739

Practice: 01480 462453

: [email protected]

Health Education East of England

Postgraduate Dental Tutor Dr. Kevin Jones

Postgraduate Centre Manager Mrs. Christine Crick



With the unexpected closure of the Postgraduate Education Centre at the QE2 in Welwyn Garden City we will be using a variety of venues to support the individual study day requirements.

You will need to refer to the programme handbook to ensure that you know the venue for each study day. You will need to plan your journey to ensure a prompt start for each study day.

We have had four very successful and happy years. It is up to you personally, and as a group ,to build on this experience, take your opportunities and become the professional people you aspire to be.

The Welwyn Garden City Scheme

The Welwyn Garden City scheme started in 2010. The expansion of dental undergraduate places in 2005 led to an increased need for Foundation Training places. It was the first new scheme in the East of England for 10 years and is now entering its fifth year.

From that starting point the scheme has developed and consolidated its creative and innovative ap-proach to teaching and learning. The educational philosophy is based on that of collaborative and workplace learning.

The purpose for learning in DFT is fundamentally different from undergraduate dental training. It is not about acquiring even more conceptual facts to put on to an exam paper. You are learning to be a func-tional, efficient and ethical practitioner working within the NHS regulations. Therefore the things and the ways you learn may feel very different from your undergraduate experience.

The purpose of study days is for you to bring your challenges and problems from practice into a safe and non judgemental environment and to be able to discuss these with peers and experts in the field.

The study days are your days. The more you contribute and participate the more you will gain.

There is opportunity for you to feedback on study days. This is invaluable in maintaining standards and responding to your learning needs as a group. There is flexibility within the second and third terms to accommodate specific group requests for study days provided they meet curricular requirements..

The WGC scheme has always been able to do demonstrate and celebrate the wide variety of talents within the group. This can vary from millinery skills, to paintballing or shooting through the trees on a zip wire.

We are the holders of the Super Seven Challenge Cup held at the residential each year. This involves dance, sporting and intellectual challenges.

As a scheme, we value the work life balance and the well being of trainees, trainers and Advisor alike. It is a joint effort to make the year successful, meaningful and enjoyable. We need everyone to play their part. We are a scheme and a learning community of professional people.


Postgraduate Centre

Resources As newly qualified dentists, you will bring to the scheme a wide variety of clinical experience, new ideas and lots of knowledge. By sharing this, and discussing how your experiences in practice use and change what you have learned, you will be a rich and valuable resource to your professional colleagues in the group.

We have an exceptional group of trainers offering a broad range and depth of experience, different interests and different perspectives on clinical practice. They will be working with you during the year at joint study days and presenting sessions and workshops during the programme.

You will be given an Athens account to aid your studies and any research. Any articles or publications from Dental magazines and journals which you consider to be of special interest to the DFT scheme should be noted and opportunities to present summaries of these articles will arise during the year.

You will also be signed up for Health Core Skills for Learning accounts. These give you access to a large variety of online modules. You will be required to complete your Equality and Diversity training online. You can choose to complete other modules to enhance your CPD in areas specific to your own learning needs.

Personnel The Postgraduate Education Centre office is staffed by our administrators Mrs Debra Satchell and Mr Liam Sherar, with our Manager, Mrs. Christine Crick being responsible for the overall running of the Centre. The Centre provides excellent, enthusiastic support for Postgraduate Dental and Medical training in Hertfordshire.

In addition to study days, there is an extensive programme of dental lectures and hands-on courses throughout the year at the Centre.

Our Dental Postgraduate Tutor is Mr Kevin Jones.


The aims of Dental Foundation Training for the General Dental Services (GDS) are to meet the needs of unsupervised general dental practice by developing the clinical skills learned as an undergraduate and teaching administrative and practice management skills to promote high ethical standards and quality care for patients.

The aims are achieved by:

• introducing the Foundation Dentist (FD) to general dental practice;

• identifying personal strengths and weaknesses and balancing them through a planned programme of training;

• enabling the FD to practise and improve skills free from undue financial pressure;

• promoting the implementation of peer and self-review;

• establishing the need for professional education, training and audit as a continuing process throughout the dentist's professional life.

Aims of Dental Foundation Training


Objectives of vocational training

The objective of Foundation Training is that the FD should be eligible to practise unsupervised as a principal within the GDS.

By the end of the training period the FD should be able to:

• demonstrate the clinical skills, knowledge and values relevant to the work of a GDS principal;

• demonstrate the necessary knowledge and some of the skills for the organisation and management of successful practice;

• manage the psychological aspects of patient care;

• work successfully as a member of the practice team;

• make competent and confident professional decisions with an awareness of personal strengths and weaknesses, including the need to refer when appropriate;

• demonstrate that he or she is working within the relevant guidelines regarding ethics and confidentiality of general dental practice;

• implement regulations and guidelines for the delivery of safe practice;

• know how to draw on the wide range of advice and support available to general dental practitioners and health care workers;

• demonstrate that he or she understands that continuing professional development should be a lifelong commitment.

• Demonstrate the necessary knowledge and some of the skills for the organisation and management of successful practice.


Dental Vocational Training became mandatory on 1st October 1993, making it compulsory for all graduates of British dental schools to complete an approved course before they can become a Provider on an NHS contract with the Area Team (AT) of the area in which they intend to practice, or to work abroad in an equivalent scheme. Non EU graduates of the UK dental schools may enter Foundation Training if specific regulations are met.

You can still practice without this certification in private practice or as an assistant within the NHS. Had you qualified at a dental school from elsewhere in the EU there would be no compulsion to comply with this regulation. EU nationals are eligible to enter the UK Foundation Training scheme. Overseas nationals who are not EU graduates may undertake Foundation Training under specific regulations.

Completion of Foundation Training is dependant upon working in your Training Practice for 12 months; maintaining and keeping up-to-date your Professional Development Portfolio; attending the Day Release Course for 30 days; and completing the case-study and project work during the year. On full completion of the FT year a Certificate of Completion will be awarded.

After Foundation Training an ethical practitioner will keep up-to-date by attending meetings and trade shows; undertaking specialised ‘hands-on’ courses; and reading a range of journals. The General Dental Council has now launched its ‘Lifelong Learning’ programme and this means that dental practitioners need to undertake 250 hours of professional development every five years:- this is expected to be 15 hours of verifiable and 35 hours of non verifiable education each year. It is currently under review by the GDC.

To help practitioners achieve this, dental courses are arranged by Postgraduate Dental Tutors, and for these, general dental practitioners may claim appropriate travel expenses through their Area Team. Practitioners can also attend private courses which may involve paying an attendance fee, expenses cannot be reimbursed.

The funding of Foundation Training used to be arranged centrally, but now money reaches Health Education East of England. Funding for the practice based component of Foundation Training comes via the Area Teams.

Learning in general dental practice


The training contract: Points of note

Make certain that all the parts of the contract are agreed and completed. Any alterations, which should only be minor, must be initialled by both parties and submitted to the Director for approval. Remember, both Trainer and FD are qualified and registered dental surgeons but the FD is employed as a full-time assistant, as defined in the NHS regulations. ‘Full-time’ in the context of the Vocational Training Scheme is taken to mean 35 hours per week. This includes chair-side clinical time, tutorials and Day Release Course. If there is no Day Release Course, the time should be spent in the practice.

The Contract lasts a minimum of one year and, during this time, the FD will receive a salary at the current rate. In exceptional cases it may be extended to allow for certification. The salary is superannuable under the NHS Superannuation Scheme, with contributions at 9% deducted by the NHS Business Services Authority (BSA) at source. The Trainer is responsible for the employer's National Insurance contributions and for deducting the FD’s NI contributions and PAYE tax. All practitioners must indemnify themselves against professional risks with one of the three recognised defence organisations.

The Trainer must offer proper educational support including allowing and requiring the FD to attend the Day Release Course. The Trainer must not insist on the FD working at the practice at this time. The FD must obey the Trainer's reasonable instructions. This is central to the professional relationship.

As it is the NHS’s Foundation Training Scheme, it is expected that the FD will carry out a full range of NHS treatment. If any private work is undertaken, the fees will accrue to the Trainer, who, as employer, is responsible for the VDP’s acts and omissions. The patient should be given a clear explanation of the nature of contract under which they are being treated. The FD shall comply with the NHS Terms of Service, although as the FD is not on a dental list he/she cannot answer NHS disciplinary hearings; it is the Trainer who would appear under such circumstances.

As an assistant, the FD signs FP17s ‘pp’ the Trainer. However, the FD’s performer number will allow identification of the FD’s work for statistical purposes.

The FD is entitled to 5.6 weeks (28 working days) leave including public holidays; leave may not, under any circumstances, be taken during term time. There is also entitlement to fifty two weeks maternity/adoption leave, and 39 weeks’ maternity/adoption pay or two weeks’ paternity leave/pay as the case may be.

If the FD moves to another practice, he/she is not allowed to accept for treatment a patient treated whilst acting as an assistant, thus protecting the goodwill and existing patients of the Training practice.


Day Release Course

Your Day Release Course is for 30 days during the FT year and is planned to help you in many areas, including the intricacies of the National Health Service and the more advanced clinical and treatment planning skills required for successful practice.

Most of the courses are based at the QE11 PGEC but there are several opportunities for visits to dental practices, the GDC and the BDA, dental companies and conferences. Most study days will include a ‘problem solving’ session where problems of a clinical or interpersonal nature can be discussed with your peers. It is amazing how many people have the same difficulties.

The structure of the course is not rigid and will be influenced by the FDs, so speak to the VT Advisor and she will see what can be done to accommodate your wishes. Study days are not lectures but discussions, so your full participation and preparation for them is a must. Attendance at these Day Release Courses is compulsory. Your completion certificate will depend on it.

Enjoy your year - it will be like most things: the more you put into it, the more you will get out! Problems can and will be sorted out quickly if they are identified, so speak to your Trainer or your VT Advisor/Course Organiser - they are there to help.

Important points to remember 1. If you are ill, please telephone the FT Advisor - this can be the

only reason for not attending. Please organise holidays, interviews and other personal arrangements outside term times.

2. Preparation for each Day Release Course is vital for your full participation - it may make a good topic for the preceding week’s ‘in practice’ tutorial with your Trainer.

3. The start time for each day is indicated in the programme. It is worth remembering that this is the time at which the first session will begin and that you will be expected to be present before the start time. Late arrival at a session may mean, and early departure from a session will mean, that you are recorded as being ‘not present’ for the session.

4. Foundation Training is training for membership of a profession. Accordingly, professional standards of dress are expected at the Day Release Course.

5. A record of attendance will be kept. Non-attendance could prevent certification of completion of the Course.


Problem solving

During the FT year there will be many opportunities for problems to arise. These may range from the ‘crowns that never fit’ to the ‘DSA who never seems to do what is needed’. During your Vocational Training year, you have available a wealth of expertise and experience to draw upon to help you to solve your problems.

In your Practice the main source of assistance in problem solving is, of course, your Trainer. During normal working hours you can approach your Trainer for assistance, or alternatively during a tutorial you can bring up a matter that is causing concern.

Sometimes the speaker at the Day Release Course will be the expert able to answer the difficult question. You are recommended to bring along to the study days clinical problems that may need to be shared.

Your VT Advisor is also always available for help on a whole range of clinical, professional or personal problems. This does not have to wait until a Day Release Course meeting; a telephone call to her mobile or home may allow early resolution of a problem and help prevent a great deal of worry.

The FT Group is also a powerful force for resolution of problems. Opportunities for group discussion occur in nearly every session of the Day Release Course. Sharing difficulties, problems or concerns with the other members of the group often brings to light examples of the same problem that have been experienced by others, and answers can often be found and discussed. Naturally openness and frankness is usually required, but all members of the group will respect our rule of confidentiality outside the sessions.

If you have a problem that you do not wish to discuss with the group, please always feel free to bring it to your VT Advisor and a mutually convenient time for discussion can be arranged.

During the week your VT Advisor can be contacted at the following numbers:

Elinor Japp

22 London Street, Godmanchester, Huntingdon, Cambs. PE29 2HU

( Home: 01480 436485

Mobile: 07730 532739

Practice: 01480 462563 (Mon and Wed)

: [email protected]



The Day Release Course strives to meet your needs and requirements and we thus need to know your opinions on the course content and presentation in order that improvements can be made and standards maintained. Feedback is very important for presenters - it gives them the opportunity to improve. It is therefore important for you to complete an evaluation form (copy opposite) for each session. In this way we have a measure of the value and standard of each presentation, and where necessary, adjustments and refinements can be made.

Please ensure that at the end of the day you have completed all the questionnaires for the day's sessions. We ask you to think carefully about your answers as it is important that they reflect your true opinion of that session. Free comments are particularly valuable as they may bring forward points that have not been addressed.

An additional form will be distributed at the end of the year to give you the opportunity to reflect on each presentation; perhaps a session regarded as unsuitable at the time had become a ‘life saver’ yesterday.

Remember, you are benefiting from the feedback given by previous Foundation dentists.

Session evaluation


Session evaluation


Professional Development Portfolio

Progress in all areas of professional life is increasingly dependant on records of the extent and nature of previous experience. This is difficult and inaccurate to do in retrospect; thus the habit of regular record keeping is best developed at the outset so that no opportunity is missed for the registration of higher professional recognition. Your internet based Electronic Professional Development Portfolio (E-PDP) is there for you to record your experiences and your reflections on a regular basis. Completion of Foundation Training is dependent upon your maintaining and keeping your E-PDP up-to-date. You will need to discuss your E-PDP with your Trainer at tutorials and at other times within the practice; and your FT Advisor also will see your E-PDP and will discuss this with you when relevant. It is essential that the E-PDP is kept up to date and that all assessments are recorded fully.

Assessment

Throughout the DFT year, monthly assessments are carried out in practice. These are mainly of two types, a Dental Evaluation of Performance (D-EP) and a Case based Discussion (CbD). However, during the first month assessment is by use of Early-stage Peer Reviews(ESPR) and after month 6 there is a patient questionnaire. All of the assessments are recorded in the E-PDP and an overall monitoring section is present which provides guidance to learning needs and educational planning.

Case presentations / Project work

Your Foundation Training Advisor will explain the requirements to be fulfilled during the Foundation Training year. Some of the project work will be based on the Foundation Key Skills; other work will be for presentation to the group. Much of it is planned to equip you with many of the requirements of the MJDF examination, which you may wish to sit during or after your DFT year. It is important that projects are completed satisfactorily otherwise full value will not be gained from the DFT year.

The presentation mode of clinical cases is of great importance, and this will be discussed at an early stage in the year. Please remember that at all clinical presentations confidential material is being discussed, and ethical considerations are paramount. You will therefore have to make sure that all items used in a case presentation are suitably anonymised before they are brought to the Day Release Course.

Records and Assignments


Mid year visit by the Advisor

Mandatory Foundation Training with final certification places great responsibilities upon all parties, but especially the Trainer/FD partnership, and problems must be identified early. The Advisor has an important role to facilitate the implementation of the requirements of the training agreement. This can best be done by a personal visit to the practice during working hours to see at first hand the trainee's working environment. This usually takes place in the period immediately after the Christmas and New Year break.

You will be advised beforehand that the Advisor will be spending some time in the surgery whilst patients are treated. Hopefully an ‘open door’ approach to training will already have been cultivated in the practice and so this will not be such an intimidating proposition. The focus of attention during the visit should be more on communication skills than clinical factors. During the visit, the Advisor will carry out one of your routine D-EP assessments and will use the visit to appraise your progress and learning in an informal and non-threatening manner.

An Audit of Patient

Waiting Times

Introduction

Bedw ell Denta l Surgery is a busy NH S su rgery with 3

dent ists, a hygien istand a VT, and is in the p rocess of

expa nding to prov id e an extra surgery . Th is large practice

treats m any pat ients a da i ly basis w hollyw ith in the

N at iona l Hea lth Serv ice, and a typ ica l day can be very busy

and fo r n um e rou s rea sons pat ients can som et im es end up

waiting beyond thei r sched uled appointm ent t im e .

Aims & Objectives

This audit a im s to look at:

1) Reasons for the d enta l team running la te

2) Pat ien ts persp ect ives on w aiting for tre atm ent

3) Average tim es pat ients end up w ait ing for appointm ents

.Through this au dit I ho pe to invest igate the reaso ns w hy

the denta l team runs late, an d ho w w e can end up reduc ing

these t im es to im p rove th e d enta l serv ice to patients an d

reduce any stress to th e denta l te am .

Part 2: DataAnalysis

A n analys is of resu lts was done to try a nd und ersta nd the

level of services of fered to p atients at th e m om ent and

w here thin gs co uld be im proved .

Resu l ts show ed tha t:

1. 8% o f patients sa id they were kept wait ing m ore that 30

m inutes, 28 % of pat ients sa id they were kept wait ing by 15 -

30 m inutes, 31 % of pat ients sa id they w ere bein g kept 5-15

m inu tes with the rem a ining 33 % of pat ients said th ey w ere

seen on t im e.

2. 59 pat ie nts sa id that the denta l team were apo loget ic

w hen they were kept w ait ing , and 8 patients sa id they were

not apolog ised to by m em bers o f the de nta l team for ru nning

la te.

3. 35 % of pat ients sa id they w ere g iven a chan ce to rebook,

w ith 65 %of pat ients say ing they weren’ t g iven an

opportun ity to rebook .

4. 75 % of pat ients w ere happy to wait b etw een 5-15 m inutes

for an appo intm ent , and 23% o f pat ien ts w anted to be seen

on tim e. Tw o pat ients sa id they would be h appy to wai t

longe r than 30 m inutes if they had run g up on that day for an

appointm ent .

A staff m eet ing was he ld to think of com m o n reason s why

pa tients were kept wa i t ing. Reasons inc lud ed :

• Too m any em e rgen cy app ointm ents w ere a ll placed

together

• New pat ients need to fill in m edica l hi sto ry fo rm s w hich

take 5-10 m inutes, but they weren’ t warned to com e in

ea rl ier to do th is

• I t was h ard to know when pat ients w ere w aiting as there is

n o com puter system and the recept ion ist doesn’ t a lw ays

have t im e to ring the surgery wh en every pat ient has arrived .

I f the nurse is ass isting treatm ent i t ’s hard for her to ru n o ut

and check regu lar ly to see if the next pat ients have a rr ived .

Cycle 1

For the next 2 w eeks a ll the n ew changes to the runnin g of th e practice w ere im plem en ted . A ll pat ients attending to

see th e V T tra in er and the V T in th e fo llowing 2 weeks were g iven ano ther questionna ire to co m plete and leave at

re ceptio n .

Results from cycle 1:

58 questionna ires w ere com pleted a nd resu lts show :

1. 4% of pat ients sa id they we re kept wait ing m o re that 30 m inutes, 16 % o f pat ients sa id they were kept wait ing by 1 5-

30 m inutes, 28 % of pa tients sa id they were being kept 5-15 m in utes with the rem ain ing 52 % of pat ients sa id th ey

were seen on tim e .

2. 5 1 pat ients sa id tha t the den ta l team were a polog et ic when the pat ients w ere kep t wait ing , and 7 p atients sa id they

w ere not apolo g ised to by m em b ers of the denta l team for runnin g late .

3. 28 % of patients sa id they were g iven a chan ce to reboo k, w ith 72 % of pat ients say in g they weren’ t g iven an

op portun ity to rebook .

O n ana lysi s I felt that th e resul tswere sat isfactory but h ad g reat room for im provem ent . Pat ien t w aiting t im es ha d

greatly redu ced, the num ber of p atie nts kept wait ing for m o re than 30 m inutes ha d been ha lved, a nd w e hit the 1st

target , how ever the 2nd and 3r d targets h adn’ t been m et .

A strong area wa s that m ost pa tients fe lt tha t the denta l team apolo g ised for runn ing late , however there w as a n

increase of 7 % in the num bers of p atients w ho weren’t g iven a chan ce to reb ook . This resu lt n eeds to be great ly

im proved to ach ieve the 5th target .

Cycle 2

The second aud it cyc le was com m enced 2 weeks late r

a fter the surgery w as g iven a ch ance to im p lem ent a ll the

changes . The sam e ano nym ous quest ionna i reused in

cyc le 1 wa s g iven to a ll pat ients of the VT and V T tra iner

over a 2 week per iod .

Results from cycle 2:

Dur ing this 2 week per iod 78 com pleted quest ionna ires

were com p leted, w hich w as an increase in th e num ber of

com pleted form s fro m the fir st cyc le . Resu l ts inc lude :

1. 2% of pat ients sa id they were kep t waiting m ore that

30 m inutes, 1 2% o f p atients sa id they w ere kept wait in g

by 15 -30 m inutes, 11 % of pat ients sa id they w ere being

kept 5-15 m inu tes withthe rem aining 75% of patie nts

sa id they w ere seen on t im e.

2. 73 p atie nts sa id th at the den ta l team were apolo getic

when they w ere kept wai t ing , an d 5 pat ients sa id they

w ere not apolog ised to b y m em bers of the d enta l team

for running late .

3. 52 % of patients sa id they were g iven a chance to

reboo k, w ith 48 % of pat ients say in g they w eren’t g iven an

oppo rtuni ty to rebo ok .

Reflection and Conclusion

Th e num ber o f pat ients kept wait ing m o re than 30 m inutes has exact ly ha lved since the fir st aud it. 94% of

pat ients said they we re apolog ised to w hen kept w aiting , and the greatest im provem en t was in the

num ber of pa tients g iven the cha nce to reb ook wh ich incre ased by 3 1%. These va lues can stil l be im proved

on especia l ly the num ber of pat ients g iven the cha nce to reboo k . A great im provem ent h as been m a de in

pat ient sta ndards sin ce th e pi lot quest ionna ire an d the fi r st 4 ta rgets have been reach ed .

A lthough th ere w ere great im provem ents in the running of the surg ery, there are severa l reasons w hy

im provem ents a re slow .

E.g . The n urse is of ten too busy assist ing to check w hich pa tients are w aiting and offer ing them th e chance

to reb ook, and the num bers of em ergency appointm ents are h igh in the pra ct ice due to the low

soc ioeconom ic area .

After this au dit took p lace the m ain suggestio n exp lo red for th e developm ent of the pract ice was to m ake

the pract ice com puter ise d . T his would let the d ent ist know w hen pat ients had arrived, ho w m any were

wait in g and how long they had been w ai t ing for which would greatlyim p rove th e ef ficiency and

o rgan isat ion of the surgery . W e hope to im ple m ent th is in the near future . L ike m a ny targets th is can

cont inua lly be assessed and im proved on . We aim to undergo this au dit year ly to ensure w e stay on target

and continue to im prove .

Method

Part 1: Datacollection

A n ano nym ous pilot quest ionna ire was g iven to every pat ient attending th e surgery to see

the V T and the V T tra iner w ithin a 2 we ek per iod (M on day to Thursday) . Each

q uest ion na i re a sks various quest ion s about p atient sati sfact ion w ith the treatm ent the y

were g ive n. Q uestions include how lon g they had to wai t for the ir a ppo intm ent , i f they

were kept w ait ing w as an apolo gy g iven and w ere pa tients g iven a chance to reb ook if kept

wai t ing . P at ien ts w ere a lso asked ho w long they th ink is a ccep tab le to wait for t reatm e nt.

From these resu lts we aim to ha ve a better idea of w here pat ients are unsat isfied with the

trea tm ent provided and w here im provem ents can be m ade .

Part 3: Outcomes of data collection

A fter observing a ll the data f rom the pilot q uest io nna i re as wel l as a l l th e points m ade at th e staff

m eet ing , ta rgets were set for the surgery to a im tow a rds in im prov ing the stand ard of care g iven to

pat ients .

I t w as ag reed tha t we sho uld a im for :

1. N o greater th an 5% o f pat ients should be m ade to w ai t longer tha n 30 m inutes for treatm ent

2. No greater than 15 % of pat ients should be m ade to wait b etw een 5-15 m in ute s for t rea tm ent

3. At least 70% of pat ie nts be ing seen o n t im e

4. At least 90 % of p atients should receive a n apology when being ke pt wa it ing for t reatm ent

5. At least 6 0% o f pa t ients being g iven a chan ce to rebo ok if they wi ll be kept wait ing longer than 1 5

m inu tes

These targets w ere im m edia tely im plem ented and changes in the running of the surg ery to ok p lace

including :

•New pat ients w ere asked to attend 10 m inutes ear lier to fill in a l l the appropr iate paperwork .

•Com plex treatm ents w ere scheduled for a longer appointm en t t im e .

•Em ergency treatm ents w ere a im ed not to be double booked an d w ere spread out m ore th ro ugho ut

the day.

Changesto be implemented for Cycle 2:

A t another staff m eeting a l l the resu lts of cycle 1 were

discusse d and staff m em bers agreed there was sti ll m ore

roomfor im provem ent . The fol low ing chan ges were

im plem ented :

•A ll sta f f m em bers inc lud ing recept ion ist sta ff sh ould

apolog ise for an y late running in the surgery a nd offer

pat ients the chance to rebook .

• A ny com p lex treatm ents were g iven long er t im e slots .


Tutorials

It is a requirement of Vocational Training that you have a tutorial of at least an hour once a week, during normal working hours. The timing needs to be agreed between Trainer and VDP as time must be set aside which is free from patient appointments and interruptions. The content of the tutorial will depend upon the learning needs of the VDP, but some structure is essential.

This is a suggested starting plan for a tutorial, but can be freely altered:

1. Review of Professional Development Portfolio. This will include:-

a. Looking at the reflective record in Section 3 for the past week/month • Self assessment: ‘What went well? What were the challenges? What

didn’t go well?’ • Considering evidence: ‘e.g. feedback from assessment? Trainer feedback?

Nurse feedback? Patient feedback? Unexpected outcomes of procedure? Own feelings?’

• Analysis: ‘Describing WHY. e.g. identifying cause & effect for unexpected case outcomes, or identifying reasons why progress slow in one competency are and fast in another etc’

• Formulating change: ‘Describe the learning outcomes from this exercise. Identify what you will do to address any slow progress or problems.’

b. Reviewing the Assessment Log in Section 2 and using this to extend your Personal Development Plan.

2. Discussing areas of concern, or problems to be solved. These will need to be entered in the Personal Development Plan in Section 2

3. Discussion of Day Release Course topics, both last and next study days.

4. Tutorial topic for the week plus plans for next tutorials.

5. Recording the tutorial in the CPD and Education Log Section 2.

If there is an assessment to be undertaken, (either a D-EP or a Clinical based Discussion) this, together with the feedback and discussion, will form the major part of the tutorial. It too will need to be recorded fully in the Portfolio.

Remember, for a tutorial to be successful planning is usually required, both by VDP and Trainer. VDPs will benefit much more from tutorials if there is regular discussion as to which subjects you are going to cover.

Tutorials do not need to be about clinical topics. Much of general dental practice is about management, communications and values. These are subjects which may not have been explored greatly in a dental school environment, and yet which need to be taught and learned.

Following is a list of suggested tutorial subjects, which may help to provide inspiration. It is not an exhaustive list.


Tutorial suggestions

Terms and conditions of service NHS Regulations Business Services Authority Health and Safety Rules Ionising Radiation Regulations Radiology Protection Sterilisation and Cross Infection Employment Legislation Role of Health and Professional Bodies Clinical Governance Diagnosis Patient Management Caries Detection Perio Assessment Consultation Skills Pain Relief X-Rays and Special Tests Referral and Assistance Treatment planning Assessing Patient Needs Co-ordinating Dental Disciplines Patient Explanation and Motivation Socio - Economic Factors Written Treatment Plan Consent Confidentiality Oral surgery and oral medicine Routine Extraction Technique Local Anaesthesia Minor Oral Surgery Resuscitation Routine Biopsy Early Diagnosis of Oral Carcinoma Referral in Oral Medicine Pharmacology and use of Drugs/Medicines Referral Criteria for Specialist Opinions Restorative dentistry Moisture Control Materials Handling in Conservative Dentistry Crown and Bridgework Endodontics Periodontal Assessment and Follow-up Reassessment Periodontal Surgery Occlusion Pædiatric dentistry Preventative Dentistry: Philosophy and Management Modern Restorative Techniques for Children

Management of Children Orthodontic Assessment and Diagnosis Gerodontics Implications of an Ageing Population Treatment Planning for Partial Dentures Patient Complaints in F/F Dentures Copy Techniques Domiciliary Visits Dealing with Elderly Patients Hypnosis and Relaxation Techniques for Impressions

Behavioural sciences Communication and Counselling Skills Patient Management and Motivation Delivering Prevention Management of Anxiety Psychology of Pain Stress Control and Relaxation Techniques Staff management and training Staff Management Chair a Practice Meeting 4 Handed Dentistry Liasing with the Hygienist Liasing with the Technician Employment Law Staff Recruitment and Staff Training Resuscitation

Business management Organise, Plan and Manage a Practice Effective use of Resources, Money, Time, Skills, Formulation of Budget Forecasts Business Plans - Accounts Delegation Ability to Assume Responsibilities of Team Leader Computers Epidemiology Superannuation Taxation Professional development and continuing education Projects During VT Year Audit as an Educational Tool Faculty of General Dental Practice MJDF Planning Your Career Peer Review Continuing Education


Case Presentations

Here are some hints which will help you when preparing a Case Presentation.

1. Present the patient’s details before you describe the clinical situation. You must anonymise the patient; make sure that the patient's name does not appear on radiographs, models etc..

2. Detail the circumstances of your treating the patient: i.e. is the patient a regular attender at the practice? Is it the first time you have seen the patient?

3. Describe the clinical picture fully where relevant, but avoid unnecessary detail. Those to whom you are presenting the case need all the relevant information so that they can make a reasoned assessment themselves. It may be necessary to have ‘extra’ information with you to provide answers to further questioning .

4. Have radiographs available, identified, and mounted if possible. Digital radiographs may need to be prepared for presentation.

5. Have study models available if possible.

6. Even if it is solely on oral presentation still write out your treatment plan or your problem beforehand, it can be very difficult to remember all the details when presenting the case.

7. Take care with your method of presenting the information. It is easy to photocopy on to acetate sheets for an overhead slide, but can other people read your handwriting? If you are presenting formally make sure that your mode of presentation shows the case to its best advantage.

8. Listen to what others say and ask. It may be helpful to write down comments from others in the group.

9. Don't be afraid to ask for comments from others in the group. It is an excellent way of learning.

To make your presentation suitable for the MJDF examination, you will need to: • Produce a typed report of no more than 2000 words.

• Ensure patient confidentiality.

• In your typed narrative, use the following sections: History—Examination—Investigations—Treatment plan—

Evidence which supports your decisions (e.g. radiographs)—Treatment undertaken—Prognosis • The report should include: Copies of clinical notes—Up to six photographs—Copies of radiographs—Relevant

correspondence (e.g. letters to specialist colleagues)—Evidence of consent—Certificate of authentication—Findings

from special investigations—Evidence-based discussion—Reference sources relating to the treatment


Finance Facts 2014

Health Education East of England

From 1st April 2013

Trainee’s Salary is £2,511.00 per month (£30,132.00 per annum)

Trainer’s Grant is £753.00 per month (£9036.00 per annum)

Service Cost is £5347.00 per month (£64,164.00 per annum)

Trainee’s Salary (per month)

Figures in blue are estimated - please check schedule and NI tables

Gross Pay £2,511.00

Superannuation at 9% £225.99

Net Pay (for income tax) £2285.01

National Insurance: Contracted out Table D. £195.27

(Calculated on gross pay)

Trainer’s payment from NHSBSA (per month)

Trainer’s Grant £753.00

Trainee’s Salary £2,511.00

Less Employee's Superannuation Contribution -£225.99

Employer’s NI Contribution £188.77

Service Costs (less patient charges) £5,347.00

Total £8573.78

Code number for “Contracted-Out Health Service Workers” (ECON) is: E3900000M

NHS SCHEME Contracted-Out Number (SCON) is: S2730000B


To make a claim for refund of travel and subsistence expenses, you must use FP84T&S Forms which are available from your Vocational Training Advisor. They should be sent to your Area Team (AT) and a photocopy should be retained by you, the dentist.

For each travel/subsistence claim Sections 1 and 3 should always be completed.

The rates payable are set by the Department of Health and changes are notified to dentists (via ATs) as they occur. There is a copy of the current rates in this handbook. You may claim:

Travelling Expenses

Mileage Allowance

Night Subsistence

Day Subsistence -

Lunch Allowance for absences of over 5 to 10 hours including the lunch period of 12.00 to 14.00 hrs

Evening Meal Allowance for absences of over 10 hours including an evening meal and returning after 19.00 hrs.

When your claim form is complete it must be signed by your Vocational Training Advisor as a mark of validation.

You must then copy the form, and keeping the copy, send the original, together with any validating receipts and tickets to your Primary Care Trust.

Expenses claims


Night Subsistence Allowances

Actual expenses incurred, subject to a maximum of:

£55.00 (receipts required)

£25.00 (non-commercial)

Meal allowance for 24hrs:

£20.00

Day Subsistence Allowances

For absence of 5 - 10 hours

(including the lunch time 12.00-14.00):

£5.00

For absence of over 10 hours

(including supper, return after 19.00):

£15.00

Mileage Allowances

For each mile:

24.0 pence per mile

Passenger allowance (per passenger attending same course):

2.0 pence per mile

Public Transport

2nd Class Fare (ticket / receipt required)

Travel and subsistence


Trainers and FDs

Trainers FDs

Mrs Marlise De Vos

Ms Hana Paul Barts and the London Dental School QMUL

The Gables Dental Practice,332, Cherry Hinton Rd Cambridge, CB1 8AZ ( 01223 248202

Mr Paaras Dhanani Mr Nimesh Patel

Miss Shivani Patel King’s College London

New Road Dental Practice, 119,New Road, Croxley Green, Rickmansworth, Herts WD3 3EN

( 01923 776270

Mr Amit Kanzaria

Miss Jasminder Guliani King’s College London

St Andrews Dental Practice, 17a High Street, Biggleswade, Beds SG18 0JE ( 01767 313182

Mr Gurpam Lidder

Miss Jannany Thasabalasingham King’s College London

Queensbury Dental Practice, 66 Langdale Road,Dunstable.,Bedfordshire. LU6 3BS ( 01582 605184

Mrs Anne Manley Mr Steve Davies

Dr Charles Pontikis King’s College London

Leighton Buzzard Health Centre, 25 Bassett Rd, Leighton Buzzard, Beds LU7 1AR ( 01582 708121

Mr Hardeep Matharu

Miss Rhea Patel King’s College London

Maple Dental Clinic, 29 Upper George Street, Luton Beds LU1 2RD ( 01582 727314


Trainers and FDs

Trainers FDs

Mrs Anne McDonald Miss Yee Lee

Miss Hiral Varsani Manchester Dental School

Dental Dept, Liverpool Road Health Centre, 9, Mersey Place Luton Beds LU1 1HH ( 01582 708121

Mr Amir Patel

Miss Rishi Sanghvi King’s College London

Chells Dental Practice, 5, Mobbsbury Way, Stevenage SG2 0HL ( 01438 312929

Mr Minesh Patel

Mr John Young Peninsula Dental School

Chrysalis Dental Practice, 334 Goldington Road, Bedford MK40 2NS ( 01234 266608

Mr Soham Patel

Mr Amit Salian Barts and the London Dental School– QMUL

Maple Dental Clinic, 29 Upper George Street, Luton Beds LU1 2RD ( 01582 727314

Mr Glen Taylor Mr Pardeep Padda

Miss Ella Woodward Peninsula Dental School

Carpenters Arms Dental Practice, 118 High St South, Dunstable, Beds LU6 3HJ ( 01582 472900

Mrs Anneke Whelan

Miss Prabhoop Kohli King’s College London

Stanstead Abbotts Dental Care,17, High Street, Stanstead Abbotts, Herts SG12 8AA ( 01920877745

Mr Constantinos Petrou University of Central Lancashire

Greenleaves Dental Practice, 244 High Street, Potters Bar, Herts EN6 5DB ( 01707 654328

Mr Martin Whelan


Useful addresses

British Dental Association 64 Wimpole Street, London. W1M 8AL ( 020 7935 0875 Web-site: www.bda-dentistry.org.uk

NHS Dental Services 1 St Anne’s Road, Eastbourne, East Sussex. BN21 3UN ( 0300 330 1348 : [email protected] Web-site: www.nhsbsa.nhs.uk/dental

COPDenD COPDEND Secretariat The Triangle, Roosevelt Drive, Headington, Oxford. OX3 7XP ( 01865 740623 Web-site: www.copdend.org.uk

Dental Protection Limited Granary Wharf House, Leeds. LS11 5PY ( 0171 3236555 Web-site: www.dentalprotection.org

Dental Defence Union 3 Devonshire Place, London. W1N 2EA ( 0171 4866181 Web-site: www.the-ddu.com/dentist/index.asp

General Dental Council 37 Wimpole Street, London. W1M 8DQ ( 020 7887 3800 Web-site: www.gdc-uk.org

http://www.bda-dentistry.org.uk


http://www.nhsbsa.nhs.uk/dental

http://www.copdend.org.uk

http://www.dentalprotection.org

http://www.the-ddu.com/dentist/index.asp

http://www.gdc-uk.org


Useful addresses

Practitioner Services Unit for Hertfordshire and Bedfordshire Charter House, Parkway, Welwyn Garden City. AL8 6JL ( 0113 824 8686 Web-site: http://www.england.nhs.uk/mids-east/hsm-at/

Dentists and General Mutual Benefit Society St James Court, 20 Calthorpe Road, Edgbaston, Birmingham. B15 1RP ( 0121 452 1066 3 0121 452 1077 Email: [email protected] Web-site: www.dengen.co.uk

Dentists Provident Society 9 Gayfere Street, London. SW1P 3HN ( 020 7222 2511 Web-site: www.dps-ltd.co.uk

Medical and Dental Defence Union of Scotland Mackintosh House, 120 Blythswood Street, Glasgow, G2 4EH ( 0141 2215858 Web-site: www.mddus.com

Faculty of Dental Surgery Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London. WC2A 3PN ( 020 7405 3474 Web-site: www.rcseng.ac.uk/dental/fds/

Faculty of General Dental Practice Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London. WC2A 3PN ( 020 7312 6671 Web-site: www.rcseng.ac.uk/dental/fgdp/

http://www.england.nhs.uk/mids-east/hsm-at/


http://www.dengen.co.uk

http://www.dps-ltd.co.uk

http://www.mddus.com

http://www.rcseng.ac.uk/dental/fds/

http://www.rcseng.ac.uk/dental/fgdp/


VT Calendar 2014 – 2015

2014

Thursday 11th September First Day of Autumn Term QE11 Postgraduate Education Centre (PGEC).

Thursday 18th September (9.30pm) to FDs present for both days

Friday 19th September (4.30pm) Residential Course for VDPs at Hilton Hotel, Watford. Trainer meeting 5pm-7pm Thursday 18th September followed by dinner. Friday 19th September trainers present all day 09.30 to 16.30.

Friday 17th October Day Release Course with FDs and DNs

Novotel Stevenage

Monday 07th to Friday 11th November Day Release Course at British School of Racing, Newmarket. You will be advised which day your VDP will attend

Friday 14th November No Day Release Course - VDPs work in practice -

Friday 05th December Last Day of Autumn Term Trainers present at QE11 PGEC from 13.30.

2015 Provisional dates

Thursdays and Fridays—January Practice Mid Year Visits - date and time to be arranged.

Friday 06th February First Day of Spring Term

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