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“ The rise in dental litigation should have sensibly seen the end to practising dentistry unaided”


colleagues in a way that is in patients’ best interests


• The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, regulation 18 (staffing) and regulation 12 (safe care and treatment).


The CQC is clear that if inspectors found CHAPERONE


state: “You must not provide treatment if you feel that the circumstances make it unsafe for patients.” They are clear that there must be at least one other person available within the working environment to deal with medical emergencies when you are treating patients. It is for the individual practitioner to check, risk assess and decide whether the other person in the practice is appropriately trained for this purpose.


When deciding whether you can safely


treat a patient alone, consideration must be given to how you would cope should a medical emergency arise. After all, we can’t always predict who will become unwell. Consider also how accessible the other person is. If you have to leave your patient, pass through doors and potentially go up or downstairs to summon assistance, what happens to the patient in the meantime? Clearly your second person needs to be rapidly accessible to fulfil any idea of patient safety.


Clinician safety Assault and aggressive/threatening behaviour is thankfully rare, but it does happen. By working in an isolated environment without assistance, you may be placing yourself and/or your employee in an unnecessarily vulnerable position. How often do you leave a dental nurse alone with a patient? They are vulnerable to both allegations of inappropriate behaviour and potential assault. Where the dental care practitioner (DCP) is an employee, you may also be breaching your duty as an employer to look after their safety and wellbeing (under the Health and Safety at Work Act). The Care Quality Commission (CQC), which


regulates primary care dental services in England, has published a series of useful Dental mythbuster guidance articles, of which number 13 relates to lone working. It states that when inspectors judge whether or not lone working is safe they consider:


• GDC Standards Principal 6: Work with


dental care professionals working alone, not in exceptional circumstances, they would be concerned. In addition, where chairside support from a dental nurse was not available, they would expect to see a risk assessment which has taken into account the medical emergency scenario for either the patient or the DCP. Their key question is: “How are risks to individual people who use the services assessed, and their safety monitored and maintained?”


Self-defence Lastly, aside from complying with the relevant regulators, the presence of a chaperone can be helpful to a clinician when faced with accusations of misconduct. Whilst comprehensive records are crucial, who can honestly say their notes fully reflect everything that was said? Patient complaints frequently also include allegations about a clinician’s manner or attitude. In these instances the supporting witness statement of your dental nurse can be key. Clearly if they aren’t in the room, then you are very much on your own as records say little about a clinician’s demeanour. The actress Greta Garbo once famously said


that she “wants to be alone”. When work is hectic we may sympathise, but the days when that was either wise or safe may well have passed.


Rachael Bell is a dental adviser at MDDUS


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