Practice Policies

To read our practice policies in full, please click to expand the relevant section.

Protection of Vulnerable Adults – Policy and Procedure

1. Introduction
The characteristics of adult abuse can take a number of forms and cause victims to suffer pain, fear and distress reaching well beyond the time of the actual incident(s). Victims may be too afraid or embarrassed to raise any complaint. They may be reluctant to discuss their concerns with other people or unsure who to trust or approach with their worries.

There may be some situations where victims are unaware that they are being abused or have difficulty in communicating this information to others.

2. Aim of Policy
The aim of this policy is to ensure the safety of vulnerable adults by outlining clear procedures and ensuring that all staff members are clear about their responsibilities.

3. Responsibilities
All members of staff have a responsibility to be aware of this policy and to report any suspicions that they might have concerning adult abuse.

4. Definition
A vulnerable adult is a person aged 18 years or over who may be unable to take care of themselves or protect themselves from harm or from being exploited.
This may include a person who:

  • Is elderly and frail
  • Has a mental illness including dementia
  • Has a physical or sensory disability
  • Has a learning disability
  • Has a severe physical illness
  • Is a substance misuser
  • Is homeless

5. What is abuse?
Abuse is a violation of an individual’s human and civil rights by any other person or persons. It can take a number of forms:

  • Physical abuse e.g. hitting, pushing, shaking, inappropriate restraint, force-feeding, forcible administration of medication, neglect or abandonment
  • Sexual abuse e.g. involvement in any sexual activity against his/her will, exposure to pornography, voyeurism and exhibitionism
  • Emotional/psychological abuse e.g. intimidation or humiliation
  • Financial abuse e.g. theft or exerting improper pressure to sign over money from pensions or savings etc.
  • Neglect or acts of omission e.g. being left in wet or soiled clothing, or malnutrition
  • Discriminatory abuse e.g. racial, sexual or religious harassment
  • Personal exploitation – involves denying an individual his/her rights or forcing him/her to perform tasks that are against his/her will
  • Violation of rights e.g. preventing an individual speaking his/her thoughts and opinions
  • Institutional abuse e.g. failure to provide a choice of meals or failure to ensure privacy or dignity

6. Rights of Vulnerable Adults
The vulnerable adults have the right to:

  • be made aware of this policy
  • to have alleged incidents recognised and taken seriously
  • to receive fair and respectful treatment throughout
  • to be involved in any process as appropriate
  • to receive information about the outcome.

7. Reporting Procedures
All those making a complaint, allegation, or expression of concern, whether staff, service users, carers or members of the public should be reassured that:

  • they will be taken seriously
  • their comments will usually be treated confidentially but their concerns may be shared if they or others are at significant risk
  • if service users, they will be given immediate protection from the risk of reprisals or intimidation
  • if staff, they will be given support and afforded protection

If an allegation is made to a member of staff or there is a suspicion of abuse then the member of staff should inform Lead Role Member , Mr D hickleton or in his absence, Lead Support Member Mr E C MacDougall as soon as possible. DH or EM will make a written record of the allegation or suspicion of abuse and immediately contact the North Tyneside Council Safeguarding Adults Team on (0191) 6437079. The Adult Safeguarding Team have a referral form. The link is:
http://www.northtyneside.gov.uk/browse-display.shtml?p_ID=559490&p_subjectCategory=421

If the person is injured or in immediate physical danger, then the Police and other appropriate emergency services should be contacted on 999. The non urgent contact telephone number for the Police is 101.

If a staff member has been told about the allegation of abuse in confidence, they should attempt to gain the consent of the person to make a referral to another agency. However, the gaining of the consent is not essential in order for information to be passed on. Consideration needs to be given to:

  • The scale of the abuse
  • The risk of harm to others
  • The capacity of the victim to understand the issues of abuse and consent

If there is any doubt about whether or not to report an issue to the Adult Safeguarding Team, then it should be reported.

8. Recruitment and Training
The organisation will ensure that all staff whose roles include working with vulnerable adults are carefully selected, screened, trained and supervised.

9. Disclosure Checks
As part of the recruitment procedure, all newly appointed staff that have contact with vulnerable adults will be DBS checked.

10. Useful Resources
The North Tyneside Gov Safeguarding Adults Framework defines who is a vulnerable adult and the circumstances of risk and harm.

Ilfracombe Dental Practice recognises that some patients may find visiting a dental practice distressing and/or embarrassing.  We wish to reassure our patients that their safety and comfort is of paramount importance to us.

All patients are entitled to the support of a chaperone.  Chaperones are people who are present throughout an appointment to support the patient.  The appointment may be for any aspect of dental care.  Chaperones are also used for medico-legal reasons, for example; to protect healthcare workers against unfounded allegations of improper behaviour.

The chaperone can be a family member or friend.  Wherever possible, we would ask you to request a chaperone to be present at the time of booking the appointment so we can make the appropriate arrangements.  If it is not possible to do so at the time of making the appointment, we will do our utmost to provide a chaperone which may be one of our clinical team or Reception staff, but we may have to reschedule your appointment.

We may on a rare occasion ask you to provide a chaperone.  This could be if you request an emergency appointment outside normal surgery hours.

If you have any questions or comments about this, please contact our Deputy Manager Steph Dodds.

Ilfracombe Dental Practice commits to a policy of compliance with Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by adhering to the following principles at all times:

  1. We will always act in an open and transparent way in our dealings with patients and all members of the dental team. We will encourage a culture of honesty in all our dealings.
  2. We will ensure that all staff members are aware of, and are trained and supported in knowing, their responsibilities in regard to a “duty of candour”.
  3. We will encourage and support staff members who report any incident, or any failure of this policy and will investigate and where necessary escalate fully any such reports. The individual responsible for investigation is either DH or EM and they will promptly appoint a deputy if there is a conflict of interest.
  4. No staff member will be victimised or harassed as a result of reporting an issue regardless of the seniority or permanency of the individuals involved.
  5. Where an error has occurred which has caused harm to any individual in the course of our work, we will openly admit the error and will apologise to the individual, or where appropriate to their parent or carer. We will follow up an immediate verbal apology in writing and will undertake to advise them of the outcome of our investigations on completion.
  6. We will ensure that all accounts of an error are complete and truthful.
  7. We will do our best to mitigate or correct any harm that has occurred and will provide support to persons affected.
  8. We will keep a record of all conversations and correspondence in connection with any such incident.
  9. We will notify the Care Quality Commission and any other appropriate body of any serious ‘Notifiable Safety Incident’ (those resulting in moderate or serious harm) as soon as possible.
  10. We will adhere to the principles of the Being Open framework (http://www.nrls.npsa.nhs.uk/beingopen/?entryid45=83726)

Dentists, as service providers, must take reasonable steps to change any policies, procedures or practices which make it impossible or reasonably difficult for disabled people to make use of their services.  This is the practice policy in respect of discrimination on the grounds of disability.  The practice is committed to working towards equality of opportunity for every member of the practice team and for every patient.  This statement is one important way of achieving this objective.

The practice recognises that discrimination on the grounds of disability is illegal.  Through this policy, through training and by example, the practice wishes to demonstrate that it does not tolerate discrimination by anyone working at the practice.

The practice and its staff will not treat a disabled person less favourably than another person because of a disability.

Less favourable treatment includes:

  • Refusing to treat a disabled patient
  • Giving a disabled patient a lower standard of service or treating him or her in a worse manner than an able-bodied patient
  • Offering a disabled patient less favourable terms

The following exceptions may occur when, in the dentist’s opinion:

  • Health and safety reasons exist where either the patient or someone else would come to some harm if the dentist did not refuse treatment.
  • A disabled patient is unable to understand their treatment need and that particular treatment is not in the best interest of the patient in accordance with our informed consent policy.

The practice will do its best to; change or remove policies, change practices and procedures, provide auxiliary aids and overcome physical features that make it difficult or impossible for a disabled patient to use the practice.

Guide Dogs

Guide dogs are welcome at the practice but we ask that you be aware of other patients and staff who may have an allergy or fear of dogs.

Employees:

  • Will not unjustifiably treat a disabled employee less favourably for a reason that relates to a disability
  • Will comply with a duty of reasonable adjustment to any physical feature of the premises or to working arrangements unless the adjustment would be of no substantial benefit.

 

The practice will not discriminate against a disabled person:

  • In the arrangements made for determining who should be offered employment
  • In the terms on which the disabled person is offered employment
  • By refusing to offer or deliberately not offering the disabled person employment
  • In the opportunities that are afforded to an employee for promotion, training or receiving any other benefits
  • By refusing to afford or deliberately not affording any such opportunity
  • By dismissal or any other detriment

The practice will undertake to provide support, assistance and if necessary, counselling to members of the practice who are victims of violence and aggression in the course of their work.  In the appropriate cases, a discretionary period of sick leave will be granted.

Late cancellations are seen as any cancellation made within twenty-four hours prior to the appointment. We recognise that there are a number of possible legitimate reasons as to why you have needed to cancel your appointment at such short notice and we firstly thank you that in such circumstances that you have considered us and secondly hope that whatever has happened, that it is not too serious.

The late cancellation policy was introduced as a result of a small minority of patients who frequently cancelled at short notice. Unfortunately, this impacts on everyone in a number of ways:

  • Surgery time has been allocated and has been made unavailable to other patients who would have benefitted from that time slot. Short notice does not allow reallocation of dental services to another individual.
  • Repeated cancellations are often associated with a reluctance to come in. We would like the opportunity to be able to help that person overcome the reason for such a reluctance. This could be by altering a treatment plan that better suits them or provide a suitable referral if the treatment concerned is due to the essential maintenance of dental health. We can only achieve this if the appointment is honoured.
  • Repeated delays in a planned piece of treatment or check-up can potentially leave enough time to elapse that if disease is present, allow the disease to progress.
  • Our dentists are only remunerated for their work done in the surgery. Whilst the occasional unforeseen coffee break can be a pleasant surprise, repeated breaks will impact on their earnings. Without any countermeasures in place, the dentist may consider working at another practice where this is not a problem.
  • The dental practice, like any other business has a set number of days in a year to gain income. Income comes in the form of an NHS contract and revenue from the surgeries. If the NHS contract is unfulfilled as the practice has not delivered a certain number of units of dental activity, then the contract is forever lost and the practice will be unable to continue offering NHS services. If revenue from the surgery is affected, as the services were prepared to deliver the agreed treatment, the practice incurs a cost but with no financial gain. This is a potential threat to the business side of the practice.

With these in mind we have a cancellation policy that states that if you cancel within a twenty-four-hour period, this is recorded in your dental notes. If it transpires that this happens four times in a six-month period, then it will be recorded as an equivalent as a “did not attend”. A further occasion will leave the practice no other option than to assume that dental treatment is unwanted and that your records will be archived and the desk will no longer be able to offer you any further appointments.

We do not want this to happen. We send out a reminder text message 48 hours prior to your appointment. Please keep your phone details up to date. We accommodate those with memory problems associated with a medical condition by offering a personal phone service reminder call from our receptionists on the day of the appointment. This can be agreed with reception in advance of the appointment. In the event of the missing of an appointment, an e mail will be sent to remind you that you have missed your appointment so that you do not fall foul of this policy. You can cancel via email , the website, telephone, mail and in person.

Missed appointments are appointments when we receive no notice of any intention to cancel prior to the commencement of the appointment time. That is to say that if you were to inform us after the appointment commencement time, we see this is as a failure to provide us with any notice. We recognise that there are a number of possible legitimate reasons as to why you have needed to miss your appointment and we hope that whatever has happened, that it is not too serious. We would prefer that you give the practice more than twenty-four hours’ notice prior to changing an appointment.

The Missed Appointment policy was introduced due to the occurrence of a small number of individuals who failed to provide notice that they were not going to attend, on a number of occasions. This impacts on everyone in a number of ways:

  • Surgery time has been allocated and has been made unavailable to other patients who would have benefitted from that time slot. Failure to provide cancellation notice does not allow reallocation of dental services to another individual.
  • Repeated missed appointments are often associated with a reluctance to come in. We would like the opportunity to be able to help that person overcome the reason for such a reluctance. This could be by altering a treatment plan that better suits them or provide a suitable referral if the treatment concerned is due to the essential maintenance of dental health. We can only achieve this if the appointment is honoured.
  • Repeated delays in a planned piece of treatment or check-up can potentially leave enough time to elapse that if disease is present, allow the disease to progress.
  • Our dentists are only remunerated for their work done in the surgery. Whilst the occasional unforeseen coffee break can be a pleasant surprise, repeated breaks will impact on their earnings. Without any countermeasures in place, the dentist may consider working at another practice where this is not a problem.
  • The dental practice, like any other business has a set number of days in a year to gain income. Income comes in the form of an NHS contract and revenue from the surgeries. If the NHS contract is unfulfilled as the practice has not delivered a certain number of units of dental activity, then the contract is forever lost and the practice will be unable to offer NHS services to who they currently do. If revenue from the surgery is affected, as the services were prepared to deliver the agreed treatment, the practice incurs a cost but with no financial gain. This is a potential threat to the business side of the practice.

With these in mind we have a Missed Appointment policy that states that if you fail to cancel with at least a twenty-four-hours’ notice, this is recorded in your dental notes. If it transpires that this happens twice within a six-month period, then it will leave the practice no other option than to assume that dental treatment is unwanted and that your records will be archived and the desk will no longer be able to offer you any further appointments.

We do not want this to happen. We send out a reminder text message 48 hours prior to your appointment. Please keep your phone details up to date. We accommodate those with memory problems associated with a medical condition by offering a personal phone service reminder call from our receptionists on the day of the appointment. This can be agreed on reception in advance of the appointment. In the event of the missing of an appointment, an e mail will be sent to remind you that you have missed your appointment so that you do not fall foul of this policy. You can cancel via e mail, the website, telephone, mail and in person.

The entire practice is smoke-free as everyone has the right to work in a smoke free environment. Exposure to passive smoking increases the risk of lung cancer and other illnesses. Ventilation or separating smokers and non-smokers within the same airspace does not completely stop potentially dangerous exposures.

Smoking is prohibited throughout the entire dental practice with no exceptions, including the use of electronic smoking devices. The policy applies to all staff, patients and other visitors to the practice.

Thank you for your co-operation.

Smoke Free Policy

This policy has been developed to protect all employees, patients and visitors to the practice from exposure to second hand smoke. Exposure to second hand smoke also known as passive smoking, increases the risk of lung cancer and other illnesses. Ventilation or separating smokers and non-smokers within the same airspace does not completely stop potentially dangerous exposure.

It is the policy of Ilfracombe Dental Practice that the entire practice is smoke free, and everyone has a right to work in a smoke free environment.

Smoking is prohibited throughout the entire practice with no exceptions, including the use of electronic smoking devices. The policy applies to all members of the dental team, patients and visitors to the practice.

The practice will encourage and support any member of the dental team or patient who requires help in giving up smoking. The NHS provides an online resource for advice, information and support to stop smoking at www.givingupsmoking.co.uk.

Overall responsibility for the smoke free policy rests with Melita Dental Practice Ltd. All staff are required to adhere to and help with the implementation of the policy. New staff will be made aware of the policy as part of their induction.

Appropriate NO SMOKING signs are clearly displayed at the entrance to the practice to inform all patients of this policy.

Non-compliance with the policy will be dealt with through the practice disciplinary process, a copy of which can be obtained from Melita Dental Practice Ltd.

  • We are not responsible for the waiting times at our referral centres. Treatment waiting times are dependent on dental needs of all being referred at any particular moment, not solely on when you joined the waiting list.
  • We are not responsible for determining whether you are eligible for NHS orthodontic treatment. This lies with the orthodontist.
  • We will send the referral within the working week of the request.
  • We will offer you a choice (if possible) of specialist.
  • We offer both NHS and Private referrals.
  • We are not bound by any contract you enter with your chosen orthodontist.
  • We do not hold ourselves accountable for the orthodontic outcome even when we have been asked to provide extractions. We are not specialists in this field and as such, will not offer opinions on success rates.
  • Once you have entered a contract with your chosen orthodontist, we are not in a position to be able to terminate your agreement and relocate you to another orthodontist.

Below are a list of common questions asked by patients and the responses given by the British Orthodontic Society.

 Am I eligible for NHS treatment?

Eligibility for free-of-charge NHS orthodontic treatment is based on the severity of the malocclusion measured using the Index of Orthodontic Treatment Need (IOTN), and on the age of the patient.

The severity of the malocclusion is measured using IOTN. This is a rating system consisting of 5 grades, ranging from ‘no need for treatment’ to ‘severe need for treatment’. As with all systems, there is a degree of interpretation and this can differ between the referring clinician and the orthodontist. It is therefor not a “sure thing” that treatment will be offered at the referral site.

Most orthodontists working in primary care can only provide orthodontic treatment for patients under the age of 18. Patients over 18 with severe malocclusions may be eligible for orthodontic treatment in the Hospital Orthodontic Service (secondary care).

If we are not sure whether you are eligible for NHS orthodontic treatment, we will make the referral and the orthodontist will make the final assessment as per the guidelines of the British orthodontic society website.

When should I be referred for an orthodontic assessment?

Most patients can be referred when the permanent teeth are first established. Find out more about the important occasions when this is not the case.

Types of occlusal problem to refer in the deciduous dentition (baby teeth):

  • Individuals with cleft lip and/or palate, or other craniofacial anomalies
  • Severe maxillary/mandibular disproportion (but only if the parents are concerned, otherwise wait until the mixed dentition stage)

Types of occlusal problem to refer in the mixed dentition (baby and adult teeth):

  • Anterior or posterior crossbites with associated mandibular displacement
  • Class III in the mixed dentition
  • Class II/I malocclusion where there is an underlying skeletal II pattern. Most functional appliances are easiest to wear when the upper first premolars are fully erupted. Such a patient entering his or her pubertal growth spurt should be seen without delay
  • Asymmetry in the pattern of tooth eruption (especially upper central incisors)
  • Severely hypoplastic/carious first molars of poor long-term prognosis
  • Lack of palpable canine bulges buccally at 10-12 years of age indicating palatal impaction
  • Hypodontia (missing teeth); supernumerary teeth
  • Submerged deciduous molars; impacted first permanent molars
  • Periodontal problems caused by severely ectopic tooth position
  • Severe crowding of incisors

Types of occlusal problem to refer in the permanent dentition:

  • All other malocclusions

Where should I be referred?

The definitive answer to this question depends on local arrangements with your Primary Care Trust, Managed Clinical Network or Local Dental Committee.

Community Dental Service:

  • Children with physical or mental handicap, growth-related problems or diseases.
  • Contact your Community Dental Service for local guidelines

Primary Care Orthodontic Provider:

  • Primary care providers (‘high street specialists’) provide a wide range of NHS and private orthodontic care.
  • NHS referrals to primary care providers need to fulfil the eligibility criteria described using the IOTN score.
  • All patients age 17 and under irrespective of case severity are eligible for an NHS assessment.
  • Individual primary care orthodontic providers and Primary Care Trusts/Managed Clinical Networks may have local referral criteria.

Hospital Orthodontic Service:

  • Malocclusions which require complex interdisciplinary orthodontics and orthognathic (jaw surgery) treatment e.those with skeletal anomalies and/or asymmetries
  • Malocclusions which require complex interdisciplinary restorative treatment, such as severe hypodontia, ankylosed teeth, previously traumatised anterior teeth, developmental anomalies affecting tooth structure (amelogenesis/dentinogenesis imperfecta), severe tooth surface loss
  • Children with physical or mental handicap, growth-related problems or disease
  • Individuals with cleft lip and/or palate or other craniofacial anomalies

How do I become referred?

These considerations are made and are intended to help get the best and most efficient treatment for you and your orthodontic referral.

  • We Include details of any previous dental treatment, particularly if there has been trauma to anterior teeth or if we consider any teeth to be of dubious long-term prognosis. Please keep us informed of any changes that have occurred in your mouth.
  • We will use the IOTN grading system as requested by the British Orthodontic Society.
  • If we feel the patient needs to be seen urgently, we will mention the reason why in the referral letter but the decision on how urgent this is, is ultimately at the discretion of the orthodontist.
  • The patient must know that they are being referred for orthodontic treatment and that they are prepared to consider undergoing treatment. This is directed towards carers of children and vulnerable adults.
  • Patients must have good oral hygiene and are caries free (unless you are being referred for advice on possible extractions).
  • If the patient has had previous orthodontic treatment please mention this to us.
  • If you have had recent relevant radiographs elsewhere, please make us aware of this.

Are there reasons for not making an orthodontic Referral?

There are occasions when an orthodontic referral may not be appropriate.

  • It is not appropriate to refer patients when they are too young in order to circumvent waiting lists. The majority of orthodontic treatment can commence in the late mixed and early permanent dentition.
  • If the patient does not want orthodontic treatment or would not wear a brace.
  • If the patient has poor oral hygiene, active caries or periodontal disease (unless advice is needed for extractions only).
  • If the patient is still sucking their thumb/finger most orthodontists will not start active orthodontic treatment. Please try to stop sucking habits before they are referred for orthodontic treatment. Deterrent appliances are usually only used in older patients resistant to more conventional techniques, such as persuasion, a plaster on the offending digit or unpleasant tasting varnishes.
  • Patients over 18 will usually only be accepted for NHS funded orthodontic treatment if they have a complex occlusal and skeletal problem requiring multidisciplinary care, and such cases should be referred to the Hospital Orthodontic Service.

Moving & Transferring During Treatment

The following advice has been sought from the British Orthodontic society website November 2019. Policies do change and as such, should only be used as a guide. Although the following has been stated there, the process of changing orthodontist mid treatment is far from straight forward. It would be our advice that you satisfy yourself with the choice of orthodontist and his/her team prior to embarking on treatment and make any reservations known at the initial assessment. It is not our responsibility to help you change orthodontist mid treatment. You enter into a separate agreement with them that we are not involved in. Equally if they request help in the form of providing extractions, we are not duty bound to act but do undertake such work if we feel that the treatment is necessary. We will endeavour to accommodate realistic treatment timescales to support your orthodontic treatment but the orthodontist has no say as to when exactly this should happen.

“Under the new NHS contract, since 1st April 2006 there has been no official obstacle to changing orthodontists. Orthodontists with NHS contracts can accept an NHS patient who has moved from another part of the country (or from overseas) and who is already under orthodontic treatment.

The patient will count as a new NHS case start and brings the full credit for a new start, as long as the patient is over 10 years and under 18 years of age when first seen by the new orthodontist. Local protocols and referral pathways may also be in place with provision and guidance for transferring patients.

The NHS Local Area Team, Managed Clinical Network for Orthodontics or Local Orthodontic/Dental Committee should be consulted for further guidance.

If you started NHS orthodontic treatment under 18 years of age but have become over 18 by the time you moved, you may still be permitted to continue with NHS treatment but your new orthodontist will need to get permission from the Primary Care Trust or Local Health Board. You may also need to pay an NHS charge.”

What happens if I am not eligible for NHS treatment?

More and more people are falling into this category as better techniques are being developed to treat milder cases that do not qualify for NHS funding and more adults as a whole consider treatment for cosmetic reasons.  A private referral can be made by your dentist. Orthodontic private rates are becoming increasingly competitive and most offer monthly payment schemes to help with affordability.

  • Ilfracombe Patient
    “I'm always made to feel welcome and at ease. The dentists are friendly, with a good chair-side manner - an excellent experience all round.”
    Ilfracombe Patient