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									Remediation of Dentists in Difficulty

Guidance notes for the management of remediation cases by
Dental Postgraduate Deaneries in England

                                           September 2009
                                                                                         Remediation of Dentists in Difficulty


1.    Introduction ................................................................................................... 1
2.    Poor performance causes ............................................................................. 1
3.    Principles of the remediation process ........................................................... 2
4.    Outcome of the remediation process ............................................................ 2
5.    Stages in the remediation process ................................................................ 3
6.    Roles and responsibilities of deaneries ......................................................... 6
7.    Responsibilities of the referrer ...................................................................... 6
8.    Responsibilities of the registrant ................................................................... 6
9.    Disclosure of information ............................................................................... 7
10. Appeals against the deanery process ........................................................... 7
11. Working party membership ........................................................................... 7

Appendix 1           Referral routes
Appendix 2           Referral information required by a deanery
Appendix 3           Assessment form
Appendix 4           Selection and training of deanery staff involved in managing
                     remediation cases
Appendix 5           GDC revalidation domains and sources of evidence
Appendix 6           Examples of remediation options for clinical subjects
Appendix 7           Examples of resource material and tools for remediation
Appendix 8           Standards for clinical / professional practice
Appendix 9           Sources of evidence of professional competence
Appendix 10          Example of an action plan
Appendix 11          Quality assurance
Appendix 12          Evidence of attainment of remediation goals
Appendix 13          Appeals against the process

Reference material
                                                                    Remediation of Dentists in Difficulty

1. Introduction
   The Committee of Postgraduate Dental Deans and Directors (COPDEND) has assisted
   with the remediation of dentists in difficulty for many years. In the past the number of
   cases being referred to deaneries has been low. The gradual transition to a more
   litigious society and a heightened awareness of the need to address poor professional
   performance has resulted in a marked increase in the number of cases requiring
   remediation. There has been a threefold increase in the number of cases heard by the
   General Dental Council in the past five years. The National Clinical Assessment Service
   (NCAS) has received more than 450 requests for advice in the past 7 years.

   The Postgraduate Dental Deans in England determined that in the interest of protecting
   the public and in light of the need for appropriate quality assurance of remedial training,
   it would be beneficial to develop a framework for handling these cases.

   Following a national workshop of stakeholders involved with dentists in difficulty,
   COPDEND subsequently established a working party of key stakeholders to prepare
   guidance on the management of these cases both for deaneries and for those agencies
   referring to them.

   The remit of the working group was to develop a framework for COPDEND members
   and stakeholders to use in order to facilitate the appropriate remediation of registered
   dentists whose performance has been found to be below accepted levels for the
   profession and to describe appropriate referral pathways for that remediation, agreeing
   wherever possible the processes that will be followed to maximise the likelihood of a
   successful outcome.

   It was agreed by all the stakeholders that ultimate responsibility for the remediation
   rests with the registrant. The role of the deanery is to provide assistance in drawing up
   a remediation action plan, to give advice on resources available to the registrant, to
   monitor the milestones in the action plan and to report back to the referring agency.

   The cost of a remediation programme is also the responsibility of the registrant,
   although support may be available from other sources.

2. Poor performance causes
   In order to manage the remediation of registrants who are deemed to be performing
   below acceptable standards it is essential to have an understanding of the factors that
   are implicated in the poor performance, as these will need to be addressed in addition to
   any clinical concerns. The issue that brings a registrant to the notice of the authorities is
   rarely the sole cause but often a manifestation of an underlying problem or problems.

   NCAS has published comprehensive guidance on the issues relating to poor
   performance. The clinical manifestation of poor performance may be due to:-

         Health issues
         Behavioural issues
         Clinical issues
         Contextual/ environmental issues

   Deaneries should be able to manage the remediation of clinical issues. It would
   generally be appropriate to develop a remediation plan for clinical activity which runs in
   parallel to those that address health and behavioural issues. If it is established that the

                                                                      Remediation of Dentists in Difficulty

   major factors are non clinical, the deanery may work with the referring agency and other
   parties to assist the registrant to deal with all the issues.

   Poor performance often occurs across many areas of professional practice; remediation
   may need to take these into consideration. Poor clinical work is often linked to poor
   record keeping and poor standards of administration. The underlying cause can take
   time to resolve and the registrant may take time to accept it is their responsibility. They
   may also need considerable support and assistance in drawing up an appropriate action
   plan as they are often not aware of the tools and resources available or how to use

3. Principles of the remediation process
         Assure patient safety / public protection
         Return the registrant to safe practice
         Have fair, consistent and transparent processes
         Appropriate
         Timely
         Clearly defined measurable outcomes
         Quality assured
         Transferable model for use with other groups of registrants

4. Outcome of the remediation process
   The objective of a remediation programme should be to return the practitioner to safe
   professional practice at an appropriate and agreed level or, if they do not satisfactorily
   complete the process, for them to be given advice on future career options. It may not
   be possible to return a registrant to their original position but to a suitable alternative
   position after remediation.

   The remediation process will address the particular issues related to poor performance
   that triggered the referral and, in addition, the registrant will be expected to have
   achieved the standards required by the GDC for revalidation. In order for remediation to
   be deemed successful, the registrant will be expected to demonstrate at the end of the
   remediation period that they have attained the standards expected of a professional to
   be revalidated in all the domains, as well as addressing any specific areas of poor

   Ideally, where clinical operative skills are a concern, a full assessment of a registrant‟s
   operative skills should be undertaken in their own working environment. However, this
   may not always be possible but as it could be assumed that most registrants would
   have operated at an appropriate standard when first registered, the end point of
   remediation should be to attain the level of competence and professional behaviour
   required for revalidation.

   If this end point is defined with the registrant at the start of the remediation process, it is
   their responsibility to demonstrate to the referring body that they have attained this level
   of competence at the end of the remediation period.

   A key principle of revalidation is that registrants should be able to reflect on their work
   and action; therefore the remediation action plan should maximise opportunities for the
   registrant to reflect on their own activity and to provide supporting evidence. The role of
   the deanery is to provide tools and a framework to do this.

                                                                Remediation of Dentists in Difficulty

5. Stages in the remediation process
      1. Referral to the deanery
      2. Initial exploration and review of problems raised, including available data on
         assessments including any health or behavioural issues.
      3. Deanery decision whether to accept the registrant into a remediation programme
      4. Develop draft action or remediation learning plan
      5. Timetable, milestones and approval of the remediation plan
      6. Registrant undertakes the action/ remedial plan.
      7. Monitoring of the plan
      8. Report to referring organisation.

   5.1 Referral to the Deanery

   Deaneries may receive referrals from different sources:-
      General Dental Council
      Primary Care Trusts
      Dental defence organisations
      Self referral by a registrant

   Appendix 1: Referral routes
   Appendix 2: Referral information required by a deanery

   5.2 Initial Review

   On receipt of a request for a remediation programme the deanery will contact the
   registrant and his/her defence organisation. The deanery will require appropriate
   assessment reports about the registrant and the areas for remediation. An initial
   meeting will be arranged with the registrant to establish the issues and identify what
   assessments have already been undertaken and what data may be needed to plan the

   Appendix 3: Assessment form

   The deanery will nominate a named person to oversee the educational aspects of the
   remediation process.

   Appendix 4: Selection and training of deanery staff involved in managing remediation

                                                                 Remediation of Dentists in Difficulty

The deanery will request the registrant to prepare a portfolio of evidence in advance of
the initial meeting to assist with the planning process. This portfolio of evidence should
contain the evidence advised by the GDC for the first stage of revalidation.

Appendix 5: GDC revalidation domains, sources of evidence and portfolio content

Initial review will include:-

      Issues that led to the referral
      Review of prior training, learning and assessment of operative skills*
      Recognition of any health or behavioural issues that may need addressing
      Referral to other bodies for health and behavioural issues as appropriate
       (occupational health, clinical psychologists).
      Prior evidence in relation to revalidation/ recertification
      Gap analysis of areas of deficiency, skills, knowledge and attitudes. The gap
       analysis will be self-driven by the registrant with the support of the deanery.

   *Evidence of the value of operative skills assessment in determining remedial
   training needs for mature practitioners is not yet well validated.

The registrant must be made aware at the initial meeting that he/she is responsible for
funding the costs of the remediation process and identifying possible sources of funding
available. The role of the deanery is to support and advise on tools and resources to
assist. The registrant must be informed about the reports which will be sent to the
referring body and when and what will happen if s/he fails to complete agreed actions.

5.3 Decision on whether to accept a dentist into a remedial programme

Once the initial review of the case has taken place the deanery will have to establish
whether it can develop and monitor a remediation plan. This may depend upon:-

      co-operation of the registrant
      funding to support the programme being available
      complexity of issues to be addressed
      any health issues that may hinder progress of a remediation plan
      timeframe for the remediation to be successful
      availability of deanery staff to draw up and monitor the plan

If, after discussion with the registrant, the deanery does not feel able to support a plan it
will inform the registrant and report back to the referring agency accordingly.

5.4 Develop a draft action plan / remediation plan

Where the issue that leads to the referral does not require external assessment in order
to fully identify the training needs, it should be possible to draw up an action plan to
work through the issues. It is likely that the registrant will need coaching on how to
develop an action plan, especially determining appropriate outcome measures.

For more complex matters, perhaps related to health or behaviour, the deanery action
plan will set out the clinical and professional issues to be addressed in parallel with
plans by any other agencies involved in the process.

When formulating the action plan it is essential that the registrant is given the
responsibility to draft the plan in the light of the advice about what is required at each

                                                                Remediation of Dentists in Difficulty

stage. This will give the registrant ownership of the plan and thus increase the
likelihood of its success.

Appendix 6: Examples of remediation options for clinical subjects
Appendix 7: Examples of resource material and tools for remediation

The plan should identify the major issues that need to be addressed, define the
acceptable evidence of the outcome and by when it will be completed. It may be helpful
if there is an action plan for each major item giving milestones along the route.
Breaking down the project into smaller activities with short deadlines may make the plan
more manageable and less daunting for the registrant.

To assess areas that may need to be specifically addressed in the action plan, the
deanery may ask the registrant or the referrer for additional information.

Appendix 8: Standards for clinical/professional practice
Appendix 9: Sources of evidence of professional competence

The role of the deanery is to assist the registrant in drawing up an appropriate plan,
advising him/her of resources to assist in attaining the goals of the plan, agreeing the
acceptable evidence required, approving the plan, monitoring progress and reports.

Action planning stages-

  1. outcomes for each area of remediation specified by the referral body
  2. outcome for each domain of the revalidation framework
  3. evidence of attainment of the defined outcome
  4. actions needed to collect the evidence
  5. success criteria for each part of the plan and what will determine the timetable to
      the outcome and indicate milestones
  6. Define what the success criteria for each part of the plan will be and what will
      happen if the dentist fails to achieve the required outcome
  7. Agree the plan with the referring body as appropriate or requested

Appendix 10: Example of an action plan
Appendix 11: Quality assurance

5.5 Timetable and milestones

To be effective, the action plan must have clearly defined milestones for each activity
and a date agreed for each milestone. These need to be recorded on the action plan.
The milestones should relate to specific actions and should have as short a timeframe
to attainment as possible.

Appendix 12: Evidence of attainment of remediation goals

5.6 Monitoring of the plan

Whilst the final responsibility for monitoring progress lies with the referrer, the deanery
will, at agreed intervals, provide the referrer and other parties with a brief report on
progress in achieving the milestones in the action plan. The deanery will notify the
referrer if it has any concern that the registrant is unlikely to attain the milestones.

                                                                  Remediation of Dentists in Difficulty

   5.7 Report

   The deanery will provide a report at the end of the remediation programme confirming
   the attainment of the action plan items and any concerns about the quality of the
   evidence of attainment if appropriate.

   The deanery will not make a judgement on the registrant‟s fitness to practice but merely
   report on the attainment of agreed actions against the plan.

6. Roles and responsibilities of Deaneries
   It is the responsibility of the deanery to:-

         Appoint a named adviser to oversee the case
         Request a revalidation portfolio from the registrant
         Advise the registrant on the activities and tools they can use to remediate
         Assist the registrant in drawing up action plans for their clinical remediation
         Assist in arranging operative assessments where appropriate
         Advise the referrer if there are concerns about health, with the consent of the
         Confirm in writing with the registrant the issues, actions and outcomes associated
          with the process
         Agree the plan with the registrant and the referrer, as appropriate
         Monitor the action plan for clinical activity
         Report progress in achieving the milestones in the action plan to the referrer
         Report failure to achieve the milestones to the referrer
         Report outcomes of the action plan to the referrer
         Liaise with the registrant‟s defence organisation as appropriate
         Keep appropriate records during the remediation period and for 11 years
         Refer back if the deanery deems it is unable to assist

7. Responsibilities of the referrer
   It is the responsibility of the referrer to:-

         Notify the deanery of a request for remediation and a named case worker
         Provide the deanery with appropriate information in relation to the referral
         Notify the deanery of their requirements for receiving update reports
         Monitor progress towards remediation
         Arrange appropriate assessments with may include occupational health and
          behavioural assessments
         Take appropriate action should the registrant fail to attain the agreed outcomes of
          the remediation process

8. Responsibilities of the registrant
   It is the responsibility of the registrant to:-

         attend meetings with the deanery‟s named adviser and staff as requested
         draft the action plan for deanery approval
         allow appropriate assessments if required
         report progress to the deanery against the action plan milestones

                                                                    Remediation of Dentists in Difficulty

         provide evidence of attainment of the action plan goals
         respond to deanery requests for information in a timely way
         fund any assessments and remediation training as determined by the action plan
         seek medical advice if appropriate
         fund the plan unless alternative sources of funding are available

9. Disclosure of information
   At the start of the deanery process, the registrant must be made aware of what
   information will be disclosed to third parties and at what points during the remediation
   programme. The registrant must also be informed that disclosures will be made to the
   General Dental Council if concerns for the safety of patients are discovered during the

10. Appeals against the deanery process
   Should the registrant believe the deanery action plan is unreasonable, they should
   consult their defence organisation for advice. If they still feel the process is unfair they
   may ask for an independent review by a panel comprising a representative from another
   deanery, a lay person nominated by the deanery who will act as chairman of the review
   panel and LDC or BDA CAR representative or other membership as approved by the
   Strategic Health Authority or Health Board.

  Appendix 13: Appeals against the process

11. Working party membership
         British Dental Association                J Husband
         Dental Defence Union                      B Harvey
         Dental Protection Ltd                     B Westbury
         Dental Schools Council                    Professor P Lumley
         General Dental Council                    M Ridler
         National Clinical Assessment Service      J Brooks, C McLaughlin
         Primary Care Trust                        C Brown
         Postgraduate Deans                        A G Miller, N Ward

                                                                                                                                                        Appendix 1
           Schematic for PCTs dealing with NHS primary care dental registrants about whom there are professional concerns

     Concerns raised                              PCT
    about Primary Care                     Collates information
      registrants by:-                       Analyses data
                                             Consults NCAS
             Patient                       Meets with registrant

        Complaints / PALS

      Registrant themselves
                                           Interim performance
                                                                           Formal performers panel                                            NCAS assessment
        Other primary care                         panel

       Salaried professional
       registrant‟s employer
                                                                            PASS scheme
            Other PCT

           Other source

                                                                                                                             Assessment and
                                            NCAS assessment                                  DEANERY                          determination

                                                                                          Remedial education

                                                                                            Outcome report

1. It should be recognised that not all PCTs will have exactly the same governance structures
2. It is important to recognise that there are crucial decisions to be made at the Interim Performance Panel stage regarding patient safety
3. This may include “contingent removal” from the Performers List, or referral to Regulatory Bodies
4. PCTs may wish to consider seeking NCAS advice at an early stage of the process

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                                                                            Appendix 2

                   Referral information required by a deanery

The referring body should provide the Deanery with the following information:

      The name and contact details of the registrant
      The name and contact details of the registrants defence organisation
      The nature of the original complaint
      The areas identified as needing remediation
      Any other areas of concern
      Any advice and guidance sought from NCAS.
      Any assessments and reports undertaken (NCAS etc)
      The referring officer who will act as the case handler and monitor
      Key reporting dates

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                                                                                Appendix 3

                                  Assessment form

Checklist to assist identifying areas for updating / remediation

         Area of concern                                    Yes/No     Rating
              Diagnosis and treatment planning
              Radiology prescription/diagnosis
              Radiology quality of images
              Routine conservation
              Crown and bridge
              Endodontics
              Dentures
              Extraction
              Minor oral surgery
              Periodontics
              Paedodontics
              Sedation/ anxiety control
              Lack of
              Poor quality
              Altered
              General concerns
              Specific concerns eg sedation
              With patients
              With colleagues
              With staff
              Allegations of rudeness
         Practice management
              Health and safety
              Lack of documentation eg IRMER
              Infection control
         Concerns raised by PCT/BSA
              Adverse DRO reports
              Lack of appropriate NHS forms
              Concerns re prescribing profile
              Band gaming
              Complaints - number and type
         Previous disciplinary matters
              GDC
              PCT
              Trust
              Previous issues
              Current issues
         History from Defence organisation
              Number of complaints

                  Rating is a numeric score of severity of the issue
                               0 = no concern 5 = high

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                                                                      Appendix 4

               Selection and training of deanery staff involved
                       in managing remediation cases

The deanery clinician appointed to act as the Remediation Advisor to the registrant
should have the appropriate skills and knowledge for the role.

The following domains in the COPDEND publication „Guidelines for Dental Educators‟
provide a useful source of reference:-

Domain 4: Assessing the learner
Domain 5: Guidance for personal and professional development
Domain 6: Quality assurance
Domain 8: Professionalism

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                                                                            Appendix 5

                           GDC Revalidation Domains

Suggested sources of evidence for the domains

Domain              Source of evidence                             Portfolio evidence
Clinical            Record keeping
                    Audits                                         Copy
                    DOPs                                           Report
                    Photographs, videos & models
                    Recent satisfactory Dental         Reference
                    Officer report
Communication       Multi Source Feedback (MSF)                    Copies
                    Videos of consultations
                    Copies of letters                              Copies

Professionalism PDP and CPD records                                Copies
                MSF,                                               Copies
                Peer observation reports                           Copies
                Minutes of meetings                                Copies
                Quality of evidence in portfolio
                Letters                                            Copies
                Publications                                       Copies
                Appraisal notes                                    Copies
                Involvement with professional committees           Minutes
                Reflective notes                                   Copies
Management & Third party accreditation – BDA, FGDP, IiP            Certificates/ reports
leadership      Denplan Excel etc.
                Minutes of meetings                                Copy
                Business plans                                     Copy
                PDP                                                Certificates
                Accredited training                                Copies
                Audit                                              Copies
                Third party reports – PCT, Dent

Suggested minimum content of revalidation portfolio:
 a. Evidence of regular appraisal
 b. A personal development plan
 c. Evidence of Continuing Professional Development
 d. Working in an accredited environment
 e. Examples of reflective practice

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                                                                           Appendix 6

             Examples of remediation options for clinical subjects

Area                Activity                        Outcome      Validated by
History taking      Audit of record keeping         Report       External review
Clinical            DOP, Audit, video, clinical     Report       External review
examination       & photographs, study
operative           models
                        Accredited Courses          Assignments External
                        Practical courses           Report      Course organiser
                        CAL material                Knowledge   External.
                        General CPD courses         Reflective  Review
                        Clinical attachments        Report      Report from
                        Clinical Observerships                  supervisor
                        Key skills
Communication           MSF                         Summary      External review
skills                  Direct observation          reports
colleagues staff   Course certificates
Leadership       & MSF                                          External review
management         Direct observation               Report
                   Accredited courses               Assignments External
Professionalism         MSF                         Report      External review
Integrity               Audit of clinical records   Report      External review
Compassion              DOPs

External review can be provided by any dentist approved by the deanery. It may be
provided by dental tutors, dental practice advisors, Dental Reference Officers, defence
body representatives, vocational training advisors, suitably trained Local Dental
Committee nominee.

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                                                                         Appendix 7

                         Examples of resource material

 FGDP Key Skills
 Smile-On communication CDs
 Smile-On clinical governance tools
 NHS PCT Local Assessment Panel – audit „cook books‟
 Denplan Excel
 BDA Good Practice Scheme
 BDA Clinical Governance Kit
 Health issues –PCTs should have access to occupational health services to assist
  with health matters related to dentists
 NCAS may be able to arrange access to the Practitioner Help Programme if required.
  There may be a charge for the PHP service
 Deanery VT Competency Assessment framework

                               Tools for remediation

 See COPDEND – Foundation curriculum
 Framework for Dental Foundation Training p33-37
 CPD planner -

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                                                                                    Appendix 8

                        Standards for clinical / professional practice

The following may assist in setting the standards required of a registrant to show attainment
of revalidation standards:

 Royal College Clinical Guidelines
 FGDP (UK) Standards in Clinical Dentistry.
 SAMS manual
 GDC First Five Years
 Curriculum for UK Dental Foundation Training

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                                                                                         Appendix 9

                 Sources of evidence of professional competence

    Clinical                                               Environment

        Dental Practice Department Business                  DRS
         Services Authority                                   DPA
        Dental Reference Service                             Deanery (VT advisers; practice visits)
        Dental Practice Advisor                              Audit*
        Expert report                                        Governance
        Clinical observation                                 Monitoring
        Multi source feedback (including patient
        Denplan Excel
        BDA Good Practice
        PCT infection control
        Audit*
        CPD records*
        Self-assessment
        Calibrated simulation
        Reflective evidence*
    Health                                                 Behaviour

        Occupational health                                  Multi source feedback*
        Private specialist report                            360 degree feedback*
                                                              Complaints
                                                              Reflective evidence*
                                                              Psychometric testing
                                                              Psychometric report

                      Evaluation of communication issues should be drawn from evidence
                              from more than one of the above assessment tools
   * portfolio evidence

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                                                            Appendix 10

                             Example of an action plan

Overview plan


 Remediation Case

 Name                                   GDC No

 Tel No                                 Email

 Key areas to be addressed
          Area                      Outcome               Completion Date


Detailed plan


 Remediation Case

 Name                                   GDC No

 Tel No                                 Email

 Item Detail            Activity                Outcome     Outcome Date

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                                                                       Appendix 11

                                Quality Assurance

The deanery should define a quality management and control process for how it handles
remediation cases.

The process should define:

 The standards the deanery sets for each stage of the process
 How these standards are monitored?
 What review of these standards, processes and monitoring take place on an annual

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                                                                                Appendix 12

                        Evidence of attainment of remediation goals

    It is essential that clearly defined outcome measures are defined in the action plans. The
    following tools may assist in this process.

             Audit
             Assessed training programme (University courses)
             DOPs, LEPs, MiniCex, CbD, and MSF* (see appendix 5)
             Clinical attachments and observership reports
             Peer review reports
             DRO reports
             Key Skills
             Practice protocols
             Notes of practice meetings
             On line CPD
             Multi source feedback
             Significant event analysis
             Case based discussion
             Records of verifiable CPD

    *Direct Observation of Procedures (DOPs), Longitudinal Evaluation of Procedures (LEPs), Mini
    Clinical Exam (MiniCex),Case Based Discsussion (CbD), Multi source feedback (MSF).

    The COPDEND publication „Evidence in support of the development of an assessment
    framework for Dental Foundation Training‟ gives helpful guidance on the most
    appropriate use of the assessment tools.

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                                                                           Appendix 13

                            Appeals against the process

If the registrant feels the process by which the remediation plan is drawn up or monitored
is unfair they may wish to appeal.

The request to appeal should be made in writing to the Postgraduate Dental Dean
managing the remediation process. The deanery will acknowledge the appeal letter
within 14 working days.

The deanery will then form an appeal panel with a lay representative as chair, a
representative from another deanery and an LDC or BDA CAR member or a panel and
process approved by the SHA/ Health Board.

The panel will normally meet within 30 working days of the initial receipt of the appeal

The panel will consider the evidence and advise the Postgraduate Dental Dean of their

The appeal panel may find in favour of the appellant and recommend alterations to the
programme, dismiss the appeal or advise the programme be re-drawn by another

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                                   Reference Material

National Clinical Assessment Service

     Investigating performance concerns - Primary care
     Back on Track - Restoring doctors and dentists to safe professional practice -
      Framework Document
     Managing dental underperformance

General Dental Council:

     Standards for dental professionals
     GDC – Revalidation Guidance
     The GDC Fitness to practice procedures


   Generic Standards for Training (Revised July 2008)
   Standards for curricula and assessment systems (July 2008)
   UK Dental Foundation Programme Training curriculum
   Cross infection control for the dental team e-learning programme

Faculty of Dental Practice (UK)

 Standards in Dentistry
 Selection Criteria for Dental Radiography
 Adult Antimicrobial Prescribing in Primary Dental Care for General Dental
 Key skills –
      Clinical record keeping Infection control
      Legislation and good practice guidelines
      Medical emergencies
      Radiography
      Risk management and communication
      Team training

British Dental Association

       Advice Sheets series A-E
       Good Practice Scheme
       Medical History Forms
       Practice Compendium
       Clinical Governance Kit

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