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Oral health is an essential, yet often neglected, aspect of care in the elderly population. A mouth free of pain and disease which is functional, comfortable and aesthetic improves quality of life. Following the shocking reports of patient neglect and abuse published in the Francis Report, the dental profession must acknowledge that there are longstanding deficiencies in the provision of oral healthcare for the elderly, whether residing in care homes, hospitals or at home with support. It must be a universal goal to improve the care provision for this population through developing a greater understanding and overcoming the multi-factorial barriers to care. This article will highlight the key features of the Francis Report and its significance in the context of oral healthcare provision for the elderly. Clinical Relevance: To provide insight into the oral healthcare needs of the growing elderly population and the necessity of dealing with the current limitations in service provision.

This article explores the potential implications of the Francis Report for members of the dental team from a dento-legal perspective. It looks at the broad recommendations in light of the existing ethical environment in which dental registrants work and asks what is new and what the recommendations will actually mean for dental professionals in practical terms. Clinical Relevance: The fundamental recommendations of the Francis Report, namely, that those who provide care should put patients' interests first and be open about outcomes and performance, are not new concepts. A breach of these ethically based expectations may, however, create grounds for legal proceedings, which is clearly a significant point for all members of the dental team. It is therefore important to be aware of what is expected of those providing clinical care.

The professional regulators were identified in the Francis Report as having a central role in maintaining fundamental standards of care. This paper describes the key themes in the Report and the importance of regulatory powers to ensure that the serious failings in patient care highlighted by the Mid-Staffs Inquiry cannot be repeated. The central role of the GDC Standards in the profession's response to the Francis Report is stressed. Clinical Relevance: The importance of our professional regulator in ensuring adherence to fundamental standards of care is a central tenet of clinical dentistry.

Regularly attending adult patients are increasingly asymptomatic and not in need of treatment when attending for their routine dental examinations. As oral health improves further, using the general dental practitioner to undertake the "checkup" on regular "low-risk" patients represents a substantial and potentially unnecessary cost for state-funded systems. Given recent regulatory changes in the United Kingdom, it is now theoretically possible to delegate a range of tasks to hygiene-therapists. This has the potential to release the general dental practitioner's time and increase the capacity to care. The aim of this study is to compare the diagnostic test accuracy of hygiene-therapists when screening for dental caries and periodontal disease in regularly attending asymptomatic adults who attend for their checkup. A visual screen by hygiene-therapists acted as the index test, and the general dental practitioner acted as the reference standard. Consenting asymptomatic adult patients, who were regularly attending patients at 10 practices across the Northwest of England, entered the study. Both sets of clinicians made an assessment of dental caries and periodontal disease. The primary outcomes measured were the sensitivity and specificity values for dental caries and periodontal disease. In total, 1899 patients were screened. The summary point for sensitivity of dental care professionals when screening for caries and periodontal disease was 0.81 (95% CI, 0.74 to 0.87) and 0.89 (0.86 to 0.92), respectively. The summary point for specificity of dental care professionals when screening for caries and periodontal disease was 0.87 (0.78 to 0.92) and 0.75 (0.66 to 0.82), respectively. The results suggest that hygiene-therapists could be used to screen for dental caries and periodontal disease. This has important ramifications for service design in public-funded health systems., (© International & American Associations for Dental Research.)

In 1997 the Faculty of Dental Surgery (Royal College of Surgeons, England) as part of a wider publication produced guidance on prioritisation for the selection of patients to receive treatment with dental implants within the NHS in the UK (http://www.rcseng.ac.uk/fds/publications-clinical-guidelines/clinical_guidelines/index.html). This update considers eight main groups who may benefit from treatment with osseointegrated implants. Where patients are being considered for implant-based rehabilitation, treatment plans must be weighed up against the risks, benefits and outcomes outlined in evidence-based research.

This paper explores the concept of patient-centred care as a dimension of quality as applied to dentistry and provides a systematic review of the literature. The new NHS dental contract, which is currently being piloted in England, is committed to delivering improvements in quality. The Dental Quality and Outcomes Framework has been developed as a tool to measure quality and focuses on three key dimensions: clinical effectiveness, safety and patient experience. A systematic review of the literature reveals a lack of information pertaining to patient-centred care within dentistry, and in particular general dental practice. It would also suggest that there is currently a poor evidence base to support the use of the current patient reported outcome measures as indicators of patient centredness.

The evolving role of the state in the provision of health care has seen the adoption of new management philosophies to ensure that goals set for the system are reached. In particular, the term New Public Management (NPM) has tended to dominate reforms to help address perceived shortcomings in public sector services. NPM is based on the use of freemarket type arrangements as a mechanism to solve problems, the control of which provides new challenges. One particular challenge that has arisen from the combination of NPM with the large number of agencies involved in care provision is that of addressing the issues arising from the improved understanding of the determinants of health. This has led to the evolution of differing care arrangements across differing sectors at all levels. If resources are to be used as intended, the control of delivery systems to oversee their use must exist. The overarching term for such activity is â governance. This paper provides an overview of the issues that arise for addressing governance of oral health care and the subsequent challenges that face those responsible for ensuring compliance.

Introduction: A mandatory scheme for clinical audit in the general dental services (GDS) was launched in April 2001. No evaluation of this mandatory scheme exists in the literature. This study provides an evaluation of this scheme. More recently a new dental contract was introduced in the general dental services (GDS) in April 2006. Responsibility for clinical audit activities was devolved to primary care trusts (PCTs) as part of their clinical governance remit., Methods: All GDPs within Essex were contacted by letter and invited to participate in the research. A qualitative research method was selected for this evaluation, utilising audio-taped semi-structured research interviews with eight general dental practitioners (GDPs) who had taken part in the GDS clinical audit scheme and who fitted the sampling criteria and strategy. The evaluation focused on dentists' experiences of the scheme., Results: The main findings from the analysis of the GDS scheme data suggest that there is clear evidence of change following audit activities occurring within practices and for the benefit of patients. However, often it is the dentist only that undertakes a clinical audit project rather than the dental team, there is a lack of dissemination of project findings beyond the individual participating practices, very little useful feedback provided to participants who have completed a project and very limited use of formal re-auditing of a particular topic., Conclusions: This study provides evaluation of the GDS clinical audit scheme. Organisations who propose to undertake clinical audit activities in conjunction with dentistry in the future may benefit from incorporating and/or developing some findings from this evaluation into their project design and avoiding others.

Care pathways have been used in a variety of ways: firstly to support quality improvement through standardising clinical processes, but also for secondary purposes, by purchasers of healthcare, to monitor activity and health outcomes and to commission services. This paper focuses on reporting a secondary use of care pathways: to commission and monitor performance of primary dental care services. Findings of a project involving three dental practices implementing a system based on rating patients according to their risk of disease and need for care are outlined. Data from surgery-based clinical databases and interviews from commissioners and providers are reported. The use of both process and outcome key performance indicators in this context is discussed, as well as issues which arise such as attributability of outcome measures and strategic approaches to improving quality of care.

This paper explores the concept of quality as applied to healthcare and its subsequent application to dentistry. The assessment of quality arose from the manufacturing industry and is viewed as a cornerstone of current Government thinking. The difficulties in defining and therefore in measuring are examined and, in particular, the tensions between quantifying quality at a population level and at an individual level. The findings of the application of quality measures to primary medical care are reviewed, especially those that are linked to financial reimbursement of care providers and the implications for any future dental agenda discussed.

The Department of Health's response to the national budget deficit is to ensure that the provision of NHS services is guided by four fundamental 'QIPP' principles: Quality, Innovation, Prevention, and Productivity. This agenda will govern all aspects of the National Health Service's (NHS') health care provision for the foreseeable future. NHS dental services will, like all other NHS services, need to make a contribution to the QIPP agenda. The purpose of this paper is to outline the implications for NHS dentistry.

An often quoted description of professionalism I like is 'doing the right thing even when no one is looking'. We all have professional responsibilities; some are easier to meet than others, but being a professional is all about trust. Richard Emms as chair of this year's LDC conference put it very movingly: 'It's a great privilege to metaphorically take a patient by the hand (CRB and ISA checks permitting of course) and lead them through an agreed treatment plan, and it's why patients stay with us because they trust us to inform them and to do the right thing.' And that describes how most of the profession - my profession - behaves. But who can forget the big show of hands during the sessions at both the BDA and LDC conferences when Phil Hammond asked if the audience knew a fellow dentist they wouldn't want as their own and that most of the hands stayed up when he asked if we perhaps knew more than one colleague we wouldn't recommend? But we take no action. We all have pride in our profession, but we all know colleagues who may be letting that profession down. This is reflected in the increase in the GDC's Fitness to Practise caseload.

Objectives: To describe a method used in a health equity audit (HEA) of oral health and National Health Service (NHS) General Dental Services., Methods: Need, demand and provision of NHS General Dental Services were estimated by electoral ward using readily available data. Need was estimated using five-year-old dmft data. Scheduled and unscheduled demand were differentiated; scheduled demand was estimated using NHS dental registration data and unscheduled demand using emergency clinic and NHS Direct call activity data. Provision was estimated using self-declared dentist NHS hours and NHS Units of Dental Activity practice allocations. All variables were correlated with socioeconomic deprivation in each electoral ward, estimated by rates of receipt of Income Support., Setting: Sheffield, England., Results: Estimated need in electoral wards varied and correlated positively with increasing socio-economic deprivation. Scheduled demand tended to be lower and unscheduled demand higher in more deprived wards. Estimates of NHS General Dental Service provision indicated marginally higher provision in more deprived wards, though the correlation was weak. A synthesis of the findings estimated where need was least well met by provision., Conclusion: A HEA of oral health and NHS General Dental Services can be undertaken using readily available data. However, data used to estimate need, demand or provision may have to change for future audits as the data routinely collected changes.

Unlabelled: This article aims to give dental practitioners the background to the new NHS quality agenda. The clinical context of Lord Darzi's NHS review is examined alongside other policy documentation and Professor Jimmy Steele's independent review of NHS dental services. The potential impact of the new quality requirements on general dental practitioners is considered. Finally, opportunities for development are suggested so that practitioners can engage with the quality agenda and can demonstrate quality measures and improvements., Clinical Relevance: All general dental practitioners in both the NHS and private sectors have an obligation to continue to deliver high quality dental services. Dentists practising in England will need to ensure that they comply with new quality requirements by 2011.

The aim of this study was to examine the effects of an incentive-based remuneration system on number of individuals under supervision and on quality of public dental services in Norway. The basis for the study was a natural experiment in which all public dental officers in one county were given the opportunity to renegotiate their contract from a fixed salary contract to a combined per capita and fixed salary contract. Comprehensive data were collected before and after the change. A main finding is that the transition to an incentive-based remuneration system led to an increase in the number of individuals under supervision without either a fall in quality or a patient selection effect.

Objective: To outline the rationale for, background to and role of the National Clinical Assessment Service (NCAS) in helping improve the quality of care provided through the NHS dental care system and identify possible lessons for international dental care delivery systems., Description: Due to shortcomings in the provision of healthcare and changes in societal attitudes towards healthcare professionals new arrangements for ensuring the quality of care are evolving. The performance of individual practitioners is increasingly being challenged as new regulatory mechanisms for the delivery of care evolve. Historically, regulatory bodies have had few options to handle poor performance and this will need to change: one such approach is the development of an agency to help identify the rationale for poor performance and, most importantly, develop solutions to address them., Summary: The creation of NCAS has provided a mechanism through which shortcomings in dental practitioners' performance can be addressed in a systematic and more appropriate manner than has previously existed. The approach used has applicability for helping improve the quality of care within all oral health care systems.

In its primary role of protecting the public the General Dental Council has many tools at its disposal, one of which is pursing those who seek to practise dentistry illegally. Such illegal practice takes several different forms: dentists who have been erased or removed from the register but continue to practise, unregistered dental technicians who practise dentistry, and beauty salons that offer tooth whitening. Consequently a variety of approaches is required in order to apprehend the miscreant and persuade, prevent and even prosecute them in the process of stopping their illegal activities. The fifth and final part of our series on the GDC discusses the modus operandi of the legal department's work in this important area.

All those involved in education have a strong motivation to ensure that all its aspects, including content and teaching practice, are of the highest standard. This paper describes how agencies such as the Quality Assurance Agency for Higher Education (QAA) and the General Dental Council (GDC) have established frameworks and specifications to monitor the quality of education provided in dental schools and other institutes that provide education and training for dentists and dental care professionals (DCPs). It then considers quality issues in programme and course development, techniques for assessing the quality of education, including content and presentation, and the role of students. It goes on to review the work that has been done in developing quality assessment for distance learning in dentistry. It concludes that, to date, much of the work on quality applies to education as a whole and that the assessment of the quality of e-learning in dentistry is in its infancy.

As an organisation whose function is to protect the public, the General Dental Council's role in investigating complaints about dentists and dental care professionals dealing suitably with those who have been shown to practise in an unprofessional or dangerous manner is obviously of paramount importance. This article looks at the GDC's fitness to practise procedures - the system that looks into complaints and allegations of malpractice about dental practitioners. It outlines the different stages in the process and introduces some of the many people involved with the efficient running of this vital service.