Quality Assurance of Dental Nurse Training Item 20 Council 1 December 2016 Purpose of paper Action This paper sets out: i) the work undertaken by the Dental Nurse Working Group to investigate the feasibility of enhanced monitoring of dental nurse training delivered by individual providers; ii) the details of the pilot being carried out by the Quality Assurance Team, in preparation for the National Examining Board of Dental Nurses inspection scheduled for 2017 For noting Corporate Strategy 2016-19 Professionals: Objective 1 To gain a full understanding of the implications for dental professionals and current dental practice, of the regulatory decisions we make. Professionals: Objective 2 To help ensure that dental professionals are properly trained in the skills necessary to practise dentistry safely from the outset. Partners: Objectives 1 To develop stronger, more effective collaborative relationships with all our key stakeholders: our partners in the NHS; professional bodies; patient groups; other regulators including competent authorities across the EU; and providers of education and training and the wider dental sector. Performance: Objective 1 To improve our performance across all our functions so that we are highly effective as a regulator. Performance: Objective 2 To improve our management of resources so that we become a more efficient regulator. Business Plan 2016 Decision Trail Objective 2: To improve our management of resources so that we become a more efficient regulator. In March 2015, the Executive was asked by Council to review the adequacy of the quality assurance of dental Page 1
nurse training because GDC activity was focused on the awarding bodies, rather than the training organisations. The Council noted a paper provided in April 2015 and asked for further consideration of the options. A paper was presented at the closed session of the October 2015 Council, setting out a range of six options. Following discussion, Council agreed that the proposal to introduce enhanced monitoring of local providers of dental nursing training with risk based inspections was the preferred option, though it was recognised that this approach would take time to assess feasibility and develop. In the interim, the QA team were asked to undertake additional sampling inspections of local providers at upcoming inspections. Subsequently a Dental Nurse Working Group has been set up consisting of five GDC QA inspectors and one Council member. Four meetings of this Group have taken place in 2016 to take forward developments. An update of developments was given to PRB on 7 September Recommendations Authorship of paper and further information Appendices Council are asked to: Note the work to date undertaken by the Working Group Krutika Patel Quality Assurance Officer (kpatel@gdc-uk.org) James Marshall Quality Assurance Officer (jmarshall@gdc-uk.org) Ross Scales Quality Assurance Operations Manager (rscales@gdc-uk.org) A - Dental Nurse Training Quality Assurance Working Group Terms of Reference B Questionnaire sent to providers delivering the NEBDN qualification C Glossary of terms sent out with the questionnaire Page 2
Executive summary 1. This paper updates Council on the progress of the work undertaken by the Dental Nurse Working Group. The Group was established by Council in 2015, to explore the feasibility of a risk based approach when quality assuring providers delivering dental nursing qualifications. 2. Council is invited to note the progress of this work. Introduction and background 3. Dental nurse qualifications are delivered and assessed in a range of ways. The GDC currently approves seven qualifications which lead to registration with the GDC as a dental nurse. There are two other qualifications currently progressing through the approval process. Four qualifications are delivered and awarded by standalone training providers, while the remainder are awarded by an overarching awarding body. The latter qualifications are delivered through more than 300 local centres to approximately 4000 students. 4. Given the increased focus on apprenticeships for qualifications, it is anticipated that this may lead to additional dental nurse qualifications being developed over the next two years. 5. Currently there is no evidence to suggest that there is any risk to patient safety from quality assuring qualifications at the overarching awarding body level, as opposed to quality assuring all individual training providers. The QA process in place is designed to be proportionate, effective and provide value for money. To ensure that all student dental nurses are receiving a consistently good learning experience on their respective training programmes, it was important to consider alternative approaches when quality assuring, which can be implemented alongside the current process. 6. A paper presented in closed session at the March 2015 Council meeting, where the Executive was asked to review the adequacy of ongoing quality assurance of dental nurse training, as the current process concentrates on the awarding bodies rather than the training organisations. Further information on the range of options available to provide greater quality assurance on the quality of dental nurse training delivered by local providers, was presented in closed session during the October 2015 Council. This paper provided a range of six options, with the potential benefits, implications and estimated costs. 7. Council agreed at its October 2015 meeting to explore the feasibility of adopting an e/paperbased approach as the primary method of quality assuring dental nurse training. This would require every local provider to evidence how they comply with a set of criteria based on the Standards for Education. Inspections would then take place if and when risks were identified in the paper based submission. 8. Since 2015, inspections of dental nursing qualifications have begun with a two-day inspection of the overarching awarding body. The inspection panel has then visited a sample of centres delivering the qualification, which is in line with the proposal agreed with Council in October 2015. This format allowed the QA Team to increase the sample of providers without undertaking an unmanageable amount of inspection work for both the QA officer and the inspectors. 9. Each programme is typically inspected once every five or six years, with all programmes leading to registration as a dentist or Dental Care Professional scheduled to be inspected between 2013 and 2018. Programmes may be subject to re-inspection if they are not meeting the required standards, which might mean that a provider or awarding body is subject to an inspection every year for two or more consecutive years. The improvements in the GDC annual monitoring process may lead to additional inspections, if issues are identified that need to be investigated further. Page 3
Dental Nurse Working Group developments 10. The Dental Nurse Working Group (DNWG) was convened in December 2015 to consider this approach and discuss the implications, costs and potential risks. They have met four times in 2016. 11. The membership of the Group is made up of quality assurance inspectors two dentists, two dental care professionals (including one dental nurse) and a lay person. Following the first meeting, the DNWG agreed it would be valuable to have feedback from the Council Member, Kirstie Moons, who is also a registered dental nurse. 12. Outcomes of Working Group developments include: discussion of the feasibility of a QA paper-based approach; what the GDC would want to know to ensure local providers are meeting our Standards; what are the perceived risks and benefits of adopting such an approach for the following groups: providers, awarding bodies and the QA Team; assessment of the approach taken by other regulators the General Pharmaceutical Council, Health and Care Professions Council, and the Scottish Social Services Council were contacted; gathering a list of how many providers and students were involved with each of the awarding bodies; and a development of a questionnaire, used to collect information on the quality assurance processes in place of individual providers. 23. Feedback from the awarding bodies generally supported the approach, and the awarding bodies were happy to work with the GDC to ensure all providers would comply with our requirements. However, one of the awarding bodies felt the questionnaire replicated the approach taken by their own Approval and Quality Assurance Advisors (AQAA) and it may be onerous for their providers to then comply with GDC requirements. The Group noted these concerns but were of the view that the GDC questionnaire focused on patient safety and student competence whilst the AQAA approach focused on the suitability of the provider to deliver the qualification. 24. Following these meetings, the Group discussed further changes to the questionnaire, and a final version was agreed during the meeting held on 9 September. A copy of the questionnaire can be found at Annex B. 25. When meeting with NEBDN, the Group asked if they would be involved with piloting the questionnaire amongst their providers. NEBDN agreed and provided details of each of their providers to the QA Team. 26. The final version of the questionnaire was uploaded to the online survey tool BOS (Bristol Online Surveys). The advantage of using such a tool means that the QA Team would be able to monitor, analyse and utilise the data obtained from this exercise more effectively and efficiently, as it will be stored electronically. 27. On 27 October, a link to the questionnaire was emailed to all of NEBDN s 151 providers, with the deadline for completion being 9 December 2016. At the time of writing this paper, 20 providers had completed the questionnaire. 28. Following the deadline, the QA Team will review the information received. A meeting will then be arranged for DNWG to assess the information and determine which providers it would be useful in visiting as part of the 2017 NEBDN inspection. This meeting will also be an opportunity to discuss thresholds of acceptability, if it s decided this exercise will be carried out prior to every inspection where multiple providers are responsible for Page 4
delivery. Currently, the plan is to visit at least six during the first half of 2017. However, this number may increase dependent on the information provided in the questionnaires. 29. Currently all activities in relation to the Working Group are being absorbed by the QA Team. Discussions regarding possible long-term implementation, timing and frequency, as well as any additional resources required, will be considered by EMT when planning and budgeting for 2017/2018. Recommendations 30. Council is asked to : Note the work to date undertaken by the Working Group; Appendices 31. The terms of reference for the DNWG are set out at Annex A. 32. A copy of questionnaire is set out in Annex B 33. A copy of the glossary sent along with the questionnaire, is set out in Annex C. Page 5
Annex A Dental Nurse Training Quality Assurance Working Group Terms of Reference Purpose: Membership: The members of the Group will be current Quality Assurance Inspectors one lay member, one dentist member and two dental care professional members. The Group will be able to seek advice and assistance from external professionals as and when required. This is likely to include representatives of dental nursing awarding bodies. Duration of the Working Group: The scope and duration of the Working Group will be an agenda item for the first meeting which is planned for January 2016. However, it is currently envisaged that the Group will not need to meet more than six times and work should be completed by the end of quarter 3 2016. The purpose of this Working Group is to establish: Whether a paper-based approach as the primary method of quality assuring dental nurse training at local provider level is feasible. How this approach would combine with the current QA system that focuses on awarding bodies. Whether such an approach could provide a relatively complete and accurate picture of UK dental nurse training. How this could be integrated into a risk based approach to quality assurance activity. In considering these aims, the Group will have to consider and discuss: The questions that should be asked in the survey; The likely capability of local providers to complete the required documentation; How we can obtain consistent and good quality returns from local providers; What information the QA inspectors would hope to learn from the exercise; Establishing a risk tolerance; What happens if there are significant issues identified across a high proportion of providers; Ascertaining and monitoring how many providers are actually delivering dental nurse training; The frequency of this quality assurance activity; The likely impact on the Quality Assurance Team s workload and budget; and How this activity may impact on the training of other dental care professional Page 6
Annex B Questionnaire sent to providers delivering the NEBDN qualification GDC Annual Monitoring for Providers Delivering the NEBDN s National Diploma in Dental Nursing 2016 Section 1: GENERAL QUESTIONS 1. Name of provider 2. Type of provider (please select all that apply) University Dental Hospital Dental Practice Further Education College Commercial/private training provider Health Board/Trust Other If you selected Other, please specify 3. State the number of students registered on the programme on 31 December 2016 (the total number registered on the programme between 1 January 2016 to 31 December 2016) 4. State the number of students who achieved the qualification between 1 January 2016 to 31 December 2016 5. How many internal verifiers/moderators do you have quality assuring the programme delivery? 6. For each issue on the list, please indicate whether they have been any changes to the programme in the last 12 months and whether these have been positive or negative Physical resource Changes to the relationship with awarding body Student recruitment Positive Neither Negative Page 7
Student supervision Student placement (including if the student receives the adequate breadth of clinical experience) Student retention Staff Funding Assessments (including external examinations) Quality assurance findings Policy If the programme has experienced a negative or positive change in any of the areas listed above or in any not listed, please provide further explanation of these changes: Section 1: PROTECTING PATIENTS 7. As a provider, do you check if a work placement provides an induction with the student, prior to the student starting in the clinic? Yes No If NO, please explain why. If YES, please select from the list below to explain how this is confirmed (select all that apply) Service Level Agreements between you and the work placement Part of the quality assurance of practice placements Guidance documents Educational agreements Feedback from the trainers/supervisors Other If you selected Other, please specify further Page 8
8. Do you check that work placements are suitable for the education and training of dental nurses? Yes No If NO, please explain why If YES, please indicate how you check this (select all that apply) Formal placement audit/visit by you Self-declaration by the individual placement Meeting The placement has been used previously The placement has successfully passed a CQC or equivalent inspection The placement is a Dental Foundation Training/Vocational Training approved training practice Student/mentor is given an induction by the provider Other If you selected Other, please specify Page 9
9. What policies do the programme provider, work placement and awarding body have in place that relate to the training of dental nurses? (Select all that apply bearing in mind that several issues may be covered by one policy) Recruitment Raising concerns Whistleblowing Provider Employer Awarding body N/A Equality and diversity IRMER regulations Needle stick injuries Health and safety Infection control Clinical waste disposal Valid consent Uniform policy/dress code Students in difficulty Student fitness to practise Complaints policy Other 10. Please explain how you monitor concerns that may be raised by students regarding work placements? 11. How patients are informed that they may be treated in a clinic with a student dental nurse present? (Please select all that apply) If you selected Other, please list the policies The student dental nurse should wear a name badge indicating their position in their work placement An example of a notice or poster, that can be displayed in the waiting room informing patients that students are being trained Those in practice wear specific colours, which correspond to their status A message that informs patients that students are training at the work placement is displayed on the practice website Patients are verbally informed that the dental nurse in the clinic is a student Patients are not told Other If you selected Other, please specify Page 10
12. Which of the following are in place to ensure that work place trainers/supervisors are supported to deliver the programme? Please indicate if the guidance or requirement is from the awarding body or the provider. Induction Training Handbook Awarding body Provider Not applicable Have a formal teaching/ assessment qualification Other If you selected Other, please specify further Standard 2 QUALITY EVALUATION AND REVIEW OF THE PROGRAMME 13. Do you regularly collect feedback about the programme from (Select all that apply) Supervisors/employers Students Patients Feedback is not collected Other If you selected Other, please specify 14. If you selected any of the options in Q.13, please explain how this information has been used or how you intend to use this information Standard 3 STUDENT ASSESSMENT 15. What measures are in place to ensure students are assessed to a consistent standard in the work placement/practice? Please indicate who each measure belongs to: Guidance for trainers/assessors Calibration exercises for trainers Training days for trainers/assessors The use of witnesses Scenarios are provided for reference Staff handbook Awarding body Provider Not in place/ Not applicable Student handbook Employer handbook Page 11
Mentor induction Other If you selected Other, please specify further 16. How does the student s designated supervisor monitor the student s experience? Please also indicate the frequency that this occurs (Select all that apply) Regular assessment Portfolios/ Logbook review Meetings with their supervisor Meetings with the student Other Weekly Monthly Six monthly Annually If you selected Other, please specify further 17. Please explain what measures would be taken if a student was not getting an appropriate range of clinical experience 18. How are students in difficulty identified? (Select all that apply) Self-declaration by the student By assessment Lack of progression through the programme Attendance Feedback from their supervisor Complaints Other If you selected Other, please specify further 19. How do you ensure there is no conflict of interest between the QA process and the assessment process? 20. Is there anything else you want to tell us about your relationship with NEBDN? Page 12
Annex C Glossary of terms sent out with the questionnaire GDC Monitoring 2016 Glossary of terms: Apprentice A student dental nurse, employed by a dental practice for the entire time they are enrolled on the programme leading to the award of the National Diploma in Dental Nursing Assessment Series of tests that the student trainee dental nurse must pass in order to gain the qualification Award National Diploma in Dental Nursing Awarding Body National Examining Board of Dental Nurses (NEBDN) Centre (otherwise known as provider) responsible for delivering or arranging the delivery of the qualification Diploma National Diploma in Dental Nursing Employed A student dental nurse working at a dental practice whilst training to receive the award of the National Diploma in Dental Nursing Employer One who employs the student dental nurse in their dental practice Provider - Responsible for delivering or arranging the delivery of the qualification Qualification National Diploma in Dental Nursing Supervising registrant The GDC registrant in the dental practice responsible for supervising or arranging the supervision of the student dental nurse Work placement The dental practice where the student will practise their clinical skills Page 13