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A former employer wrote to the GDC expressing concern about the registrant’s standard of diagnosis and treatment with many of the patients she had seen in the short time she had worked as an associate at the practice. The GDC commissioned a clinical dental adviser to assess the available documentary evidence. The clinical adviser concluded that the standard of care had been “significantly below the level of professional practice reasonably expected”. The alleged shortcomings in treatment concerned 19 patients at various times over approximately two weeks. The case examiners have considered all the evidence available and found a genuine possibility (“real prospect”) that nearly all the factual allegations would be found proved; a real prospect that these facts would amount to misconduct and deficient professional performance; and a real prospect the registrant's fitness to practise would be found currently impaired. The case examiners note however that, at this stage, nothing has been proved as a fact. However, rather than referring this case to a practice committee for a fuller investigation and resolution of the facts, the case examiners have agreed a set of undertakings with the registrant. This is to give her the opportunity to show that her knowledge and practice are at an acceptable level. The case examiners consider that undertakings would be an effective, proportionate and adequate measure in protecting patients and maintaining public confidence in the dental profession. The undertakings will remain in force for a period of 18 months, unless otherwise agreed or extended, and will have a review before their expiry. This undertakings agreement refers to a “development adviser” and a “workplace supervisor” (see note at end of Section 1). Further details, of what is meant by these and other terms, are also available on the GDC website and from the GDC’s Case Review Team (CRT). The undertakings agreement is in two sections: • SECTION 1 – Getting support, and providing evidence of safe practice and new learning • SECTION 2 –Deadlines, to help the GDC monitor progress. The aim of this agreement is to give you the opportunity to show that your knowledge, and standards of practice, are at an acceptable level. To this end, the following has been agreed. SECTION 1 – Getting support, and providing evidence of safe practice and new learning Personal professional development plan 1. You will work with a development adviser* (see explanatory note below) who will be nominated by you and agreed by the GDC, to formulate a personal professional development plan (PPDP), using the template which the GDC will supply. This will be specifically designed to support you in addressing the possible deficiencies identified by the GDC’s clinical adviser in their report, in particular in the following areas of practice: a. Dental charting b. Diagnosis of caries c. Taking of radiographs d. Record keeping e. Diagnosis of periodontal disease f. Treatment planning g. Root canal treatment 2. You must provide the development adviser with a copy of the full case examiner decision relating to these undertakings. 3. You will meet with the development adviser on a regular basis, to discuss your progress towards achieving the aims set out in your PPDP. The frequency of your meetings is to be set by the development adviser. 4. The development adviser should provide a report to the GDC every six months reporting on: • progress on the development objectives set out in Undertaking 1 • any updates to the PPDP. 5. You will hereby allow the GDC to exchange information about the standard of your professional performance and your progress towards achieving the aims set out in your PPDP with the development adviser, and any other person involved in your further learning and supervision.

Supervision and working arrangements 6. At any time you are providing services which require you to be registered with the GDC, you agree to remain under the supervision of a workplace supervisor* nominated by you and agreed by the GDC. You must have agreed your nominated supervisor with the GDC before you start working under these undertakings. The workplace supervisor must be a GDC registrant at least in the same category of the register as you. 7. The supervisor will provide “close supervision*” as defined by the GDC, with the restrictions thereby included in that definition (see explanatory note below). 8. You will keep your professional commitments under review and limit your dental practice in accordance with your workplace supervisor’s advice. 9. You must not work as a sole practitioner, locum or undertake any out-of-hours work or on-call duties. 10. You must provide the workplace supervisor with a copy of the full case examiner decision including the undertakings. 11. The workplace supervisor will provide reports to the GDC on your progress every three months. These will include the following: • details (including dates and times) of any activities undertaken with the supervisor as part of these undertakings; • copies of any audits and case-based discussion reports that have occurred since the last supervisor’s report was submitted; • confirmation of progress in relation to learning and improvement activities in the categories agreed with the development adviser, including those listed in undertaking 1, above; • any new concerns the supervisor has (the supervisor should notify the GDC promptly if significant concerns arise). Audits by you and by an independent person 12. You agree to carry out audits and arrange for these to be provided to the GDC every three months. The audits will cover the particular aspects that are to be included in the PPDP, as listed in undertaking 1, above. These audits should be signed by the workplace supervisor, to verify the information. 13. After six months, and again after 12 months, at least one of the full sets of audits must be completed by a different independent dental professional (who is not your supervisor) agreed in advance with the GDC. You must give them a copy of the full case examiner decision including this undertakings agreement and your PPDP – they should confirm this in their audit report which they must send to the GDC on completion. (This is so we can have fuller independent evidence about your current standards of practice.) This will be someone who is at least of the same category of registration as you. The name and contact details of this person should be provided to the GDC. 14. You should bear in mind that, if the independent audit does not show satisfactory progress, case examiners may expect to see a later independent audit. If this appears to be the case, for example based on the independent auditor’s comments, you may wish to supply a further such audit closer to the end of the undertakings period. Independent observation and assessment 15. You will, at least once every three months, spend half a day being observed whilst assessing and treating patients. The observer would be either your workplace supervisor or, if more workable, an equivalent alternative dental professional approved by the GDC (this can be the same person as the independent dental professional who will carry out an audit – see above). 16. You and the observer will complete and sign case-based discussions reports, and the observer will give a detailed assessment of the standard of clinical care observed. These will be included in the supervisor’s regular reports to the GDC. This (and the requirement, above, for an independent audit) is to help give us objective information with which to make our assessment of progress.

Notes on definitions (Further information is available on the GDC website and from the GDC’s case review team) * Workplace supervisor/ “Closely supervised”: This means your day-to-day work must be supervised by a registered dental professional, as prescribed in the relevant undertaking. The workplace supervisor must supervise the registrant’s day-to-day work in a way prescribed in the relevant undertaking. The workplace supervisor must always be on site and available when the registrant is working. Where the workplace supervisor is unavailable through illness or planned absence, the registrant must not work unless an approved alternative workplace supervisor is in place. The workplace supervisor must review the registrant’s work at least twice a week in one to-one meetings using case-based discussions. These meetings must focus on all areas of concern identified by the undertakings. *Development adviser: Development advisers are named individuals who are approved by the GDC to support dental professionals who need to develop their skills and competencies as a result of conditions or agreed undertakings. Development advisers are responsible for guiding and supporting dental professionals in the areas of development or learning identified in the determination of a practice committee, or those detailed in a case examiner decision sheet. They also offer support to dental professionals in developing and keeping up to date a Personal Professional Development Plan (PPDP). The role undertaken by development advisers can further enhance the skills and knowledge of those who take up the role in support of other dental professionals. SUMMARY – meetings and reports Frequency Meet with workplace supervisor for discussions “Closely supervised” – discussions twice a week Meet with development adviser As agreed with development adviser Workplace supervisor reports and audits to GDC Every 3 months Independent observation and assessment session At least every 6 months Independent audit After 6 and 12 months Development adviser progress report, including updated PPDP to GDC Every 6 months SECTION 2 – Deadlines to help the GDC monitor progress Audits and reports 17. These are set out above (underlined) and in the chart above. Initial disclosures to the GDC 18. (a) You must notify the GDC, within 7 days of the commencement of these undertakings, of: • any professional appointment you are currently undertaking; • the contact details of your employer, or any organisation for which you have a contract or arrangement to provide dental services; • details of all the NHS regional teams/Health Boards with whom you have an arrangement, either as a contract holder or by being on our Dental Performers’ List. (b) You must also do this within 7 days, if you accept any such new professional appointment or contracts or entry onto a Dental Performers List. 19. Within 14 days of the commencement of these undertakings, you must send the GDC written evidence that you have complied with the requirement to inform employers and commissioning bodies about these undertakings (see “Informing other people about the undertakings agreement”, below). Ongoing issues and changes in circumstances 20. Within 7 days of it happening, you must inform the GDC: • of any formal disciplinary proceeding taken against you; • of any complaint made against you; • if you apply for dental employment outside the UK (within 7 days of the date of application); • if you are registered, or subsequently apply for registration, with any other overseas regulator/relevant authority, within 7 days of the date of application for future registration, or 7 days from the date these undertakings take effect for existing registration. • about a change in your employment or commissioning arrangements such as accepting any new professional appointment or contracts or entry onto a Dental Performers List (see above – “Initial disclosures to the GDC”).

Informing other people about the undertakings agreement 21. You must, within 7 days of the commencement of these undertakings, inform the following people that these undertakings have been agreed: a. any organisation or person employing or contracting with you to undertake dental work; b. any prospective employer (at the time of application); c. the commissioning body on whose Dental Performers List you are included, or Local Health Board if in Wales, Scotland or Northern Ireland (or if seeking inclusion, at the time of application). 22. As stated above, you must, within 14 days of the commencement of these undertakings, forward to the GDC written evidence that you have done this. Standard agreement on exchanging information 23. You must allow the GDC to exchange information with your employer or any organisation for which you have a contract or arrangement to provide dental services, and any development adviser, auditor, reporter or workplace supervisor referred to in these undertakings. 24. You will permit the GDC to disclose the above undertakings (unless marked “private”) to any person requesting information about your registration status.