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A patient wrote to the GDC with concerns about the dental treatment she had received from the registrant, a dentist. She said that, having regularly seen the registrant for check-ups and treatment, she had then seen another dentist. That dentist had identified significant problems with her dentition that the registrant had not addressed. The GDC commissioned a clinical dental adviser to assess the available documentary evidence. The clinical adviser concluded that some of the standard of care had been ‘significantly below the level of professional practice reasonably expected’. (The registrant has also submitted expert evidence that challenges this overall assessment.)The GDC registrar raised a number of factual allegations reflecting concerns. The case examiners have considered all the evidence available and found a genuine possibility (‘real prospect’) that nearly all the factual allegations relating to this matter, would be found proved; a real prospect that these facts would amount to misconduct; and a real prospect the registrant's fitness to practise would be found currently impaired. 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 10 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: o) Clinical examination and record keeping p) Assessment, diagnosis and management of periodontal disease and caries q) Treatment of caries, tooth wear and periodontal disease r) Assessment of risk of periodontal disease, caries and endodontics s) Consultation with patients including discussion of risk/benefits t) Treatment planning, and communicating treatment plans to patients u) Obtaining informed consent. 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 6 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. They must not be within your line management control. 7. Supervision will be at one of the three levels defined by the GDC’s ‘Fitness to Practise Glossary of Terms’, with the restrictions thereby included in the relevant definition. For this case, the level will be ‘supervised’ (see explanatory note below). The supervisor will be available for advice and assistance, and to provide the GDC with evidence of competence, as describe in the undertakings sections 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 3 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).

Direct observation 12. You will, at least once every 3 months, allow yourself to be directly observed by your workplace supervisor whilst treating patients. The supervisor (or alternative approved by the GDC) must directly observe a minimum of 9 procedures during the first 6 months of the undertakings period, and should overall include observation of all areas of concern identified at undertaking 1. The supervisor should assess your performance against the standard of professional practice reasonably expected of a registrant working in the same discipline, and then give feedback and discuss the learning needs highlighted by the assessment. 13. A record of the observations should be provided to the GDC every 3 months, using the template form which will be provided by the GDC. As set out in the template forms, the supervisor should include an assessment of the areas set out in undertaking 1, within the context of the following standard elements of general dentistry: • Patient examination • Diagnosis/clinical judgement • Treatment planning • Procedural knowledge • Technical ability • Communication (patient and staff) • Your insight into your own performance Case-based discussions 14. You must provide a verbal presentation of your management of a clinical case to the workplace supervisor at least once every 4 weeks. A minimum of 6 case-based discussions must be completed within the first 6 months of the undertakings period and should focus on all areas of concern identified by undertaking 1. 15. The workplace supervisor should assess your performance in the case-based discussions against the standard of professional practice reasonably expected of a registrant working in the same discipline, and then give feedback and discuss the learning needs highlighted by the assessment. 16. A record of the observations should be provided to the GDC every 3 months, using the template form which will be provided by the GDC. As set out in the template forms, the supervisor should include an assessment of the areas set out in undertaking 1, within the context of the following standard elements of general dentistry: • Patient record keeping • Investigations/referrals • Clinical diagnosis • Treatment planning • Follow up/patient management • Overall clinical judgement • Your insight into your own performance The GDC will, where relevant, provide templates for the workplace supervisor to use for reports, and for the recording of case-based discussions.

Audits 17. You agree to carry out audits and arrange for these to be provided to the GDC every 3 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. The audits should be a sample from your recent practice, of your previous 3 months work. The sample size should be approved by the workplace supervisor as proportionate whilst ensuring a reasonable picture of your standard of work. Notes on definitions (Further information is available on the GDC website and from the GDC’s case review team) * Workplace supervisor/ ‘Supervised’: the workplace supervisor must supervise the registrant’s day-to-day work in a way prescribed in the relevant condition or undertaking. The workplace supervisor does not need to work at the same practice as the registrant, but they must be available to provide advice or assistance if the registrant needs it. 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 once a fortnight in one-to-one meetings and case-based discussions. These meetings must focus on all areas of concern identified by the conditions or undertakings. These meetings should usually be in person. If this is not possible, at least one of every two fortnightly meetings must be in person. *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 ‘Supervised’ – review work once a fortnight Case-based discussions, using template Every 4 weeks, minimum of 6 in first 6 months Direct observation of clinical work by workplace supervisor At least every 3 months, with a minimum of 9 procedures observed in first 6 months – send to GDC every 3 months. Meet with development adviser As agreed with development adviser Send to GDC: Workplace supervisor reports, including copies of case-based discussions, direct observations and audits Every 3 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 18. These are set out above, including in the chart above. Initial disclosures to the GDC 19. (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. 20. 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 21. 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 22. 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). 23. 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 24. 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. 25. You will permit the GDC to disclose the above undertakings (unless marked ‘private’) to any person requesting information about your registration status.