We carried out an announced comprehensive inspection on 15 August 2016 to ask the practice the following key questions: Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations.

Background

In May 2013 the General Dental Council changed the regulations on how patients can access treatment with a dental hygienist. The change of regulations means that dental hygienists are permitted to see patients directly in order to undertake care and treatment within their scope of practice without a referral from a dentist. This arrangement is known as ‘direct access’.

The Hygienist opened in 2015 and is situated in a new retail development in Hereford city centre. It provides direct access private dental hygienist treatment. The practice is not a general dental practice and does not provide general dental treatment. It does offer tooth whitening in line with relevant direct access guidance from the General Dental Council (GDC). This is carried out under prescription from a dentist who visits the practice to complete the necessary assessment before the dental hygienist provides the treatment. The dentist is also present at the practice for patients’ first whitening treatment.

The dental hygienist who established the practice told us their aim was to extend patient choice and provide a flexible service aimed at helping patients to improve their oral hygiene.

The dental hygienist is the director of the company and the registered manager. A registered manager is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

The practice has one dental hygienist (the registered manager) who is supported by a dental nurse. The dental nurse also carries out reception and administrative duties.

The practice has one dental treatment room and a decontamination room for the cleaning, sterilising and packing of the instruments used in dental hygiene treatments. There is level access and double doors from the pavement into the practice. The patient toilet is on the ground floor and is equipped for patients with physical disabilities.

The practice is open from 9.30am to 5pm from Monday to Friday and 9.30am to 1pm on Saturdays (information on the practice website highlighted that the practice charged a £5 surcharge for Saturday appointments).

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to use to tell us about their experience of the practice. We collected 20 completed cards, met one patient during the inspection and saw patients’ comments on social media and in the practice’s own patient survey results.

Our key findings were:

• The practice and had systems to assess and manage infection prevention and control. The premises were visibly clean and patients commented on the high quality of the surroundings.

• The practice had suitable safeguarding processes and staff understood their responsibilities for safeguarding adults and children.

• The practice had clear processes for dealing with medical emergencies and for ensuring that dental equipment was available and regularly maintained.

• Dental hygienist treatment records provided clear and detailed information about patients’ care and treatment.
• Staff received training appropriate to their roles and were supported in their continued professional development.
• The practice provided a direct access service in line with guidance from the General Dental Council. This included clear referral systems, arrangements for working under prescription from a dentist when providing tooth whitening and suitable arrangements for the management of medicines including local anaesthetics.

• Patients were able to make appointments when needed.

• The practice had established a variety of ways to gather patients’ views including in-house surveys and social media.

• Patients received a flexible and responsive service and staff treated them in a caring, respectful and professional way.

• The practice had governance processes to manage the practice effectively.

• The practice had a strong focus on supporting and encouraging patients to improve their oral health. They used patients’ appointments, social media and regular competitions to promote oral hygiene and to educate patients. This is notable practice because it shows a commitment to encouraging improved oral health for their patients and the wider community.

There were areas where the provider could make improvements and should:

• Review the practice's recruitment arrangements so an effective process which reflects relevant legislation and guidance is in place for future staff appointments.
• Review whether the practice should register with the Information Commissioner.