A Practical Guide to Compliance- Outcome 4

Welcome to the fourth edition of the 'Practical Guide to Compliance' series.  This series is intended to act as informal guidance to dental teams working toward CQC compliance.  The contents of these articles are based on personal opinion and interpretation of the CQC framework and other relevant legislation.  Whilst the author has full confidence in the suitability and appropriateness of the information contained within these articles, the information shall not be regarded as fact and those requiring definitive information should consult the relevant governing body. 

Outcome 4 Care and welfare of people who use the service


This outcome is centred around ensuring that you are delivering safe and appropriate care to your patients.

What do the regulations say?

"People should get safe and appropriate care that meets their needs and supports their rights".
- CQC Essential Standards

Compliance with this outcome will be achieved through having systems and procedures in place for managing patient care.

You will need to demonstrate your process for assessing patients prior to treatment, this could be in the form of a written procedure for examinations/assessments, it should detail what the assessment entails, how you involve the patient in the process and how you identify and take into consideration their individual needs and choices.

Every patient should be given a written care plan detailing their individual needs and choices, the detail included within this care plan will depend upon the complexity and nature of their treatment needs however it essential all patients are given a full details of all care and treatment options appropriate to them.  The treatment planning process needs to take into consideration a patients indivdual needs and preferences and patient involvement here is key.  A treatment planning policy will serve as a means for setting the required standard of treatment planning in your practice.  There should be provision within your treatment planning processes for dealing with changes in treatment needs/wishes and how patients are involved in this process.  The operation and monitoring of an effective treatment planning policy will not only serve as evidence of compliance to this CQC outcome but will also count towards compliance with the outcomes we have already covered in this series (1, 2 and 3).

Educating your patients about their treatment needs is paramount you must make sure that you have made every effort to support their decisions regarding treatment, this could include discussions, providing further information and resources or even offering alternative option where appropriate.  It is important that patients are made aware of the consequences of foregoing a particular treatment.

All care provided should be done so in line with the appropriate clinical guidance for example demonstrating your compliance with NICE recall guidelines would be considered evidence of this.  This can be done by having a Recall policy detailing the criteria for recall selection and subsequent recall interval audit to monitor the operation of this policy.

All assessments and treatment planning processes should be operated in line with your practices equality and diversity policy to ensure people are protected from unlawful discrimination. 

Having the above processes in place will reduce the risk of patients receiving unsafe or inappropriate treatment.  By carrying out a detailed assessment you will be obtaining all the relevant information to ensure your treatment recommendations are the most appropriate course of action to address the patients individual needs.

This outcome also requires practices to plan for any foreseeable emergency situations.  To do so you must be aware of what risks exist in your practice, this will be covered in much greater detail in Outcomes 8-10 but in brief you will need to:


·                     Carry out risk assessments and reflect on the findings
·                     Show evidence that you have learned from adverse events, incidents, errors and near misses
·                     Evidence that you operate a being open policy with regards to patient care, if there an error, incident or adverse event has occurred in the course of patient care that has caused or may cause harm, you should offer a full explanation and the appropriate apology.
·                     Take notice and actions in relation to relevant safety alerts

When planning for foreseeable emergencies it is necessary to think about what could go wrong and how can we minimise the effects of such emergency.  For example we all undertake annual medical emergency training (or at least I hope everyone does) and we put into practice what we learn.  We keep the appropriate emergency drugs and equipment and know how to identify different conditions and how to provide immediate and potentially life saving treatment before medical help arrives, this is an example of planning for a foreseeable emergency.

Other types of foreseeable emergencies might include fire or major equipment failure, things that may put your surgery/practice out of commission for some time.  How do you ensure patients are provided with safe care and treatment and continuity of care during this time?  A detailed business continuity plan will help you put plans in place for these situations as well as many others and it is a necessity to achieve full compliance.  Once you have a plan it is essential everyone knows about it and what role they play.

Of course the key to all of the above is implementation, team training, monitoring and review.  Make sure your team understand all your policies and procedures and are knowledgeable about what their individual role in each process is.

Set up systems for monitoring everything that you put in place for example a record keeping audit will help highlight the effectiveness of a treatment planning policy.

It is important to review the effectiveness of your policies and procedures to make sure you are using the most up to date methods and guidance. 

You will now start to see that many of the CQC outcomes are inter-linked in many ways and evidence you have started collecting for earlier outcomes will also serve as evidence for this and others too.


If you’d like to know more about how Practice Perfection can help you with CQC compliance please get in touch at [email protected] or call 07703627873