NHS England have introduced new procedures to make it easier for GDPs to keep records. But Peter Ingle argues that this is far from the 'landmark moment' that some have called it

Seasoned practitioners might be forgiven for experiencing a frisson of schadenfreude as they read about the latest attempt to cool down the record-keeping arms race.

NHS England has introduced Standard Operating Procedures (SOP) for common procedures, a move that has been welcomed by indemnifiers. They have provided examples of notes with and without the use of SOPs, and some examples of SOPs. This out of character act of kindness by NHS England comes in response to the realisation that clinicians are spending more and more time writing their notes up, at the expense of interacting with patients.

In the midst of an intractable access crisis, it has dawned on NHS England that there is a large potential increase in numbers of patients seen, if only they can encourage dental teams to complete their records in less time. Indeed, it’s likely that the potential time freed up would improve access just as much as one or more of the rash of new dental school openings being planned. Even better, it would be delivered immediately and at much lower cost.

The GDC lead clinical adviser, fitness to practice, Shamir B Mehta was quick to blog about the use of SOPs. He co-authored a British Dental Journal article about ‘note bloat’ and has previously blogged for the GDC on the subject, back in 2024.

A cynic might wonder if there is one particular reason for the GDC’s belated acknowledgment that there is such a thing as defensive dentistry, its recent proclamations that it does not want to be feared by registrants, and now a concern about long form record keeping. Perhaps the Department of Health and NHS authorities have told the Council that fearful, defensive, and screed writing dental teams, do less actual dentistry.

Which would be all well and good but for one or two problems. The supersizing of clinical records did not come out of nowhere. It was a perfectly rational response to perceived threats. For years the same protection organisations that have described the use of SOPs as ‘a landmark moment’ reminded members that, ‘if it was not written down, it didn’t happen’.

SOP has a nice military ring to it, and was introduced to the profession by former forces and English CDO, Sara Hurley, during the pandemic. Like many acronyms, SOP, and indeed the concept it describes, is neither innovative nor disruptive. SOPs, for those that have missed out on them so far, are simply cut and paste by numbers.

Practices will in theory set up a library of SOPs which will be kept as a separate accessible document referred to in a patient’s record for each specific procedure. For example we could have some SOPs for our complete dentures. Let’s have, say, SOP #305 for lower denture fits: ‘#SOP305. Denture fitted. Retention and occlusion excellent. Aesthetics superb. Patient in tears of delight and had to explain to them that it would be inappropriate to mention me in their will’.

Far-fetched, of course. But will the Fitness to Practice panel be convinced when every anterior composite has a record as per the NHS suggested SOPs? And what will our friends at The Dental Law Partnership make of every examination or consenting process looking the same?

Here is the SOP offered by NHS England for an anterior composite at the restoration placement stage:

  • Appropriate isolation and protection of soft tissues.
  • Use matrix and wedge when clinically appropriate.
  • Undertake etch and bonding technique in line with manufacturer’s instructions and clinical guidelines (reference the material and guidelines you follow and keep a copy of the manufacturer’s instruction sheets with the SOP).
  • Place composite in line with manufacturer’s instructions and clinical guidelines (reference the material and guidelines you follow and keep a copy of the manufacturer’s instruction sheets with the SOP).
  • Remove matrix and wedge.

Once the gaps have been filled in, this will only work if clinicians always do the same thing, with the same materials. It will be of little use to those with a few drawers of different restoratives, let alone the free thinkers who do not use the same bonding agent for every case. It is likely that SOPs will either require a lot of time consuming-customisation, or be used when they are not a true reflection of what was done. Inevitably fitness-to-practice panels and the claims companies will become as suspicious of SOPs as they quite have understandably become of pre populated templates.

But that may be the least of the challenges this ‘landmark moment’ faces. In endorsing SOPs NHS England are taking a knife to a gun fight. We all know that AI will result in the loss of many jobs. This is likely to include SOP writers at the various compliance companies who will no doubt soon be offering helpful ‘an SOP for every occasion’ packages.

Many readers will already be using AI to some degree in their record keeping. In the opinion of at least one jaded practitioner, it is fabulous. Readers may be aware of that sinking feeling when you realise that you forgot to write down an aspect of your discussion with a patient that was a bit out of the ordinary, but in their case very relevant. With the microphone on, and AI notes, that will happen a lot less. And those abbreviations that can be so problematic – gone. We can now include the chemical composition of our chosen bonding agent and stop using trade names. AI assisted notes will be longer, and when used properly, finally contain the ‘if it isn’t written down’ jeopardy.

If the powers that be really want to control the record keeping arms race they will need to try a different approach. There is an alternative to insisting that we record that we have checked the occlusion on every restoration and then adjusted and finished it, if required. They could recognise that as professionals this is baked in, if only for the reason that the patient will be back in a few days with food trapping, a high bite, a broken restoration, or all three, if we omit this basic step.

That would of course require a degree of trust by our regulator and other bodies in the profession. Much as the adoption of SOPs will require a great deal of trust by dental professionals in the opposite direction.