CQC's inspection programme of Defence Medical Services: Annual report for Year 6 (2022/23)

We inspect only 10% of high street dental services each year and we do not formally give a rating to these services. We take the same approach in the DMS inspections – although there is no rating, we judge whether the quality of care at the service is meeting regulatory standards and we make recommendations in the inspection report.

In Year 6, DMSR asked CQC to carry out first comprehensive inspections at 24 dental centres. Of these, 21 were meeting the regulations for all key questions (Figure 3). Common shortfalls were due to poor infrastructure and failure by the contractor or station to provide clear information and resolve risks relating to routine water safety checks and the cleaning contract.

Figure 3: Inspections of dental centres in Year 6

The dental service has been operating as a joint (RAF, Navy and Army) service for 25 years and the benefits of operating together are clear, with standardised operating procedures used consistently and centralised guidance. There is also a strong focus on preventative health promotion work through delivering Project MOLAR/MOLAIR. This is a treatment strategy used to improve the dental health of personnel entering military service. The project ensures that recruits have protected time for dental assessment and treatment during their training.

However, as in previous years, there are a couple of areas that require action to secure a system-wide solution:

Water safety: Station teams are often responsible for monitoring water safety and have a remit to ensure that water temperatures sit within certain parameters to minimise the risk of Legionella in the water system. But the results of these checks are often not shared with dental teams. As in previous years, we have found instances where water temperatures have strayed outside an acceptable range, but there has been no mitigating action and the dental centre team were not informed.

DPHC must ensure water temperature checks are routinely shared with the practice so they have assurance that the checks are being carried out and that temperatures are within the parameters as outlined in HTM 01-05 (chapter 19).

Building maintenance: Facilities that are not custom-built to deliver dental care or are poorly maintained were unable to achieve ‘best practice' as detailed in Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance. Although dental teams had placed the risk on their risk registers, escalated the risk appropriately and submitted statements of need for remedial work, funding had not been approved and so improvements had not been delivered.

Improvement on re-inspection

We re-inspected one dental centre in Year 6 to follow up our previous recommendations (figure 4). As with all DPHC facilities, dental centres are unable to address environmental or infrastructure concerns themselves, relying on the station's Health and Safety Team or Regional Headquarters to bid for funding for improvement work. We re-inspected Wittering dental centre after essential building work to create a new central sterile services department and laboratory. As a result, the dental centre now complies with national guidance on infection prevention and control and decontamination.

Figure 4: Re-inspection of Wittering Dental Centre in Year 6