Speaking up when something does not seem right can be one of the most difficult parts of working in dentistry.

This can feel particularly challenging when you are newly qualified or have recently joined a practice. You may notice something that concerns you, but the person involved has considerably more experience or authority.

You might wonder:

What if I have misunderstood?

Who am I to question someone more experienced?

What if people think I am difficult?

Could speaking up affect my job?

These are understandable concerns, but professional responsibility does not disappear because speaking up feels uncomfortable.

The GDC requires dental professionals to raise concerns where patients might be at risk because of a colleague’s health, behaviour or professional performance, the environment in which treatment is provided, or because someone has asked them to do something that conflicts with their duty to protect patients.

For dental nurses, learning how to raise concerns appropriately is therefore an important part of professional practice.

What Does Raising a Concern Actually Mean?

The phrase “raising a concern” can sound dramatic.

You might immediately imagine reporting a dentist to the GDC or becoming involved in a formal whistleblowing investigation.

In reality, many concerns begin much closer to home.

Raising a concern can simply mean bringing a potential problem to the attention of the appropriate person so that it can be assessed and addressed.

Depending on the practice and circumstances, that might involve speaking to:

• a senior dental nurse
• the practice manager
• the treating clinician
• a clinical lead
• the practice principal
• another person identified in the practice’s raising-concerns procedure

The GDC advises that, where possible, concerns should initially be raised with an employer or manager. However, it also recognises that this may not be appropriate where that person is themselves the source of the concern.

The important principle is simple: a genuine patient-safety concern should not be ignored merely because raising it feels uncomfortable.

What Sort of Concerns Should a Dental Nurse Raise?

Not every disagreement at work is a patient-safety concern.

However, dental nurses may encounter situations where remaining silent could allow unsafe practice to continue.

Examples could include:

• repeated failures in infection prevention or decontamination
• equipment that appears defective or unsafe
• serious problems involving emergency medicines or equipment
• a colleague repeatedly working in a way that could put patients at risk
• being pressured to undertake something outside your competence
• patient-safety incidents being deliberately concealed
• records being falsified or altered to disguise what happened
• serious safeguarding concerns
• concerns that a colleague’s health may be affecting their ability to practise safely
• unsafe aspects of the clinical environment

Context matters.

A disagreement about how someone organises a surgery is not equivalent to repeatedly failing to follow essential infection-control procedures.

Professional judgement involves recognising the difference.

What If You Are Not Sure?

This is one of the biggest barriers to speaking up.

You see something that concerns you but think:

“I need to be certain before I say anything.”

You do not need to conduct your own investigation or prove wrongdoing before raising a genuine concern.

The GDC specifically states that dental professionals should not have to prove their concern for it to be investigated. It also advises professionals who are unsure to consider what might happen in the short or longer term if they say nothing.

There is, however, an important difference between raising a concern and making an accusation.

Compare:

“I know this person is deliberately putting patients at risk.”

with:

“I observed this happen and I am concerned that it could create a patient-safety risk.”

The second statement explains what you actually know.

You are identifying something that needs consideration, not deciding the outcome of an investigation yourself.

Keep Facts Separate From Assumptions

How you communicate a concern matters.

Imagine you are worried about repeated infection-control failures.

Saying:

“She doesn’t care about infection control.”

is an interpretation of someone’s attitude.

Saying:

“I observed this step in the decontamination process being missed on three occasions this week.”

describes what you actually observed.

When raising a concern, focus on:

• what happened
• when it happened
• what you personally observed or heard
• who was involved where relevant
• whether it has happened before
• why you believe there may be a risk
• what immediate action, if any, was taken

Avoid presenting assumptions about another person’s motives as facts.

Accurate documentation can become particularly important if events later need reviewing. When raising a concern, focus on what happened, when it happened, what you personally observed or heard, who was involved where relevant, whether it has happened before, why you believe there may be a risk, and what immediate action was taken. Keep your account factual and avoid presenting assumptions about another person’s motives as facts.

What If You Are Asked to Do Something You Think Is Unsafe?

This can be particularly difficult for newly qualified dental nurses.

A dentist or more experienced colleague asks you to perform a task.

You are uncertain whether you have the necessary training, knowledge or competence.

Because they are senior to you, you may feel that you should simply comply.

But seniority does not remove your professional responsibility.

GDC Principle 8 specifically covers situations where someone asks a dental professional to do something they believe conflicts with their duty to put patients’ interests first and protect them.

Being a good team member does not mean agreeing to everything you are asked to do.

If you genuinely believe you are not competent to undertake something safely, say so and seek appropriate guidance.

Our Understanding Your Scope of Practice as a Dental Nurse guide explores professional boundaries and competence in greater detail.

What If the Person You Are Concerned About Is Your Manager?

This is where speaking up can become more difficult.

If the person you would normally approach is involved in the concern, check the practice’s raising-concerns or whistleblowing procedure for an alternative route.

That might involve another manager, the practice owner, clinical leadership or another designated person.

There are also circumstances where external escalation may be necessary.

The GDC says referral to it may be appropriate where local action is impractical or has failed, where the issue is sufficiently serious to require regulatory involvement, where there is genuine fear of victimisation or deliberate concealment, or where a registrant may not be fit to practise because of their health, performance or conduct.

The key point is that:

“My manager is involved” does not mean there is nowhere else to raise the concern.

Raising a Concern Is Not the Same as Having a Workplace Grievance

This distinction is important.

You may dislike the rota.

You may disagree with your manager.

Two colleagues may have a personality conflict.

You may be unhappy about annual leave or pay.

These can be legitimate employment issues, but they are not automatically patient-safety concerns.

Sometimes, however, an employment problem and a safety concern overlap.

For example, being short-staffed on one occasion is not automatically a regulatory concern. But if staffing arrangements repeatedly create circumstances where patients cannot be treated safely, that may raise a genuine patient-safety issue.

Focus on the risk, not simply the disagreement.

Is Raising a Concern the Same as Whistleblowing?

Not necessarily.

“Whistleblowing” is often used informally to describe almost any situation in which an employee reports something wrong at work.

Legally, it has a more specific meaning.

Current GOV.UK guidance explains that whistleblowing involves a worker reporting certain types of wrongdoing in the public interest. Depending on the circumstances and whether the legal requirements are met, this can constitute a protected disclosure. Workers making qualifying disclosures are protected from unfair treatment or dismissal because they blew the whistle.

Examples of wrongdoing that can potentially qualify include danger to health and safety, criminal offences, breaches of legal obligations and deliberate concealment of wrongdoing. Personal grievances generally do not qualify unless the particular circumstances engage the public interest.

Dental nurses do not need to become employment-law experts before raising genuine patient-safety concerns.

However, if you believe your circumstances may involve whistleblowing, particularly where you fear retaliation, obtaining appropriate independent advice may be sensible.

What If Nothing Happens After You Raise the Concern?

Sometimes concerns are raised and dealt with appropriately.

Sometimes they are not.

If you reasonably believe patients remain at risk after you have used the appropriate local route, further action may be necessary.

Exactly where a concern should go depends on what the issue is and who is involved.

Current GDC guidance identifies routes including the relevant healthcare regulator and, depending on the circumstances and UK nation, bodies such as the CQC, Health Inspectorate Wales, Regulation and Quality Improvement Authority or Healthcare Improvement Scotland. Concerns about another regulated healthcare professional should be referred to the relevant regulator where appropriate.

Not every unresolved workplace concern belongs with the GDC.

But where a registered dental professional may present a serious risk to patients or may not be fit to practise, GDC involvement may become appropriate.

The GDC also provides specific advice for dental professionals who are considering raising a concern.

Speaking Up After a Mistake or Near Miss

Mistakes and near misses should provide opportunities to improve patient safety.

Problems become more serious when people feel pressured to hide them.

Imagine an incident occurs and you are told:

“Don’t report it. Nothing happened anyway.”

The fact that a patient escaped harm does not necessarily mean the underlying risk should be ignored.

Our When You Make a Mistake at Work: A Professional Guide for Dental Nurses explains why appropriate reporting, honesty, reflection and learning are important when something goes wrong.

If an incident is deliberately concealed, the concern may no longer be only about the original mistake. It may also indicate a wider problem with the practice’s safety culture.

Practices Have Responsibilities Too

Speaking up should not depend entirely on how confident an individual dental nurse feels.

Those who employ, manage or lead dental teams also have responsibilities.

GDC Principle 8 requires dental professionals in leadership positions to encourage and support a culture in which staff can raise concerns openly without fear of reprisal. It also requires effective procedures for raising concerns and expects concerns to be taken seriously, investigated appropriately and followed up.

A healthy practice should therefore make it clear:

• how staff can raise concerns
• who concerns should normally be reported to
• what alternative route exists if that person is involved
• how concerns will be investigated
• how confidentiality will be handled where appropriate
• how staff who raise concerns will be supported

If you have never seen your practice’s raising-concerns procedure, it is worth finding out where it is.

Speaking Up Does Not Make You Disloyal

This can be the hardest part.

Dental teams often work closely together. You may have worked beside the same dentist, nurse or manager for years.

Raising a concern about someone can therefore feel like betrayal.

But professional loyalty has limits.

The GDC is clear that the duty to raise patient-safety concerns overrides personal or professional loyalties and concerns about appearing disloyal or being treated differently by colleagues or managers.

That does not mean treating every mistake as evidence of misconduct.

It means recognising when something presents a genuine risk and responding appropriately.

This is part of the professional judgement discussed in Becoming the Dental Nurse Clinicians Trust: Building Reliability, Judgement and Initiative.

A trusted dental professional is not someone who quietly agrees with everything.

It is someone who knows when something matters enough to speak.

Professional Confidence Includes Knowing When to Speak

You will not always be the most experienced person in the room.

You will not always be certain that your concern will ultimately be upheld.

And sometimes, after investigation, there may be a reasonable explanation for what you observed.

Professional confidence is not believing that your judgement can never be wrong.

It is being prepared to use that judgement responsibly.

When you believe something may put patients at risk:

Recognise the concern.

Consider the risk.

Raise it through the appropriate route.

Stick to the facts.

Keep appropriate records.

Escalate further when genuinely necessary.

Most importantly, do not allow fear of appearing difficult to become the reason an important patient-safety concern remains unspoken.

Speaking up can be uncomfortable.

But protecting patients is part of being a dental professional.

Frequently Asked Questions

When should a dental nurse raise a concern?

A dental nurse should raise a concern where they believe patients may be at risk because of a colleague’s health, behaviour or professional performance, the treatment environment, or because they are being asked to do something that conflicts with their professional duties.

Do I need proof before raising a patient-safety concern?

No. The GDC states that you should not have to prove your concern for it to be investigated. You should have a genuine basis for raising it and communicate what you observed accurately rather than making unsupported accusations.

Who should I report a concern to in a dental practice?

Where appropriate, concerns should usually first be raised through the workplace route, such as with an employer, manager, clinical lead or another person identified in the practice’s raising-concerns procedure. If that is inappropriate or ineffective, further escalation may be required.

What if my manager is the person I am concerned about?

Use an alternative reporting route identified by the practice. The GDC recognises that raising a concern with an employer or manager may not be appropriate when they are themselves the source of the concern.

Can a dental nurse raise a concern about a dentist?

Yes. The duty to protect patients is not determined by seniority. Dental nurses have their own professional responsibilities as GDC registrants, and concerns about another dental professional should be raised where patients may be at risk.

Is raising a concern the same as whistleblowing?

Not always. Whistleblowing has a particular legal meaning and generally concerns specified wrongdoing reported in the public interest. A patient-safety concern may also qualify as whistleblowing, but the two concepts are not automatically identical.

When should a concern be reported to the GDC?

GDC referral may be appropriate where local action is impractical or unsuccessful, the matter is particularly serious, there is genuine fear of victimisation or deliberate concealment, or there is concern that a registrant may not be fit to practise because of their health, performance or conduct.