When Local Action Is Not Enough

Local action will not always resolve concerns. GDC guidance recognises that escalation is needed when local measures are impractical, have failed, the issue is serious, there is a risk of victimisation, or patients and the public require protection from a registrant.

This applies to dental nurses where the usual local route may be the source of the problem. If the concern involves an owner, dentist, manager or senior nurse, speaking up can feel risky. Professional responsibility to protect patients remains, regardless of hierarchy.

Escalate beyond the usual local route if

• The concern is serious, repeated or unresolved.
• The person you would normally tell is involved in the concern.
• You are told not to raise a genuine safety concern.
• Records are being altered or incidents concealed.
• You fear victimisation or deliberate cover-up.
• Patients or the public may need protection from a dental registrant.

External options include a commissioner, local regulator, safeguarding body, professional association, indemnity provider, Protect advice line, the Independent National Whistleblowing Officer for Scotland (for NHS services), or the GDC for concerns about fitness to practise and public protection.

Gagging clauses and retaliation

If the local route is blocked, unsafe or ineffective, the mechanism changes. The duty to protect patients remains.