December 2019

Issue 19 - December 2019

Chair’s message
Board news
Registration
Regulation at work
- Dentist suspended for practising without professional indemnity insurance
National Scheme news
Keep in touch with the Board

Chair’s message

Murray Thomas

Welcome to the Dental Board of Australia’s December newsletter. Release of our last newsletter for 2019 also marks my first year as Chair of the Board. My thanks to all dental practitioners and their teams for the safe and quality care you have provided to the community over the past 12 months.

Parliament recently tabled the Ahpra and National Boards’ Annual Report 2018/19, which gives useful insights into the work and performance of the National Registration and Accreditation Scheme (the National Scheme).

A detailed snapshot of the Board’s work, Dental practice in 2018/19, is also on our website.

An essential part of our work to keep the public safe is dealing with notifications (complaints) about dental practitioners. Again, for the reporting year, there has been a significant increase in notifications received.

Each year, a few practitioners raise concerns about the possible rise of vexatious complaints. A vexatious complaint is a groundless complaint made with an adverse primary intent to cause distress, detriment or harassment to the subject. Although vexatious complaints may occur, they are few, and the Board understands the damaging effect this kind of claim may have on the practitioner and their practice. An Ahpra report, Reducing, identifying and managing vexatious complaints, provides excellent insights into this issue. A recently released Ahpra podcast also takes a lively in-depth look at vexatious complaints.

As with all complaints, good frontline management at the point of healthcare delivery, using effective communication, will reduce formal complaints and lead to improvements in our patient care and practice.

I wish you all a happy and safe festive season.

Untold suffering seldom is. Franklin P. Jones

Murray Thomas
Chair, Dental Board of Australia

Board news

Revised Scope of practice registration standard approved

The Dental Board of Australia’s revised Scope of practice registration standard will take effect from mid-2020 after it was approved at the November meeting of the Council of Australia Governments (COAG) Health Council (CHC).

What has happened?

The Dental Board’s current registration standard has been in place since 2014. A scheduled review of the standard began in late 2017 and included wide-ranging public consultation from March to May 2018. In November 2018, the Board submitted its proposed revised Scope of practice registration standard to the CHC.

At the CHC’s March 2019 meeting, Health Ministers referred the proposed standard to the Australian Commission on Safety and Quality in Health Care (the ACSQHC). The purpose of the referral was for the commission to independently assess the patient quality and safety implications and the consumer benefit of the revised standard. The ACSQHC completed its review in July 2019.

The ACSQHC’s independent review report was submitted to the CHC’s November meeting. Health Ministers noted the finding that there is no evidence the proposed revised Scope of practice registration standard will have an adverse effect on patient safety and quality. The review also indicated that the changes may increase the capacity of the dental workforce, may provide greater access to services and reduce waiting times for services in rural and remote communities.

In light of the ACSQHC’s independent report, Health Ministers approved the revised Scope of practice registration standard. They also supported publication of the ACSQHC’s independent report.

Health Ministers were given a copy of the Board’s draft revised Guidelines for scope of practice. These guidelines have been updated after taking into account the independent review and the Board’s ongoing engagement with the profession throughout 2019 to support the implementation of the revised standard.

The CHC decision is published in the communiqué from its November meeting.

The ACSQHC’s independent review report is published on the CHC website.

What will happen now?

The Board has recently published further materials to support the standard, including the strengthened guidelines that help to clarify certain aspects of the changes. Information about implementation of the revised standard will also be shared over coming months.

Practitioners and stakeholders should monitor the Board’s website to not miss updates about stakeholder forums for the profession in each capital city and in some regional hubs. This information will be published on a webpage dedicated to implementation of the revised Scope of practice registration standard to be announced soon.

The Board is continuing to engage with the dental profession and key stakeholders in the lead-up to the planned start of the standard in mid-2020.

For more information

Advance copy: Revised Scope of practice registration standard
Advance copy: Revised Scope of practice guidelines
COAG Health Council letter - Approval of revised Scope of practice registration standard (49.4 KB, PDF)

Dental Board holds its national conference

The Board held its fourth biennial national conference at Melbourne Museum in late October.

The conference was a great opportunity for the Board to share ideas and innovations and to network with others involved in regulating dental practitioners.

National Board members and state and territory committee members attended with senior staff from Ahpra and external stakeholders such as representatives of the Australian Dental Council, the Dental Council of New South Wales and the Health Professional Councils Authority in NSW.

The keynote address from Senior Counsel Gail Furness highlighted the importance of ‘procedural fairness’ in our work and challenged us to critically review how we implement the National Law.¹It was important to tailor the National Law’s provisions to the individual, particularly around timeframes for responding to Ahpra and Board correspondence, because every person needed the opportunity to be heard, she said.

Ms Furness said procedural fairness helped to improve decision-making and when exercising our functions in the public interest, we should act impartially. Procedural fairness can be demonstrated by ensuring our reasons for decisions are clear and by engaging with a practitioner’s submissions. This would help individuals accept regulatory decisions and increase public confidence in the process and, ultimately, in outcomes.

A lawyer for more than 30 years, Ms Furness was senior counsel helping the Royal Commission into Institutional Responses to Child Sexual Abuse between 2013 and 2017. She said trust was a commodity in short supply and recommended the Board adopt some of the lessons learned from the inquiry into how it responds to complaints about dental practitioners.

Jayde Fuller, Ahpra’s Aboriginal and Torres Strait Islander Health Strategy Program Manager, spoke about cultural safety with Dr Chris Bourke, Strategic Programs Director for the Australian Healthcare and Hospitals Association. Both are Gamilaroi and Chris is Australia’s first Indigenous dentist.

The pair explained how many Aboriginal and Torres Strait Islander Peoples don’t identify unless they feel safe to do so. Some fear they will receive a lesser standard of care if they do and research has confirmed this to be a valid concern.

Attendees participated in a group exercise which gave them opportunities for reflection on their own practice and how prejudices and/or stereotyping might creep in. The take-home message was that ‘cultural safety’ was not about ‘what you do’ but ‘how you do it’ when treating an Indigenous patient.

Gail Furness addresses dental conference

Senior Counsel Gail Furness gives her keynote address.

DBA community member Jacqui Gibson (left), Dr Chris Bourke (dentist) and Aboriginal and Torres Strait Islander Health Strategy Program Manager Jayde Fuller.

Dental Board conference whiteboard

The ‘Introduction to cultural safety’ session’s key messages were written on a whiteboard for conference attendees to reflect on later.

1 The Health Practitioner Regulation National Law, as in force in each state and territory (the National Law).

Consultation on proposed options for dental records guidelines

The Board is now consulting on the Guidelines on dental records.

The guidelines were developed at the start of the National Scheme in 2010. The Board is keen to ensure that any published guidelines remain relevant to the profession and would like to hear your feedback on the proposed options for the guidelines.

We invite dental practitioners, stakeholders and the wider public to provide feedback to the public consultation. Due to the upcoming holiday period, this consultation is longer than the usual eight-week consultation period to ensure all interested stakeholders have the chance to make a submission. The public consultation will close on 24 January 2020.

To have your say, please visit the Consultation page on the Board's website.

Registration

Indigenous women graduate as dentists

The Board, which is now accepting graduate applications for registration, is excited to share that three Indigenous women recently graduated as dentists from the University of Western Australia.

This wonderful achievement was highlighted in a joint media release from the Indigenous Dentists’ Association of Australia (IDAA) and Indigenous Allied Health Australia (IAHA). More information about the Indigenous graduates is on The University of Western Australia (UWA) website.

In September 2018 there were 48 Indigenous dentists across the whole of Australia: about 0.3 per cent of dentists, whereas Aboriginal and Torres Strait Islander people made up about 3 per cent of the population.

The Board joins the UWA, IDAA and IAHA in congratulating the three Indigenous graduates who, through their qualifications, skills and culture are set to make a valuable contribution to their communities.

Tips for graduates: watch our video and note the requirements

Graduates of dental study need to be registered as a dental practitioner in one of the five divisions (type of registration) of dental practice with the Board before they start practising.

A video for final-year students of dental study is on the Board’s website. It gives some helpful information about applying for registration and provides an overview of the obligations that all registered dental practitioners must meet to maintain registration.

The video can be found on the Board’s dedicated Student registration webpage as well as the Board and AHPRA’s YouTube channel and Facebook page. Information on how to apply, and which registration standards apply to graduates, is in a news item on the Board’s website. Graduates should note the requirements for certifying documents, particularly those for certifying photo ID.

Dental workforce data update

The latest workforce data for the profession were released in November. In the period 1 July to 30 September 2019, there were 23,818 registered dental practitioners. By division, there were:

17,794 dentists (including 1,781 specialists)
1,898 oral health therapists
1,453 dental hygienists
1,268 dental prosthetists
879 dental therapists.

Of these practitioners, 531 held registration in two or more divisions.

For more information and data breakdowns by principal place of practice, age, gender and dental specialty, visit our Statistics page.

Regulation at work

Dentist suspended for practising without professional indemnity insurance

The State Administrative Tribunal has found that a Western Australian dentist engaged in professional misconduct by practising as a dentist without appropriate professional indemnity insurance (PII).

Dr Mario Cavallaro admitted that he practised without appropriate PII cover between 2013 and 2017. Dr Cavallaro also admitted that he had falsely declared he had complied with his PII responsibilities in his applications for renewal of his registration as a dentist and that he had failed to give the Dental Board of Australia notice that he no longer held PII cover as required under the National Law.

Dr Cavallaro further admitted that he had failed to comply with three notices requiring him to provide the Board with details of his PII arrangements. The Board and Dr Cavallaro agreed the terms on which the matter could be resolved. Dr Cavallaro admitted that his conduct constituted professional misconduct. He was reprimanded and his registration was suspended for four months.

Dr Cavallaro submitted that his ill-health, remorse and his retirement and intention not to practise again as a dental practitioner were mitigating factors in relation to the penalty to be imposed by the tribunal.

The orders are published on the eCourts Portal of Western Australia website.

National Scheme news

Annual report 2018/19 released – one in 17 working Australians on the national register

The latest report on the National Scheme is packed full of data and descriptions of what National Boards and Ahpra do and how we work in partnership. While its most attentive readership is Health Ministers and their staff, the report is also a useful source of information for a wide audience: board members, other regulators, registrants, students, overseas-trained health professionals, employers, education providers, consumer groups, patients and the broader community.

It’s quite startling to realise that one in every 17 working Australians is a registrant in one of the regulated health professions in the scheme. At over 744,000 registrants, this is a huge and growing workforce.

When paramedics joined the scheme last year, becoming nationally regulated and registered for the first time, the number of professions regulated increased to 16, and the number of National Boards to 16 (the professions of nursing and midwifery are both regulated by one board).

To ensure this large workforce is trained, qualified and competent, there are now over 1,000 approved programs of study.

The report also shows Ahpra directly received 9,338 concerns (notifications) about registered health practitioners and closed 8,979 during 2018/19. More notifications were received and more closed than ever before. We are committed to improving the notification experience for both notifiers and practitioners and this report indicates we are making progress. The number of notifications received by Ahpra also suggests the public are becoming more aware of their option to report their healthcare concerns.

Other insights from the year include:

41,696 new registered health practitioners joined the scheme, bringing the total to 744,437 health practitioners across 16 regulated professions.
Student registrations increased by over 21,000 registrants to 182,657.
17,323 paramedics registered for the first time in 2018/19 after officially joining the National Scheme in December.
Across the professions, the largest growth in registrants (aside from paramedicine) was Aboriginal and Torres Strait Islander Health Practitioners +7.6%, occupational therapy +6.9% and osteopathy +6.6%.
75% of all registrants are female.
12,445 practitioners had a notification made about them (1.7% of all registered health practitioners). The top three reasons for a notification made to AHPRA were clinical care (46.3%), medication issues (10.7%) and health impairment (6.5%).
Ahpra reduced the average time taken to resolve a notification by 5.1%.
Ahpra received 380 new offence complaints relating to title and practice protection and 668 complaints related to advertising.
2,584 practitioners were monitored for health, performance and/or conduct during the year.
Ahpra completed 15 proceedings in the Magistrates’ and Local Courts. All prosecutions resulted in convictions.

To view and download the 2018/19 annual report, visit the Ahpra website.

Dental profession summary and statistics

A profession-specific statistical summary and a report from the Chair that covers the work of the Dental Board of Australia over the 12 months to 30 June 2019 is also available online.

The summary draws on data from the 2018/19 annual report of Ahpra and the National Boards. This information provides a snapshot of the profession as at 30 June 2019, and includes the number of registered dental practitioners, a breakdown by gender and age and outcomes of practitioner audits.

Notifications information includes:

the number of complaints or concerns received
the types and sources of those complaints
the number of complaints closed during the year
the number of mandatory notifications received
how many times (if any) immediate action was taken
the number of practitioners monitored
the number of any tribunals, panels or appeals.

As well, information is provided about:

the number and type of criminal offence complaints made
the number of criminal offence complaints closed.

Profession-specific data tables are also available for downloading.

To gain an insight into the profession during 2018/19 and to access the data tables visit the Board’s 2018/19 summary.

New resources help practitioners check for acceptable evidence in health advertising

New resources to help practitioners and other advertisers understand if claims made in advertising are supported by accepted evidence are now available.

You can access the new information via a link on the Advertising resources page on the Board’s website.

The approach taken to assessing evidence to support claims is consistent with the wider scientific and academic community. However, there is an important difference between acceptable evidence for claims made in advertising and the evidence used for clinical decisions about patient care.

When treating patients, practitioners must obtain informed consent for the care they provide and are expected to discuss the evidence for different treatment options. In advertising, the claims are generic, and practitioners are not available to clarify whether a treatment is appropriate for an individual patient.

There are many aspects to take into consideration when reviewing whether there is acceptable evidence to support a claim made in advertising a regulated health service.

Factors to consider include:

Is the evidence relied on objective and based on accepted principles of good research? Is the evidence from a reputable source? For example, a peer-reviewed journal.
Do the studies used provide clear evidence for the therapeutic claims made or are they one of a number of possible explanations for treatment outcomes?
Have the results of the study been replicated? Results consistent across multiple studies, replicated on independent populations, are more likely to be sound.
Has the evidence been contradicted by more objective, higher quality studies? If it has, then this type of evidence is not acceptable.

Study design is also an important aspect to consider when assessing if claims are supported by acceptable evidence. The following types of studies will generally not be considered acceptable evidence for advertising claims:

studies involving no human subjects
before and after studies with little or no control or reference group
self-assessment studies
anecdotal evidence based on observations in practice
outcome studies or audits, unless bias or other factors that may influence the results are carefully controlled, and/or
studies that are not generalisable to the advertising audience.

The evidence base for clinical practice is constantly developing so it is important to make sure that the evidence you rely on is current.

The new information on acceptable evidence in health advertising, which includes issues to consider about study design, is available in the Advertising resources section of the Ahpra website.

Social media guide for health practitioners

Ahpra and National Boards have published a new guide to help registered health practitioners understand and meet their obligations when using social media.

The guide reminds practitioners that when interacting online, they should maintain professional standards and be aware of the implications of their actions, just as when they interact in person.

The guide does not stop practitioners from engaging online or via social media; instead, it encourages practitioners to act ethically and professionally in any setting.

To help practitioners meet their obligations, the guide also outlines some common pitfalls practitioners may encounter when using social media.

Community trust in registered health practitioners is essential. Whether an online activity can be viewed by the public or is limited to a specific group of people, health practitioners have a responsibility to behave ethically and to maintain professional standards, as in all professional circumstances.

In using social media, health practitioners should be aware of their obligations under the National Law, their Board’s Code of conduct, the Advertising guidelines and other relevant legislation, such as privacy legislation.

This guide replaces the Social media policy on Boards’ codes, guidelines and policies pages and is available in the Advertising resources section of Ahpra’s website. The guide will be updated as needed.

Understand your obligations. New guide on use of social media. Avoid the pitfalls.

Mandatory notifications resources

Ahpra and National Boards have produced new resources to explain mandatory notifications and when they do and do not need to be made.

Mandatory notifications are an important part of patient safety. We need to know when patients may be at substantial risk of harm from a registered health practitioner.

We also want to ensure that practitioners with health issues feel safe to seek treatment without fear of an unnecessary mandatory notification being made about them. A practitioner with a health issue, on its own, does not require a mandatory notification.

New resources have been published to explain mandatory notifications and when they do and do not need to be made, in preparation for new requirements that take effect in early 2020. The resources aim to support practitioners to understand changes to the law about mandatory notification requirements which were made by Health Ministers.

They explain that there are very specific circumstances when a treating practitioner needs to report: when an impairment, intoxication at work or practice that departs significantly from accepted standards places the public at substantial risk of harm.

For more information read:

the news item about the new mandatory reporting resources
the Dental Board’s Mandatory notifications: what you need to know webpage.

Ahpra launches podcast about vexatious notifications

Ahpra has released an important podcast that takes an in-depth look at vexatious notifications.

Episode one: Vexatious notifications, takes a deeper dive into a subject of concern for many health practitioners who fear that wrong motives could provoke a patient or colleague to report them to the regulator inappropriately.

The episode talks about the defining characteristics of vexatious notifications and how common they are. It also looks at the impact they have on practitioners and explores how the regulator is working to identify, respond and manage vexatious notifications.

Host Susan Biggar speaks with Associate Professor Marie Bismark at University of Melbourne, Kate Griggs, a health consumer advocate and member of Ahpra’s consumer reference group, Dr Sara Bird, manager of medico-legal and advisory services at MDA National, and National Director of Notifications for Ahpra, Matthew Hardy.

This podcast is the first in an exciting series that is currently in development to provide greater insight into the work of health practitioner regulation and information about key healthcare concerns.

Social research results: understanding perceptions about the National Scheme’s work

Ahpra and National Boards have released results from a social research project aimed at helping us understand perceptions about us and our work.

The aim of the social research project was for Ahpra and National Boards to better understand what the community, regulated health professions and our stakeholders think and feel about us, particularly in areas of understanding, confidence and trust.

Ahpra and National Boards are using insights gained from the project to better understand how registered health practitioners view what we do and to inform how we can improve our engagement with both the professions and the community.

Ahpra has released a report of results from the project which included a short, anonymous survey of a random sample of registered practitioners from across 15 of the 16 regulated health professions. (Because the practitioner survey was conducted before paramedics joined the National Scheme the report does not include survey results for this profession.)

The anonymous survey of practitioners was done simultaneously with an anonymous survey sent to a random sample of members of the public across communities in Australia. Both surveys were managed by an independent consultant. We invite you to take a look at the results.

Ahpra and National Boards social research project - Presentation (6.55 MB, PPSX)
Ahpra and National Boards social research project - PDF (5.16 MB, PDF)

The National Boards have also published profession-specific reports based on the results of the online survey of registered health practitioners.

To help inform our future work to ensure the public has access to a safe registered health workforce, we surveyed practitioners and the community again in 2019.

Updated logos for Ahpra and National Boards

Ahpra and the 15 National Boards are in the tenth year of implementing the National Scheme.

The National Scheme started in July 2010, initially regulating 10 health professions. Since 2012, five more health professions have joined the scheme, the latest being paramedics in December 2018. (Nursing and midwifery were officially recognised as separate professions under amendments to the National Law last year.) The scheme now regulates over 744,000 practitioners across 16 health professions.

This growth in the number of regulated health professions was pivotal to refreshing the Ahpra logo, which also lists the National Boards and is used to represent the National Scheme.

The bold but simple design of the new Ahpra logo aims to serve the scheme well into the future. It still has a key element of the old logo, namely the map of Australia, but is better suited to digital platforms (websites, social media) and for use across a variety of other materials.

Most importantly, it will not need updating as the old logo would if Health Ministers decide public safety would benefit from other health professions becoming regulated.

The National Board logos reflect the ongoing partnership between the National Boards and Ahpra in our shared role of protecting the public.

Both logo designs also include ‘AHPRA’, now with just an initial capital: ‘Ahpra’. This helps people to pronounce the regulator’s name correctly and distinguishes Ahpra from other regulators with similar acronyms.

The new logos are being rolled out over coming months across all our materials and online platforms. As we say goodbye to the old logos and welcome the new, thanks for your patience while we complete this transition.

Dental Board and Ahpra

Keep in touch with the Board

As always, we encourage you to regularly check the Dental Board website for information and updates relating to the dental profession.

Visit our website for information on the National Scheme and the mandatory registration standards, codes, guidelines, policies and fact sheets. Board communiqués and consultation papers are published on the site under News.
Lodge an online enquiry form.
For registration enquiries call 1300 419 495 (from within Australia) or +61 3 9275 9009 (for overseas callers).
Address mail correspondence to: Executive Officer, Dental Board of Australia, GPO Box 9958, Melbourne VIC 3001.