May 2018

Issue 14 - May 2018

Board news
National Scheme news
Keep in touch with the Board

Board news

Update on revalidation and ‘professional assurance’ for dental practitioners

The Board has announced it will be commissioning research into ways for dental practitioners to keep their skills up to date during their career in the profession.

The Board has been considering the relevance and appropriateness of revalidation for dental practitioners. As part of this, the Board used a working definition of revalidation as ‘a process for dental practitioners, to regularly show that they are up to date and fit to practise dentistry, giving patients and the community the assurance that the practitioner is competent.’

What the data are telling us

Under National Law¹, dental practitioners must meet the Board’s mandatory registration standards, including on recency of practice and continuing professional development (CPD). Practitioners are also subject to a random audit for their compliance with those standards.

We have looked at current data² about notifications (complaints) made about dental practitioners. These data indicate that the Board should consider seeking additional assurance about dental practitioner performance and professional development. The data also show dental practitioners have consistently been reported as experiencing one of the highest notification rates within the National Scheme.³

Last year, 3.8 per cent of registered dental practitioners were the subject of a notification. This rate continues to remain high when compared to the national average for all other registered health practitioners.

It is worth noting that notifications received about dental practitioners’ performance far outweigh those received about conduct issues. When this is compared with other regulated health professions, dental practitioners receive a higher proportion of notifications about their performance.

These trends in notification (complaint) data raise the questions for the Board about what it should do to actively managing these risks and what other opportunities exist to tackle those issues.

Models of revalidation are being actively considered by international health practitioner regulators in the United Kingdom (UK), New Zealand and Canada. ‘Revalidation’ is closely aligned with ‘recertification’, in New Zealand and ‘maintenance of licensure’ in the United States of America.

Closer to home, the Medical Board of Australia has recently has designed a Professional Performance Framework to ensure that all registered medical practitioners practise competently and ethically throughout their working lives.

Why this is important

Last year, the Board hosted a roundtable with stakeholders from the dental profession and community that started a conversation about revalidation for dental practitioners in Australia. The focus was: how could revalidation for dental practitioners enhance public safety.

We were joined by all the dental professional associations, regulatory colleagues from the Dental Council of New South Wales and the Dental Council of New Zealand, representatives from state health departments and public dental services, those involved in educating and training dental practitioners, consumer representatives and insurers for professional indemnity and private health insurance.

The roundtable was an opportunity to exchange views and ideas about revalidation for dental practitioners. It also gave us insights from our main stakeholders about the opportunities and challenges of adopting revalidation for dental practitioners in Australia.

Participants heard from Professor Liz Farmer who shared her learning as Chair of the Medical Board of Australia’s Expert Advisory Group on revalidation. Professor Farmer also showcased initiatives being considered by other registered health professions internationally, along with the benefits revalidation can have for public safety.

Where we are now and what are happens next

While different aspects of revalidation were discussed at the roundtable, the Board has not yet decided to adopt any specific approach to revalidation. We remain interested in understanding more about revalidation models for dental practitioners in the Australian context.

We understand that using the term ‘revalidation’ in an Australian context can be confronting for practitioners. With this in mind we prefer the term ‘professional assurance’.

Over the next three years, the Board will explore ways to support dental practitioners to maintain and enhance their professional skills and knowledge and remain fit to practise.

The challenge facing the Board is to decide if the current requirements and processes in place for practitioners are sufficiently robust to ensure ongoing competency while adequately protecting the public.

We plan to commission research to identify the characteristics of ‘at risk’ and poorly performing dental practitioners. This research will also consider the types of support needed to make sure dental practitioners keep their skills up to date throughout their professional lives.

The research will help inform the Board’s future direction and decision-making about dental practitioner professional assurance and ensure it is effective, evidence-based and practical. This research will be conducted over the next 12 months.

For more information

Read the Board’s registration standards for dental practitioners.
Read the Board’s communiqué about our roundtable discussion.

¹Health Practitioner Regulation National Law, as in force in state and territory (the National Law).
² Dental Board of Australia Annual report summary 2016/17
³ The National Registration and Accreditation Scheme (the National Scheme).

Public consultation on a proposed revised Scope of practice registration standard and guidelines

We’re interested in what you think of the Board’s proposed changes to its Scope of practice registration standard and Guidelines for scope of practice.

Public consultation is an important part of the Board’s engagement with the profession. The feedback you provide is greatly valued and informs the Board’s development of regulatory documents.

The scope of practice public consultation paper is published on the Board’s website under Current Consultations.

You are invited to provide feedback by email to dentalboardconsultation@ahpra.gov.au by close of business on 14 May 2018.

Management of tongue ties by dental practitioners

Recently the Board was made aware of concerns relating to dental practitioners involved in the treatment of tongue ties⁴ and the subsequent use of surgical procedures, such as frenotomies, on infants to treat these conditions.

We would like to remind all dental practitioners of their obligations as registered practitioners under the National Law.

The Board describes its requirements of dental practitioners in its registration standards, codes and guidelines published on the Board’s website. These documents do not refer to specific clinical areas of practice as they need to apply to all dental practitioners across a range of clinical settings, to meet the needs of patients. The Board expects dental practitioners to practise within this regulatory framework at all times including when treating tongue ties.

Of particular importance if you are managing tongue ties:

The Scope of practice registration standard describes the Board’s requirements of all dental practitioners to practise within the scope of their education, training and competence.
The associated Guidelines for scope of practice include a broad definition of dentistry. Dental practitioners need to practise within this definition.
Anyone practising the treatment of tongue ties must be able to demonstrate they have the necessary training, qualifications and competence to be able to do so safely.
The Code of conduct describes the Board’s expectations of what constitutes good practice. You have a duty to make the care of patients your first concern and to practise safely and effectively at all times.
Treatment for tongue ties should only be used if it can be justified. Informed consent, including financial consent, must be obtained and the risks associated with the treatment explained to the patient, and documented.
You need to be particularly aware of the patient’s expectations about treatment for tongue ties. You must communicate effectively with the patient to ensure that you are meeting this standard and that the patient’s expectations are reasonable.
Any person, including businesses, advertising the treatment of tongue ties must comply with the requirements of the National Law when advertising a regulated health service.
The Board and AHPRA have published information to help dentists better understand their advertising obligations, including further information on advertising therapeutic claims.
This information does not replace the Board’s Guidelines for advertising regulated health services, which should be your first point of reference to understanding your obligations. The burden is on you to substantiate any claim you make that your treatments benefit patients.
If you do not understand whether the claims you have made can be substantiated based on acceptable evidence, then you need to remove them from your advertising.

If your practice was brought into question through a complaint or concern raised with the Board, you would be expected to demonstrate how you had complied with these obligations.

⁴ Anklyglossia or tongue tie can be described as a congenital birth defect whereby there is partial or complete fusion of the tongue to the floor of the mouth or the lingual frenulum may be short, tight and thick.

Update on specialist registration pathways for overseas-trained dental specialists

As part of the Board’s work program on specialist registration pathways for overseas-trained dental specialists, last year the Board and the Australian Health Practitioner Regulation Agency (AHPRA) engaged the Australian Dental Council (ADC) to develop an outcome-based assessment model for overseas-trained dental specialists applying for specialist registration in Australia. The ADC has now completed this project.

The ADC conducted a literature review of best evidence in the assessment of competence of health practitioners, as well as an environmental scan of the processes of other National Boards and comparable international dental regulators in an earlier phase of this engagement.

Based on these findings a number of preliminary models for the assessment of competence of overseas-trained dental specialists were developed. These preliminary models were evaluated by key stakeholders of the dental specialties. The ADC has recommended to the Board an assessment model that consists of three stages including initial assessment of application, panel assessment and assessment(s) of competence. The assessments are based on the entry-level competencies for the dental specialties and are applicable for all of the recognised dental specialties in Australia. The ADC has also developed a framework to support the implementation of assessment model.

Over the coming months, the Board will consider the ADC’s recommendations and any other requirements that may be needed to support future registration pathways for overseas-trained dental specialists. We will provide regular updates as work progresses.

Recognition of oral health therapy

On 1 November 2017, the Dental Council of New Zealand (DCNZ) scope of practice for oral health therapy (OHT) came into effect. Subsequently, the New Zealand government approved the DCNZ’s application to recognise oral health therapy as a profession, and on 18 January 2018, oral health therapy was formally recognised as a profession in New Zealand.

The Board has considered how this change is interpreted under the Trans-Tasman Mutual Recognition Act 1997 and is satisfied that the activities carried out by a New Zealand OHT are substantially equivalent to an Australian OHT.

Accordingly, OHTs who are registered to practise in New Zealand are eligible to apply for general registration under Trans-Tasman mutual recognition (this applies irrespective of where training was completed). The updated application form is published on the Board’s website.

Workshop on notifications with dental leaders

Senior leaders from the Board, AHPRA, Dental Hygienists Association of Australia (DHAA), Australian Dental Prosthetists Association (ADPA) and Australian Dental and Oral Health Therapists Association (ADOHTA) met on 16 February 2018.

The workshop focused on building a joint understanding of how notifications (complaints) are managed in the National Registration and Accreditation Scheme (the National Scheme). A joint communiqué of the meeting is published on the Board’s website.

The Board was represented by Chair Dr John Lockwood AM, Ms Jenny Bishop, practitioner member, Mrs Susan Aldenhoven AM, practitioner member, Mr Paul House, practitioner member, Dr Murray Thomas, practitioner member, Dr Sajeev Koshy, practitioner member, Ms Kim Jones, community member and Mr Robin Brown, community member.

Self-assessment tool launched to help practitioners and advertisers

The Board and AHPRA want to help make your compliance with the National Law’s advertising requirements as easy as possible.

Our new self-assessment tool is easy to use and asks users to consider a number of questions about their advertising which can help them understand if it is in breach of the Guidelines for advertising regulated health services, and in turn the National Law.

The self-assessment tool is the latest of a series of advertising resources for practitioners, healthcare providers and other advertisers of regulated health services to use to help them stay in line with the law.

This work is part of a broader strategy ‒ the Advertising compliance and enforcement strategy for the National Scheme ‒ which started last year. The strategy has met a number of its targets since its launch including clear, concise and helpful correspondence for when AHPRA receives a complaint about advertising and new resources such as:

a summary of advertising obligations
frequently asked questions
tips on words to be wary about, and
all-professions examples of compliant and non-compliant advertising.

The self-assessment tool is now available to use on the check, correct and comply section of the AHPRA website.

The Board and AHPRA have also developed some further examples of non-compliant dental advertising and changes that would help it to comply with the National Law. The examples will be published on the Advertising resources section of the AHPRA website shortly.

Board publishes resources for students starting their dental studies

The Board has published new information for students who have started first year of dental studies, including what they need to know about their regulatory obligations as a student.

Even though students have not yet qualified as a dental practitioner, and are very much at the start of their career, they already have responsibilities under the National Law they need to understand.

If you’re a dental student in Australia in a program of study approved by the Dental Board that qualifies you for registration in the dental profession; your education provider has already registered you with the Board. Many first year students are unaware of this fact.

The Board has published information, including a new vodcast, on its website to help students understand what being registered with the Board as a student means. The vodcast will tell students what the Board does as a regulator and what they need to know and do as a registered dental student, both now and before you complete your studies.

Students should go to www.dentalboard.gov.au for more information.

National Scheme news

Public consultation on review of accreditation arrangements

The National Boards and AHPRA are consulting on the arrangements from mid-2019, when the current term of assignment of accreditation functions ends.

The National Law sets out the accreditation functions in the National Scheme. These include:

developing accreditation standards
accrediting programs of study against approved accreditation standards, and
assessing overseas qualified practitioners.

Each National Board decides whether the accreditation functions for the profession it regulates are carried out by an external accreditation body or a committee established by the Board. If the National Board decides on an external organisation, AHPRA enters a contract with them which specifies the scope of accreditation functions and sets out associated reporting requirements and funding arrangements. If the National Board decides on a committee, these matters are specified in terms of reference.

All National Boards and AHPRA are consulting on their accreditation arrangements. Feedback will be taken into account in making decisions about the assignment of accreditation functions from mid-2019. Feedback will also be considered in the next phase of the review, which will involve establishing new agreements with external accreditation authorities and terms of reference for accreditation committees.

The consultation paper is available on the Board’s Consultation page.

You can provide feedback by:

completing a survey,
or
eEmail your feedback marked ‘Scheduled review of accreditation assignments’ to accreditationreview@ahpra.gov.au.

The consultation closes 12pm 14 May 2018.

Consultation on the draft guideline for informing a National Board about where you practise

The Board wants your feedback on a draft guideline for informing a National Board about where you practise.

Recent amendments to the Health Practitioner Regulation National Law, as in force in each state and territory (the National Law) include changes to the information a registered health practitioner is required to provide about their practice arrangements when requested by the National Board (referred to as ‘practice information’). The draft guideline has been developed to assist registered health practitioners to provide practice information in a way that meets their obligation under the National Law.

The consultation paper is available under Current consultations, and the Board invites feedback from practitioners, stakeholders and the community.

Please provide any written submissions by email, marked, ‘Draft guidelines: Informing a National Board about where you practise’ to nationallawamendments@ahpra.gov.au.

Consultation closes on 25 May 2018.

Research finds truly vexatious complaints are very rare

New independent research commissioned by AHPRA has looked internationally at vexatious complaints, finding these are very rare and that there is more risk from people not reporting concerns than from making complaints in bad faith.

The research found that while being on the receiving end of a complaint is tough, the complaint is much more likely to be vexing than vexatious.

AHPRA commissioned the research from the School of Population and Global Health, University of Melbourne to find out the size of the problem of vexatious complaints and identify how they can be better prevented, identified and managed. AHPRA initiated the work in line with its commitment to the Senate Affairs Reference Committee inquiry into the medical complaints process in Australia.

The report found that the number of vexatious complaints dealt with in Australia and internationally is very small, less than one per cent, but they have a big effect on everyone involved. The research also confirms that the risk of someone not reporting their concerns is greater than if the complaint turns out to be vexatious.

Most of Australia’s 680,000 registered health practitioners provide great care, but patients also have the right to make a complaint when things don’t go so well.

AHPRA commissioned this research to find out if is there a potential for misuse of its complaints processes for health practitioners and are vexatious complaints against health practitioners a big problem in Australia?

The evidence shows that when a complaint is made about a health practitioner it is not immediately obvious that it is vexatious. In the unlikely event that it is vexatious, there may still be genuine risk to patients involved. AHPRA’s primary concern is to protect the public, so even if the intent behind a complaint is vexatious AHPRA has to take regulatory action to manage any risk to patients.

The researchers noted that being on the receiving end of a complaint is a distressing experience for any health practitioner, and regulators need to have good processes for dealing with unfounded complaints quickly and fairly.

The research found that the term ‘vexatious’ is often loosely used in debate to refer to complaints that may simply have been the result of a miscommunication or a misunderstanding. A truly vexatious complaint is a complaint that is groundless and made with the intent of causing distress or harm to the subject of the complaint.

The best available evidence suggests that truly vexatious complaints are very rare, and that under-reporting of well-founded concerns is likely a far greater problem.

There is a common misconception that a complaint must have been vexatious if it resulted in no regulatory action. However, a decision by a National Board not to take regulatory action does not mean that the complaint was unfounded or made in bad faith. For example, a risk to the public may have been adequately addressed between the time the complaint was made and when the investigation concluded.

The research identified some helpful processes for identifying and responding to this type of complaint in a timely way. Efforts to better prevent and manage vexatious complaints must be carefully designed so they don’t discourage those with legitimate concerns from coming forward.

The report will be used to inform best practice for reducing, identifying, and managing vexatious complaints and helps to identify opportunities to work with others to help reduce their frequency and adverse consequences.

The report is available on the AHPRA website under Published research.

National regulation of paramedicine moves a step closer

The national regulation of paramedicine moves a step closer with the appointment of the first Paramedicine Board of Australia.

The federal, state and territory Health Ministers made the announcement of the nine-person board at the Council of Australian Governments (COAG) Health Council meeting held on 19 October 2017. Paramedicine will be the first profession to be regulated under the National Registration and Accreditation Scheme (National Scheme) since 2012.

Registration of paramedicine is due to start from late 2018. Paramedics will be able to register once and practise anywhere in Australia. The title ‘paramedic’ will also become a ‘protected title’ – only people registered with the Board will be able to call themselves a paramedic.

More information, including news about the implementation of the regulation of paramedics and the newly appointed Board members, is available on the Paramedicine Board of Australia’s website.

New research framework launched to improve patient safety

In January, National Boards and AHPRA published a research framework to help transform health practitioner regulation to improve patient safety.

A research framework for the National Scheme: Optimising our investment in research sets out the research priorities and principles for National Boards and AHPRA to focus their research efforts.

The framework includes the priority research areas of: defining harms and risks related to the practice of regulated health professions, regulatory taxonomy or classification scheme, risk factors for complaints and/or poor practitioner performance, evidence for standards, codes and/or guidelines, evaluating regulatory interventions, stakeholder satisfaction and engagement, work readiness and workforce capacity and distribution.

It has been published to provide a solid base to facilitate risk-based research and evaluation activities, with a clear focus on translating the outcomes of research into initiatives that will inform regulatory policy development and decision-making to maximise the public benefit.

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 for 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 8708 9001 (for overseas callers).