October 2019

Issue 18 - October 2019

Chair’s message
Board news
Registration
- Dental workforce update
Regulation at work
- Dentist disqualified for inappropriate prescribing
National Scheme news
Keep in touch with the Board

Chair’s message

Murray Thomas

The Board will be holding its biennial conference in Melbourne in late October, bringing together dental regulators from throughout Australia, including AHPRA staff. The meeting will explore the changing regulatory environment and prepare for the upcoming challenges in dentistry for consumers and practitioners.

The Board has four important public consultations open and we’d like your feedback. It’s easiest to respond by online survey – see details below.

The Pharmaceutical Society of Australia (PSA) has raised concerns about a dental supply business promoting the dispensing of medicines by dentists. If you prescribe and supply medicines, make sure you meet your professional and ethical obligations: see our advice in this newsletter.

Registration renewal is approaching and there are new questions about exposure-prone procedures you will need to answer as part of your renewal application. See details below.

Faced with the choice between changing one's mind and proving that there is no need to do so, almost everyone gets busy on the proof. John Kenneth Galbraith (1971)

Murray Thomas
Chair, Dental Board of Australia

Board news

Update on scope of practice

In our last newsletter in May we told you about the progress of the Board’s proposed revised Scope of practice registration standard (the standard).

Health Ministers referred the standard to the Australian Commission on Safety and Quality in Health Care (the commission), in March 2019 to independently assess the patient quality and safety implications and the consumer benefit of the revised standard. The commission reported back to Health Ministers in July 2019.

We are continuing our engagement work to support the implementation of the standard and will keep you updated on progress.

Key points about the proposed changes

The proposed changes will not alter the scope of practice of any registered dental practitioner: dentists, dental hygienists, dental prosthetists, dental therapists and oral health therapists. The scope of practice of each division of dental registration is described in the revised guidelines and in detail in the professional competencies for each division developed by the Australian Dental Council.
The proposed changes will not allow dental practitioners from the other four divisions − dental hygienists, dental prosthetists, dental therapists and oral health therapists − to become or practise as a dentist, through continuing professional development (CPD) courses. CPD programs may improve or broaden a practitioner’s knowledge or provide experience in a technique or procedure within their scope of practice.
The current requirement for a structured professional relationship does not include supervision. It is a referral and management framework only. All dental practitioners are still required to work within their scope of practice and refer when necessary, which is made clear in the revised standard, and also in the Board’s Code of conduct.

Changes to renewal questions about working with blood-borne viruses

Each year at registration renewal, dental practitioners are asked to declare that they are aware of their infection status for blood-borne viruses and comply with the requirements of the Australian national guidelines for the management of healthcare workers living with blood borne viruses and healthcare workers who perform exposure prone procedures at risk of exposure to blood borne viruses (the CDNA guidelines) and the Board’s Guidelines on infection control.

The CDNA has recently revised its guidelines, so the Board has updated its compliance questions for this year’s registration renewal.

What’s changing?

This year at renewal, the Board will ask practitioners who perform exposure-prone procedures (EPPs) to answer several questions about their compliance with the CDNA guidelines.

Each renewal question will provide definitions, information and links to resources to help you answer accurately.

For most practitioners, there is no change in what they must do – that is, to be aware of their blood-borne virus (BBV) status and comply with the CDNA guidelines.

All registered health practitioners who perform EPPs, or who are living with a BBV, need to comply with the CDNA guidelines.

Most dental practitioners in clinical practice will perform EPPs.

EPPs are procedures where there is a risk of injury to the practitioner resulting in exposure of the patient’s open tissues to the blood of the practitioner. These procedures include those where the practitioner’s hands (whether gloved or not) may be in contact with sharp instruments, needle tips or sharp tissues (spicules of bone or teeth) inside a patient’s open body cavity, wound or confined anatomical space where the hands or fingertips may not be completely visible at all times.

What are the CDNA guidelines?

The CDNA guidelines provide guidance on testing for BBVs and the circumstances when practitioners living with a BBV can resume performing EPPs. This guidance is based on current evidence and international practice.

Where do I go for more information?

The CDNA guidelines and helpful resources are available on the Department of Health website.

Practitioners who perform EPPs who are not living with a BBV can view an information sheet developed by the CDNA to find out more about how to meet the guidelines.

A CDNA information sheet is also available for practitioners who are living with a BBV and performing EPPs.

If you are uncertain about whether you perform EPPs, you should contact your employer or professional association for further advice.

DIY dental services – be aware of your obligations

The Board is aware of an increase in ‘do it yourself’ (DIY) forms of dental services that has received recent media attention.

The availability of these products has developed rapidly and continues to do so. These products are marketed in different ways using various media – some marketing offers just a product, some offer a product and service, some involve registered dental practitioners and others do not. Some products are marketed through traditional means while others use social media.

Although these might be new products or advertised in different ways (such as through social media), a range of existing regulatory requirements apply.

This type of disruption is happening across all health services, not just dental. While these types of businesses are relatively new to Australia they have been operating overseas, particularly in the USA, for some time.

While AHPRA regulates the provision of services (that is, when the sale of the product is coupled with a service) through to criminal offences which relate to performing restricted dental acts and unlawful advertising by individuals (including registered health practitioners) and corporate entities, it does not regulate the product itself. The Therapeutic Goods Administration (TGA) has oversight of therapeutic products.

AHPRA is considering these services including their marketing to determine if the requirements under the National Law are being met.

If a procedure is being performed by a registered dental practitioner, the Board expects the practitioner to act in accordance with the Code of conduct and comply with the Board’s other standards and guidelines.

The Board expects that registered dental practitioners will exercise their professional judgement and work within the scope of their competence, education and training.

The Board has power to enforce restrictions on practice where these are necessary to protect the public.

For information on advertising a regulated health service, see the Board’s website.

Financial and commercial dealings

A recent newspaper story had the headline ‘Secret dentist incentives drive growth in teeth straighteners’. The article alleged that some dentists might not be fully disclosing financial incentives about their patients' care. It also suggested these incentives may be a driver of a dentist's treatment recommendations rather than a patient’s needs.

The Board’s Code of conduct requires a practitioner to have the care of the patient as the primary concern in clinical practice.

The code also requires a practitioner to be transparent in financial and commercial matters relating to work, including dealings with employers, insurers and other organisations or individuals. In particular, declaring to patients or consumers any professional and financial interest in any product or service a practitioner might endorse or sell from their practice and not making an unjustifiable profit from the sale or endorsement.

Consultation open on blood-borne viruses guidelines for dental practice

The Dental Board of Australia, in partnership with the Medical, Nursing and Midwifery, Paramedicine and Podiatry Boards of Australia, is consulting on the draft Guidelines for registered health practitioners and students in relation to blood-borne viruses (the draft guidelines).

The draft guidelines are intended to support practitioners in these professions to comply with the CDNA guidelines, as detailed in the previous story.

All registered health practitioners who perform exposure-prone procedures, or who are living with a blood-borne virus, need to comply with the CDNA guidelines. The Boards have developed the draft guidelines to support health practitioners and students to decide whether they perform exposure-prone procedures in their practice and if so, how to meet the requirements of the CDNA guidelines.

Feedback on the draft guidelines is invited from health practitioners, employers and the wider public.

To have your say, please visit the Current consultations page on the Dental Board website. Consultation closes on 1 November 2019.

Three important consultations now open – we'd like your feedback

Three public consultations are now open asking for people to have their say on revised guidance to help practitioners and others understand their mandatory notification obligations, understand their obligations when advertising a regulated health service and to support a responsive and risk-based approach to supervised practice.

The Board is conducting the consultations alongside other National Boards and the Australian Health Practitioner Regulation Agency (AHPRA) on:

revised Guidelines: Mandatory notifications about registered health practitioners and Guidelines: Mandatory notifications about health students
revised Guidelines on advertising regulated health services, and
a proposed Supervised practice framework.

We invite dental practitioners and stakeholders to provide feedback to these important public consultations. To ensure everyone has the chance to respond the closing dates for public consultation have been staggered as follows:

Public consultation on the mandatory notifications guidelines will close on 6 November 2019.
Public consultation on the advertising guidelines will close on 26 November 2019.
Public consultation on the supervised practice framework will close on 17 December 2019.

The consultation papers are available on the Consultation page of the Board’s website.

Practitioner support service – stakeholder roundtable

The Board hosted a roundtable on Wednesday 4 September 2019 with stakeholders to begin a conversation about a practitioner support service for the dental profession.

The support service would be a confidential and independent information and referral service, available nationally for dental practitioners and dental students who may be experiencing health-related issues or life stresses.

The Board was joined by a range of professional associations representing all the registered dental professions, regulatory colleagues from New South Wales, representatives from state and territory health departments, including public dental services and those involved with the education and training of dental practitioners.

The roundtable gave the Board an opportunity to exchange views and ideas about a support service for dental practitioners. It also provided insights into the opportunities and challenges of developing a support service for dental practitioners in Australia.

Supply of medicine by dentists

The Board has received correspondence from the PSA raising concerns about a dental supply business promoting the dispensing of medicines by dentists. The company’s website encourages dentists to increase direct dispensing to patients to improve patient experience and for commercial benefit.

Dentists, authorised by their respective state and territory drug and poisons legislation and acting in the lawful practice of their profession, may administer, possess, prescribe or supply Schedule 4 or 8 medicines.

Supply, for a controlled or restricted drug, often means give, or offer to give a person one or more treatment doses of the drug, to be taken by the person during a certain period.

Dispense usually means to supply in accordance with a prescription. The Board's guidelines defines dispensing as: ‘The review of a prescription and the preparation, packaging, labelling, record keeping and transfer of the prescribed medicine including counselling to a patient, their agent, or another person who is responsible for the administration of the medicine to that patient.’

The PSA’s correspondence is an alert for dentists to exercise their professional and ethical obligations when prescribing and supplying medicines. These obligations, set out in the Code of conduct, include:

ensuring the care of the patient is the primary concern for health professionals in clinical practice
providing treatment options based on the best available information and not influenced by financial gain or incentives
conforming to the legislation in the relevant states and territories, including about self-prescribing, and
maintaining adequate records, including being mindful of additional informed consent requirements when supplying or prescribing products not approved or made in Australia.

Reminder about the closure of the Public Sector Dental Workforce Scheme

As mentioned in our November 2018 communiqué, the Board decided to close the Public Sector Dental Workforce Scheme (PSDWS) after a public consultation on whether the scheme was still needed. The PSDWS will close on 1 January 2020.

The PSDWS was established in 2005 by state and territory health ministers in response to a shortage of dentists at that time. The Board’s public consultation explored whether there was a need to maintain the pathway given the growth in new graduates, the decline in PSDWS registrants (currently there is one dentist in the pathway) and other registration pathways open to overseas-trained dentists.

We will continue to work closely with current PSDWS registrants and other stakeholders to coordinate the transition.

Registration

Dental workforce update

The latest workforce data for the profession were released in July. In the period 1 April to 30 June 2019, there were 23,730 registered dental practitioners. By division, there were:

17,727 dentists (including 1,818 specialists)
1,874 oral health therapists
1,451 dental hygienists
1,264 dental prosthetists
877 dental therapists.

Of these practitioners, 537 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 disqualified for inappropriate prescribing

In July this year, a former Northern Territory dentist was reprimanded and disqualified from holding or applying for registration until 1 July 2020 for professional misconduct after he inappropriately prescribed medication to a family member and himself.

The Board began an investigation into Dr Desmond Worboys’ conduct in May 2016 following a notification from a pharmacist in relation to Dr Worboys’ prescription of benzodiazepines to a family member.

The investigation found that from 1 September 2011 to 31 July 2016, Dr Worboys issued up to 65 prescriptions for benzodiazepines, up to 69 prescriptions for antibiotics and up to 15 prescriptions for paracetamol and/or codeine in a family member’s name. Each prescription had been presented to a pharmacy and filled.

It also found that during that time Dr Worboys issued one prescription for benzodiazepines and six prescriptions for antibiotics in his own name. All prescriptions were filled, with the last prescriptions issued in May 2016, after Dr Worboys had received notice of the notification made to AHPRA.

In November 2016 the Board’s Immediate Action Committee imposed a condition on Dr Worboys’ registration preventing him from prescribing any medication until approved to do so by the Board. Later that month he surrendered his registration.

In September 2017 the Board referred the matter to the Northern Territory Civil and Administrative Tribunal (the tribunal), which found that Dr Worboys engaged in professional misconduct by inappropriately prescribing medication to his family member and himself and failing to provide adequate treatment and care to a family member.

It found he acted outside the scope of his registered health specialty in the treatment and care of a family member, failed to maintain professional boundaries in relation to his treatment and care of a family member and in doing so acted in a way that was contrary to the profession’s code of conduct. Dr Worboys also gave false and misleading information to an investigator about his prescribing and his employment status.

National Scheme news

Tackling the fear of notifications – practitioners’ perspectives

Earlier this year, AHPRA launched a series of videos to support the public and registered health practitioners as they go through the notification process.

The video series, called ‘Let’s talk about it’, explains what happens when concerns are raised with the regulator, gives easy-to-follow information about the notifications process and addresses common questions, so consumers and health practitioners know what to expect when they interact with AHPRA and National Boards.

The series is part of work to minimise the adverse impact of the notifications process on practitioners and notifiers. Over the last few months two new videos were added. These provide a first-hand account of the notification process from a practitioner’s perspective:

The other videos in the series are:

A notification has been made about me features five health practitioners who work within the National Scheme and is directed at health practitioners who have had a notification made about them.
I have a concern, am I in the right place? is targeted at members of the public who have a concern but aren’t yet sure whether AHPRA is the right place in which to raise it.
I have raised a concern with AHPRA provides information for individuals who have just raised a concern with AHPRA.

The videos sit alongside other written resources available on the website, including information about understanding the notifications experience. See: www.ahpra.gov.au/Notifications.

You can view the videos on the AHPRA and National Board websites or on our YouTube and Vimeo channel, and join the conversation by following AHPRA on Facebook, Twitter or LinkedIn, use the hashtag #letstalkaboutit and tag @AHPRA.

My experience: receiving a notification

Fake practitioners face jail and hefty fines under new regulatory powers

From 1 July this year, the law got tougher on people who pretend to be a registered health practitioner.

The penalties for anyone prosecuted by AHPRA under the National Law for these offences now include bigger fines and the prospect of prison time.

Australia’s health ministers wanted to address the serious risk to the public posed by anyone who pretends to be a registered health practitioner, so they increased the sanctions offenders face.

AHPRA has a strong track record of taking action on individuals pretending to be a registered health practitioner when they are not. Since 2014, AHPRA has successfully prosecuted more than 50 cases where people were falsely claiming to be registered practitioners.

These included people pretending to be medical practitioners, pharmacists, nurses, physiotherapists, psychologists and dentists.

Fake practitioners betray the trust that patients place in them. Under the changes to the law, offenders face the possibility of a maximum term of three years’ imprisonment per offence. They also face an increase in the maximum fines from $30,000 to $60,000 per offence for an individual and from $60,000 to $120,000 per offence for a corporate entity.

Everyone can check the online register of practitioners to make sure they are seeing a registered practitioner who is qualified and meets national standards.

Summary of the new laws

The amendments were passed in February 2019 by the Queensland Parliament under the Health Practitioner Regulation National Law and Other Legislation Amendment Act 2019 (Qld) (the Act).
The new offence provisions will apply in all states and territories, except Western Australia.
The amendments apply to people pretending to be a registered health practitioner. Under the National Law, anyone who calls themselves any of the ‘protected titles’, such as ‘dentist’, ‘podiatrist’, ‘medical practitioner’ or ‘psychologist’, must be registered with the relevant National Board. It is an offence to use one of the protected titles, and it is also an offence to knowingly or recklessly claim to be a registered practitioner when you’re not or use symbols or language that may lead a reasonable person to believe that an individual is a registered health practitioner or is qualified to practise in a health profession. These offences are known as ‘holding out’.
The amendments to offence provisions do not apply to advertising offences under the National Law.

AHPRA scoops international regulatory excellence award

The Council on Licensure, Enforcement and Regulation (CLEAR) has bestowed its Regulatory Excellence Group Award on AHPRA’s Notifications team, recognising its contribution to improving the experience of health practitioners and the public when engaging with the regulator.

The prestigious award recognises an outstanding team contribution to the enhancement of occupational or professional regulation, regulatory processes or consumer and public protection.

To receive the award the team had to demonstrate exceptional leadership, vision, creativity, results and outcomes above and beyond the regular functions of the job or expectations, and beyond what is normally achieved.

AHPRA’s National Director Notifications, Matthew (Matt) Hardy, accepted the award on behalf of his team and project leaders National Engagement Advisor Susan Biggar and Program Manager Monica Lambley.

‘I also want to thank all of our notifications teams across Australia who are deeply committed to our public safety mission and have embraced new ways of working to communicate better with health practitioners and the public,’ Matt said.

‘They have led the introduction of surveys and interviews to ask how practitioners and the public have felt through the notifications process, which has led to real changes in how we do our work. Since 2016, we have received over 5,000 surveys and conducted nearly 100 face to face interviews with practitioners and notifiers. This work has transformed our staff training and support materials.

‘More recently, the team has developed the Let’s talk about it video series to support notifiers and health practitioners as they go through the notification process,’ he added.

Matt received the award at CLEAR's 2019 Annual Educational Conference in Minneapolis, Minnesota on 20 September. AHPRA’s Executive Director of Regulatory Operations Kym Ayscough is the incoming President of CLEAR. Kym has been a member of the CLEAR Board of Directors since 2016 and is the first President from the southern hemisphere.

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.