March 2020 Newsletter

Message from the President 

Welcome to the first edition of the Council’s Newsletter for 2020.

The Council continues to see an increase in the number and complexity of complaints.  As you are aware, this led to an increase in the complaints component of the registration fee late last year. The Council publishes its regulatory activity in its Annual Report published on the Council’s website. 

This newsletter includes an overview of the process the Council follows when a complaint is received.  We hope this answers any questions that you may have.

Additionally, following a serious infection control breach in NSW, the Council introduced two initiatives to confirm practitioners’ compliance with infection control guidelines and standards.  This included a remote desktop audit, and a random inspections program.  A summary of the outcome of these initiatives is featured below.  Noting the importance of ensuring public safety, and to ensure practitioners are meeting their obligations regarding infection control, the Council has determined that random inspections will continue in future.

Recently the Council has received a number of complaints raising concerns that dental practitioners may be practising and/or teaching techniques which may fall outside the definition of dentistry, and that are potentially placing patients at risk.  It’s important to realise  the Dental Board of Australia (DBA) expects all dental practitioners to practise within the definition of dentistry and their dental practitioner division. You must only perform dental treatment for which you have been educated and trained, and in which you are competent. 

Further information regarding the DBA’s standards, codes and guidelines can be viewed on its website.  We also recommend that you make contact with your professional indemnifier, if you have any queries regarding specific components of your practice.

Conjoint Associate Professor F, Shane Fryer OAM

President

Outcome of infection control initiatives

Following a serious breach of infection control in 2018, the Council introduced two initiatives to ensure practitioners in NSW were complying with the DBA’s Guidelines on infection control and other approved standards.

The primary focus of these initiatives was to ensure patient safety and that appropriate action was taken swiftly where concerns were identified.  However, they were also aimed at supporting and educating practitioners in understanding their obligations and requirements of the approved standards and guidelines.    

Remote desktop audit

The first initiative involved a remote desktop audit, which ran from August 2018 to February 2019.  As part of this, practitioners who were the subject of a new complaint that was managed by the Council were required to submit documentary evidence, relating to:

·  the nature of his/her practice

·  infection control protocol observance at the practice setting, including the practitioner’s understanding of these protocols such as sterilisation procedures or CPD activities

· adherence to infection control protocol such as  logbooks of ultrasonic cleaner/autoclave tests; autoclave cycle records/validation certificate; awareness of blood borne virus status, and photographs of rooms/areas within the practice.

Following completion of this audit, it was determined that 98 per cent  of these practitioners were fully or substantially compliant with the DBA’s guidelines on infection control. 

In the case of two practitioners, serious concerns were raised regarding non-compliance and immediate action proceedings were convened by the Council.  This resulted in one practitioner having conditions placed on registration requiring them to stop practising until the Council was satisfied they were safe to practise.  The other practitioner was counselled on infection control obligations.

Random infection control inspections program

The second initiative was a program of random inspections.  This program ran from November 2018 to November 2019. 

All dental practitioners who held practising registration in NSW as at November 2018 were included in the program, and it included practitioners in both office-based and public settings. 

It is pleasing to note that 96 per cent were deemed to be compliant or substantially compliant with the Board’s guidelines following the completion of the program.  Only three practitioners were referred to immediate action proceedings.  Of these, only one was required to cease practising until the Council deemed them safe to do so.

Whilst the results are pleasing, the initiatives highlighted a number of areas where practitioners’ compliance/knowledge can be improved.  The main areas identified related to:

·  infection control obligations, protocols and the need for ongoing continuing professional development activities in this area

·  validation certification and processes relating to the maintenance, testing and use of steam sterilisers

· reprocessing/sterilisation of instruments

· sharps disposal

· clean and contaminated zones

· adequate instrumentation for aseptic procedures and batch code information (BCI)

·  hand hygiene understanding and protocols.

The Council reminds you of the importance of ensuring you are practising safely and are, at all times, adhering to the DBA’s guidelines on infection control and other approved standards.  All practitioners have an obligation to ensure they are aware of the areas which pose a potential risk to the public, particularly in relation to cross contamination and the possibility of the spread of blood borne infections. 

You have an individual responsibility to understand the risks and to ensure appropriate protocols/procedures are implemented, and adhered to, in your practice environment to ensure these risks are minimised. In addition practitioners and practice staff should undertake continuing professional development activities in this area on a regular basis.

To assist practitioners in meeting their obligations, a number of infection control resources are available on our website.

Apply now: Dental Council of NSW Education and Research Grants: Mid-year round of funding

The primary role of the Council is to protect the public by managing complaints about conduct, performance and health matters concerning registered dental practitioners practising in NSW and health and conduct matters related to registered students training in NSW.

Under section 41S of the Health Practitioner Regulation National Law (NSW) the Council may establish an Education and Research Account to provide funding for research and education purposes relating to the health, performance and conduct of registered dental practitioners and students.

The Council’s Education and Research Program provides Grants to applicants to undertake approved research/education projects – up to $10,000 per application. Grants are available to applicants who are registered dental practitioners (all divisions) whose principal place of practice is in NSW, or registered students (all divisions) training in NSW. Grants may be awarded to individuals, groups or institutions.

Examples of the types of projects the Council may support include:

·         Identification of areas of need in the Council’s regulatory programs. For example, deficiencies in educational programs that lead to registration, identification of risk factors associated with complaints, or the assessment of outcomes relating to health, performance or conduct pathways

·         Development and evaluation of Continuing Professional Development courses or training that will support the Council’s regulatory activities. For example, professional ethics, regulatory processes, or training for members of the Council, Tribunals or Panels

·         Preparation, coordination and conduct of conferences to convey outcomes of research relevant to the Council’s regulatory work.

The Research and Education Grants Guidelines provide further information about the application process.  To apply, please use the Research and Education Grants Application Form.

Applications open on 1 March 2020 and close on 1 May 2020.

For more information, please visit the Council’s website.

Overview of the complaints process 

The Council is comprised of dental practitioner members, community members and a legal member.  We manage complaints about the conduct, performance and health of registered dental practitioners (all divisions) and students in NSW.  Our functions/powers are governed by the Health Practitioner Regulation National Law (NSW) (the National Law (NSW)).

The complaints process focuses on safe professional practice, maintaining public safety and minimising risk.  Where we take action, the protection of the health and safety of the public is our primary consideration and the process is designed not to be punitive.

In NSW, complaints are managed by a co-regulatory model where the independent Health Care Complaints Commission (HCCC) assesses each complaint that is made against a registered health practitioner with the Council, to determine how the individual complaint is to be managed. Each complaint is assessed on an individual basis, and the Council and the HCCC take into account a range of factors when assessing a complaint including the practitioner’s response to the complaint, relevant clinical records and the practitioner’s complaint history.

The HCCC generally manages those complaints that raise concerns of unsatisfactory professional conduct, or professional misconduct, of a sufficiently serious nature to justify suspension or cancellation of a practitioner’s registration. 

For complaints referred and managed by the Council, professional members (dental practitioners) are involved throughout the consideration and decision-making process.  Practitioner members are able to assess, from a professional perspective, whether your conduct or performance is below the standard reasonably expected of a practitioner of an equivalent level of training or experience.  Consideration is also given to community expectations regarding treatment and patient safety and, for this reason, community representation is also important and included in the complaints process. 

The Council recognises the impact a complaint has on an individual practitioner and we aim to deal with complaints expeditiously.  Over time the Council has recognised the need to ensure that processing times for complaints improve and efforts have been made in recent years to ensure ongoing improvement in this area.

The length of time a matter takes to proceed through the process varies depending on the circumstances of the individual complaint and whether any further investigation or assessment is required, prior to determining an outcome.  Following the determination regarding the course of action a complaint is to take, we aim to finalise the majority of complaints within reasonable timelines.  For more complex matters, where further investigation/assessment or an inquiry is required to be held, the processing time can be extended.  The Council keeps the practitioner informed of the status of their matter throughout the process.

From our experience, a very small number of complaints may be vexatious or frivolous and we aim to have these not proceed beyond the consultation stage with the HCCC. However, in some circumstances, the information provided by the complainant may require further consideration, prior to us making this determination.

The practitioner is provided the opportunity to make submissions in response to any allegations made in the complaint and opportunities are also provided throughout the process for further submissions to be made.  We will carefully consider all of the information provided, both from the complainant and the practitioner, before deciding a course of action or outcome of a complaint.

Being mindful that the complaints process can be a very stressful time for the practitioner we recommend that the practitioner makes contact with their professional association and/or indemnifier to ensure they receive appropriate support throughout the process.

We have also developed a number of fact sheets relating to the complaints and review/appeals processes and these are available on our website at www.dentalcouncil.nsw.gov.au/fact-sheets-den  

Information regarding the regulatory action taken by the Council, in any given year, appears in its Annual Report. It is noted that the majority of complaints do not result in Council action.

Courses of action that can be taken by the Council

The National Law (NSW) provides the Council with various options for managing individual complaints.  

The Council may:

· make further inquiries about a complaint prior to determining the outcome.  This could include referral to an Assessment Committee, which is established to further investigate complaints, mainly of a clinical nature.  As part of its investigation, the Committee can request an independent assessment of the treatment provided, and any other information, prior to making a recommendation to the Council

· invite the practitioner to an interview if the complaint raises performance issues, to gain further information as to the treatment provided. This will then inform the Council’s decision regarding further course of action

·  direct a practitioner to counselling.  Counselling is usually held when there are issues of concern which may constitute a departure, but not a significant departure, from acceptable standards of practice and/or conduct.   The purpose of Counselling is to ensure that the practitioner is aware of, and intends to comply with, an acceptable standard of conduct and/or performance in future

· determine that the practitioner’s performance or health be assessed independently by a Council-appointed assessor

·  establish a Performance Review Panel or Impaired Registrants Panel to review a practitioner’s performance or health.  This can lead to conditions being placed on registration relating to practice and/or health.  These processes are aimed at supporting the practitioner and to allow them to continue practising, while also ensuring that the public is safe

· a complaint may be dealt with by Inquiry at a meeting of the Council as a complaint of unsatisfactory professional conduct.  Inquiries are generally held when the nature of the complaint is sufficiently serious, but would not lead to a finding of professional misconduct. This process can lead to the practitioner being reprimanded or cautioned, and/or having conditions/orders placed on their registration.