Newsletter: December 2016

All functions are set out in section 118 of the Health Practitioners Competence Assurance Act 2003 (the Act).

In this issue, we are looking at how the Council sets standards, as mandated by section 118(i) of the Act, which requires us to “set standards of clinical competence, cultural competence, and ethical conduct to be observed by health practitioners of the profession”.

The primary purpose of the Council is to protect public health and safety by ensuring oral health professionals are safe, competent and fit to practise. At the heart of this is the setting of standards for the oral health sector, one of the Council’s core statutory duties.

Background

Many of you may know that historically we have worked closely with the New Zealand Dental Association (NZDA) to set practice standards, formerly known as codes of practice.

Historically, the NZDA would develop the standards, which were considered and endorsed by Council for use by dentists and dental specialists. The NZDA also allowed these codes of practice to be adapted for use by the other oral health professions.

In 2011, the Council made the decision to bring the development and review of practice standards “in-house”, in a separate, Council-led process, rather than using the Association’s codes of practice as a basis.

This was due to a number of reasons, the primary one being that legal advice made it clear it was simply not a function the Council should delegate externally. This reflected Council’s statutory responsibility under s118 of the Act to set standards for all oral health professions. It also highlighted the fact that delegating the function was in direct conflict with the Act’s intent in establishing independent regulation rather than allowing professions to set standards for themselves.

The Council was also aware that while the arrangement with the NZDA meant the views and interests of dentists were well represented, some of the other professions did not feel adequately represented or included by this arrangement.

The Council was further aware there was a growing body of material—in the form of best practice standards, guidances, guidelines—from a range of organisations, employers and associations that practitioners were also relying upon for guidance in their practice. Often these standards are focused on achieving excellence in practice, and these play an important and specific role in all professions. However, the Council felt it was important to differentiate these standards from Council-set standards, which are mandatory standards that all registered oral health practitioners must comply with. 

How we set standards

In August 2015 the Standards Framework for Oral Health Practitioners was implemented. The standards framework describes the minimum standards of ethical conduct, and clinical and cultural competence that the public can expect from oral health practitioners. This consists of five ethical principles and 23 professional standards which set out how practitioners should conduct themselves in order to ensure they adhere to the ethical principles. The third component of the standards framework is made up of 17 practice standards, which set out the expectations of practitioners and offer associated guidance relating to specific practice areas.

The framework is available on our website in an interactive wheel format, or as a pdf document.

The Council has a schedule of reviewing the practice standards which ensures they remain current and meaningful. The Council frequently assesses its practice standard review priorities based on a regulatory risk analyses. Review or development of a new practice standard might be prioritised in response to an increased risk to patient safety. Risk levels may be heightened through an increased number of notifications or complaints of breaches of a particular practice standard; changes in other legislation; or significant changes in practice that means the standard is no longer fit for purpose. Otherwise practice standards will be reviewed on a cyclical basis.

In general, the process of reviewing a practice standard involves:

1. The Council staff and Professional Advisor Standards lead the review. This includes taking into consideration known issues or concerns with the standard; similar local and international standards or guidelines; changes in technology, practice or public expectations since the last review; and external considerations such as changes in the workforce or training. External subject matter experts and the Council’s professional advisors are consulted as necessary.
2. A draft practice standard is developed, and submitted to the Council for consideration. 
3. Once ready, stakeholders are consulted. These include practitioners and other relevant stakeholders such as educational institutions, the Ministry of Health, district health boards and any other identified parties who can provide insight.
4. Submissions are received and carefully analysed. All submissions and the detailed analysis are considered by the Council. Changes are made to the consultation draft, as considered appropriate by the Council. Expert advice on technical aspects might be sought and submitted to the Council to inform the consideration of the consultation submissions. If the changes are substantive, there will be a second round of consultation.
5. Once the practice standard is approved, a suitable implementation period is determined by the Council to allow practitioners to familiarise themselves with the new obligations and for necessary changes to be put in place—for example, educational institutions may need to develop or update training programmes, or practitioners may need to adjust workplace protocols or purchase new equipment.
6. The outcome of the consultation and the final practice standard is communicated to all stakeholders.

The Council acknowledges that this process is resource intensive and time consuming, but it prides itself on the robust development process. Extensive consultation with its stakeholders helps ensure that it makes the most informed decisions. As a risk proportionate regulator, the Council continuously balances its obligation to protect patient safety with the obligations placed on oral health practitioners.

Our standards work plan for 2017

The practice standards on the Council’s 2017 work plan are those relating to professional behaviour, cultural competence and informed consent. The review of the cultural competence practice standard may continue beyond next year, as extensive engagement with various groups is planned. 

Practitioners are invited to submit any particular concerns within these practice standard areas to the Council in preparation for these reviews. Any concerns or reference material can be emailed to consultations@dcnz.org.nz.