Newsletter: April 2019

From the Chief Executive

Greetings from the Chief Executive

We’ve had another busy start to the year in 2019.

Our highlight so far was making our online services available to practitioners in early February.

We have been working towards making online services possible for some time and I’d like to acknowledge and thank my team here in the secretariat office who have all contributed to the IT project. Consolidating our registry and finance information and moving to online transactions was a challenging undertaking but it is making our internal processes much more efficient.

We have just completed processing just over 1,800 online forms from practitioners whose APCs expired on 31 March 2019. Although this was the first time practitioners used our online services, we were extremely pleased that the round was completed smoothly and without any major technical problems.  For most practitioners, the new online system made applying for their APC faster and easier than the previous paper-based system. Our focus was on helping the smaller group of practitioners who experienced difficulties—mainly with logging in and downloading paid invoices—through our inquiries email and phone service. 

At the February meeting, Andrew Gray was appointed as chair and John Aarts as the deputy chair of the Dental Council. Andrew and John have been Council members since 2013 and 2012 respectively and bring a great deal of regulatory and clinical experience to the Council—I look forward to working with them in their new roles.

I’d like also to thank the outgoing Chair, Robin Whyman for his excellent leadership and contributions over the last 3 years. Robin  has remained focussed on positioning Council as a right-touch, risk-based regulator to minimise non-compliance and public risk, and support practitioners to upgrade their knowledge and skills at the same time. It has been an absolute pleasure working with Robin - under his leadership since 2015, Council has introduced the Standards Framework and the OHT scope of practice, put in place a new IT system and reviewed our recertification framework. 

Other appointments for Councillors with expired terms are yet to be finalised. While we continue to liaise with the Ministry of Health, membership of the Council has not changed.

In late February we moved into new offices on level 8 of Kordia House in Willis Street together with the Pharmacy Council. Although this is still temporary accommodation, this move allows both Councils more time to resolve the safety issues with the building at 80 The Terrace. We are enjoying the benefits of co-location (such as cost sharing, access to meeting rooms and other facilities) and resuming our close working relationship.

This newsletter sets out more details about the outcomes from the budget and recertification consultations. Practitioners are also reminded that the current consultation on the age limit for restorative activities in the oral health therapy scope of practice will end on 18 April 2019. To date we have received nearly 200 submissions on this proposal.

I’d like to take this opportunity to congratulate Dr David Crum on behalf of the Council who was appointed to be an Officer of the New Zealand Order of Merit (ONZM) at the beginning of 2019. This is a wonderful personal achievement for David and recognises his services to dentistry in New Zealand.

And finally, the Christchurch mosque attacks have given us all pause to think since 15 March 2019. Referencing our values of inclusiveness, tolerance, and respect for the diverse people of New Zealand society is more important than ever as life resumes for those personally impacted by this tragedy, and us all.     

IT system update

Our online services are now available.

Practitioners applying for APCs for the 1 April 2019 to 31 March 2020 annual practising cycle have made and paid for their applications online. New applicants are also making their registration applications online and a number of practitioners have updated their personal contact details and applied for a  certificate of good standing online.

If you have used our online services, we’d love to hear from you. Email us at comms@dcnz.org.nz and let us know about your online experience.

Practice standards audit questionnaires will also be completed online as part of our new IT system. If you are one of the 10% of practitioners randomly chosen, you will receive an email and a link to the online questionnaire you’ll need to complete.

Dentists and dental specialists will also be invited to apply for their APCs online later in the year. In the meantime, contact us for instructions on how to activate your online account if you require any of the following services:

• change your name or update contact details
• change practising intentions during a practising cycle
• download and print a 2019 practising certificate or retention letter
• download and print an invoice and evidence of payment for the 2019 APC cycle
• apply for registration in other scopes
• apply for a certificate of good standing.

Recertification review update

The outcomes document from phase 2 of consultation has been issued.

Thank you to everyone who participated in the consultation proposals for improving our approach to recertification. Your input has been invaluable, and it has, and will continue to inform and guide the decisions we make to improve our approach to recertification.

We issued the outcomes document on 22 March 2019. This document details Council’s consideration of submissions received, confirms that the proposals will be adopted (some with refinements) and outlines next steps.

Dental Council staff have now started developing the operational framework required to implement changes for Council to consider in the next few months. The work programme being developed will concentrate on the necessary refinements to the proposals that aim to:

• address respondents’ requests for further detail, templates and guidance for practitioners
• identify the mechanisms required to establish and implement the proposals
• identify the key actions and timeframes required to begin rollout of our new approach to recertification in 2020
• include a communications plan for managing the change process.

The recertification page on the Dental Council website has also been updated with additional information.

Proposed changes to the OHT scope of practice

Consultation on changes to the oral health therapy scope of practice is now open.

The oral health therapy scope of practice was established in November 2016 and came into effect on 1 November 2017.

The Council is now revisiting the restorative treatment age and is proposing to remove the 18-year age limit for restorative activities from the oral health therapy scope of practice.

Consultation is now open until 18 April 2019. We invite you to:

• read the discussion document
• provide your feedback by completing an online submission.

Budget and fees consultation outcome

Outcome from consultation. On 11 February, we issued the outcome letter from the 2019/20 proposed budget and fee consultation.  Council approved the APC fee and disciplinary levies for the 2019/20 year as set out in the outcomes document and confirmed an increase by 2% for all other fees.

Practitioners’ corner

Sharpening your x-ray vision.

Radiographs are an essential part of the practice of dentistry – for diagnosis of dental disease, as well as treatment planning and monitoring. 

The Radiation Safety Act 2016 and supporting regulations came into force in early 2017 and established a new framework for safe and beneficial use of ionising radiation while protecting public health and the environment from its harmful effects. This legislation replaced the previous Act and regulations. 

Case study

A patient recently complained to the Dental Council about their dentist who refused to remove a tooth without taking a pre-operative radiograph. The patient was adamant that they had the right to refuse an x-ray and the dentist was not entitled to refuse to treat just because of this. From the patient’s point of view, it was a simple decayed tooth which had fractured, and extraction was the only option.  

Under the Code of Health and Disability Services Consumers’ Rights consumers have the right to make an informed choice and give informed consent (Right 7). Specifically, every consumer has the right to refuse services and to withdraw consent to services. 

Does the dentist have the right to refuse to treat a patient?

It is unwise to undertake any extraction without an appropriate pre-operative radiograph. Once the reasons for requiring a radiograph have been fully explained and the reason behind the refusal understood (for example it may relate to additional costs or concern about radiation) then one option is to terminate the relationship with the patient. 

Care is required in situations where you refuse to proceed with treatment and taking advice from your association or indemnifier can be helpful to minimise complaints or the likelihood of the patient taking action. 

Remember that in an emergency there is an obligation to help the patient – relief of pain, treating infection or stabilising after trauma – or ensuring a referral for appropriate care. 

An examination for a dentate patient almost always will include radiographs. One option is to include radiography in the cost estimate rather than charging for each radiograph separately. Patients may have legitimate concerns regarding radiation – especially those receiving radiation treatment. Involving specialist colleagues can be helpful in managing these situations. 

Getting it right

Council regularly undertakes practice audits – at random and in responses to notification of concerns. This will usually include a review of patient records which usually includes radiography. Radiography comes at a cost – both financial and biological cost. It is important radiographs are fit for purpose and this includes appropriate field of view and acceptable quality of the image. 

Routine bitewing radiographs are a fundamental diagnostic tool and the expected field of view includes interproximal contact areas and bone levels from first premolar back.

In some patients a second view may be required, or a larger film or sensor used – especially in the presence of third molars.

Quite often during practice audits it is apparent that the hard, bulky nature of some digital sensors can present real challenges in positioning to ensure the appropriate field of view (example below). The key is to evaluate the images and ensure they are fit for purpose.

Periapical radiographs must show a clear view of the apex of appropriate teeth.

Having taken a radiograph for a specific purpose – in the example above a review of root canal treatment – there is an obligation to record incidental findings. Caries on the first molar and the presence of the third molar visible in these pictures should be noted. 

With extra oral radiographs the evaluation for incidental findings can be challenging. OPG, cephalometric radiographs and CBCT scans all require expertise to evaluate the whole image.  If appropriate, images can be referred to our specialist colleagues for assessment. 

Keeping radiographs as part of the dental records

Patients are entitled to a copy of their dental records. Radiographs are an essential component and digital radiographs are easy to copy. Radiographic film is less so. Taking a digital photo of the image on a lightbox is an option to ensure radiographs remain with the practitioner’s records. 

Placing the equipment carefully

When extra-oral radiographic equipment is installed into an existing practice, there are health and safety concerns to consider. In one practice audit, we found new equipment had been installed on the other side of the wall from the receptionist’s desk. When asked, it was apparent that the practice has not considered taking radiation measurements or installing insulation for protection. 

In another practice extraoral equipment had been installed adjacent to a passageway from waiting room to the bathroom. The solution found by the practice was to use road cones to prevent access to the area when the equipment was in use.

If you have any comments or questions about this article, please contact us.