Newsletter: December 2019

What do you do if you become aware that a colleague may be practising in a way that could pose a risk of harm to patients?

Competent practitioners use knowledge, skills and judgment to deliver safe oral health care within their scope of practice. But practitioners’ competence may decline and fall short of required standards at any time in their professional life. Often such decline is associated with factors such as professional isolation, physical and mental health issues—including substance abuse and addiction.

Recognising a practitioner’s competence issues early will allow us all to put mechanisms in place to minimise risk more quickly and protect the public from harm.

What qualifies as a “risk of harm”?

The nature of a health practitioner’s work means simply practising potentially poses some risk of harm. However, “risk of harm” must be one which exists over and above that which is a necessary incident of practice. This is a high threshold. The risk must be to a member of the public—that means patients or potential patients—rather than to practitioners or employers.

Council has agreed that risk of harm is indicated by:

• a pattern over time that suggests the practitioner’s practice may not meet the required competence standards
• a one-off incident that demonstrates a significant departure from accepted standards
• recognised poor performance where local (non-regulatory) interventions have failed—including local interventions where internal review or audit were unavailable to the person notifying the concern
• professional isolation where declining standards become apparent.

Examples of a risk of harm could include:

• failure to diagnose and manage dental disease over time (supervised neglect)
• definitive or expensive treatment in the presence of active disease
• deficient or poor quality of treatment characterised by early failure
• dentistry based on practitioner bias rather than on the patient’s best interests
• lack of informed consent
• dishonesty including inappropriate claiming from third parties. 

In every case, the Council will consider the context and circumstances of the practitioner and their practice.

Your role is to raise concerns about patient safety

If you think a colleague’s practice potentially poses a risk of harm to patients, you have a discretion under the Health Practitioners Competence Assurance Act 2003 (the Act) to make a formal notification to Council. Section 34(1) provides:

“If a health practitioner (health practitioner A) has reason to believe that another health practitioner (health practitioner B) may pose a risk of harm to the public by practising below the required standard of competence, health practitioner A may give the Registrar of the authority that health practitioner B is registered with written notice of the reasons on which that belief is based.”

If appropriate measures such as support, mentoring or remediation programmes are in place and patients are not at risk, notification at that point may be premature.

If a practitioner resigns or is dismissed from employment for reasons relating to competence, you are legally required under section 34(3) to notify Council:

“Whenever an employee employed as a health practitioner resigns or is dismissed from his or her employment for reasons relating to competence, the person who employed the employee immediately before that resignation or dismissal must promptly give the Registrar of the responsible authority written notice of the reasons for that resignation or dismissal.”

As the overall intention of the Act is to protect the public, it is reasonable that the obligation to notify equally applies to self-employed practitioners contracted to provide dental services to any organisation.

If you have good reason to believe a colleague is suffering from a health condition which could affect their ability to deliver patient care or place colleagues at risk, you are legally required under section 45(2) of the Act to inform the Council:

“If a person to whom this subsection applies has reason to believe that a health practitioner is unable to perform the functions required for the practice of his or her profession because of some mental or physical condition, the person must promptly give the registrar of the responsible authority written notice of all the circumstances.”

This notification requirement applies to health practitioners, employers of health practitioners and those in charge of an organisation that provides health services.

Ethics and professionalism

Council has established a Standards Framework (link) describing the minimum standards of ethical conduct, and clinical and cultural competence that patients and the public can expect from oral health practitioners.

These standards are defined in the five ethical principles, 28 professional standards and several practice standards that all practitioners must comply with. We highlight the following professional standards: 

27           You must protect the interests of patients and colleagues from any risk posed by your personal issues or health, or those of a colleague.

28           You must protect the interests of patients and colleagues from any risk posed by your competence or conduct, or that of a colleague or an employee.

Guidance is provided to help you meet the professional standards.  The guidance for professional standards 27 and 28 states you have a legal and professional duty to inform the Council if you know or suspect there is an issue with the competence, conduct or health of a colleague or an employee where patients may be at risk.

Reporting is an important mechanism to protect public health and safety. Public safety is the Council’s priority and we treat all notifications seriously. When we receive a notification, we will decide whether a risk of harm or serious harm exists and respond where required to protect public health and safety.

Ethically, practitioners are required to protect the interests of patients from any risk posed by the competence of a colleague or an employee. This applies whether the practitioner is employed or is contracted to provide services. Acting without delay if you have good reason to believe that a practitioner may be putting patients at risk is a professional responsibility.

Carefully consider too, your responsibility to comply with following professional standard:

23           You must ensure your professional and personal conduct justifies trust in you and your profession

If you have genuine concerns about the safe practice of another practitioner and don’t raise those concerns with the Dental Council, you are falling short of your professional obligations to keep patients safe.

Situations involving the competence of your colleagues, peers and employees are difficult and stressful. It is often advisable to consult senior colleagues or your professional association for support and advice.