5 minute read
NEW SCOPE. NEW HORIZONS.
The recent approval of the revised scope of practice is epic news, not least because it has unlocked a wealth of new career opportunities for oral health professionals
By Cheryl Dey
AFTER TWO YEARS of consultations, surveys, submissions, and meetings, the DHAA was excited to hear in November that the revised scope of practice registration standard was approved by the Council of Australia Governments (COAG) Health Council (CHC), and that the revised Standard will take effect from mid-2020.
The decision came after significant work completed by the Dental Board of Australia to review the existing registration standards for dental practitioners. In addition to the strong evidence available, the change was also independently assessed by the Australian Commission on Safety and Quality in Health Care (ACSQHC). We were pleased to see that the Commission agreed that the proposed change will not have any adverse effect on patient safety and quality. This provides no surprises as the DHAA strongly believes that our members have the best interests for patients and our profession.
The revised standard removes the requirements for ‘independent practitioner’ and a ‘structured professional relationship.’ It has also removed reference to programs to extend scope, giving effect to the Board’s decision to phase out the approval process of these programs.
These changes recognise the dental hygienists, dental therapists and oral health therapists as the highly trained and educated oral health professionals we are.
Independent Practice
A professional can be defined as “a member of a profession… governed by a code of ethics, and profess commitment to competence, integrity and morality, altruism, and the promotion of the public good within their expert domain. Professionals are accountable to those served and to society”. All health professionals, regardless of their profession, division or endorsements, through the process of registering for practice are committing to providing services within their scope of practice.
Being recognised as independent practitioners will allow greater opportunities for DH/DT/OHT to practice in a variety of settings, including residential aged care facilities, group homes, wards and units in hospital settings, and homes for the disabled. Services can be provided in designated underserved areas, as well as schools, institutions, residences, skilled nursing facilities, and private homes of homebound persons. This model reaches some of the most under-served populations.
Structured Professional Relationship
Removing the structured professional relationship will lift the required one-on-one relationship with a dentist is which can be restricting practice for DH/DT/OHT. This will enable flexibility for dental practice and referral pathways and create opportunities to work within a collegial team-based approach to care.
DH/DT/OHT will now have more freedom to be employed in places where the dentist may not be the head of the team. In a residential aged care facility it may be the patient’s GP who is the head of the team, for a paediatric patient it may be the speech pathologist, for a cancer patient it may be their oncologist, or in a dental practice it will be the dentist. It may be that a DH/DT/OHT chooses to open a practice and they will be the head of their own team.
How so ever a DH/DT/OHT choses to practice it must still be within their own scope of practice, and anything outside of that scope must be referred appropriately. The DHAA welcome this new model where dentists, specialists, hygienists, therapists, oral health therapists and prosthetists can work together respectful of each other’s scope of practice, in a team-based approach to care.
Programs to Extend Scope
The Dental Board discontinued approval of programs to extend scope on 31 December, 2018. These types of programs can now be delivered as Continuing Professional Development (CPD.)
Dental practitioners who undertake CPD to increase their knowledge and learn new skills must self-assess:
• The quality of the training provided, theoretical and clinical
• Whether there was sufficient clinical experience
• If it falls within their division of registration
For example: Listening to a 30-minute podcast on tooth whitening won’t give you the theoretical knowledge nor the clinical skills to perform this procedure in practice, however a workshop with a theory component to build on your foundational knowledge and a hands-on component to learn the practical clinical skills could do so.
Determining your scope of practice
The Scope of Practice Registration Standard states: “Dental practitioners must only perform dental treatment for which they have been educated and trained , and in which they are competent.
Determine your own scope: When trying to determine your scope of practice ask yourself these questions...
• What was I taught to do in my original training?
• What am I registered to do? DH/DT/OHT/other?
• What additional skills have I acquired through CPD?
• Am I competent in these skills?
• Do I have recency of practice?
Check the rules and regulations: This will give you a basic idea of what is included in your scope. Then you will need to consider things like:
• What does the National Law allow me to do?
• What do my State/Territory Laws allow me to do?
• Are there requirements from the Environmental Protection Agency?
• Are there restrictions from the Poisons Act?
Every State and Territory has different legislation so if you’re moving from place-to-place it is important to find out what might be different.
What does your employment contract say?Just because you have a certain skill it may be that your employer prefer you not perform that procedure. Conversely you cannot be forced to perform a procedure that you do not feel trained and competent in, even if requested.
Does your insurance cover you? When determining if any skill or procedure is within your scope of practice think to yourself – “If there were a complaint made to the Board about this would I be able to give justification of why I felt trained and competent to perform this procedure?” That should give you your answer.
The Dental Board has advised that supporting documents for the newly revised standard, including updated guidelines, will be released before the standard takes effect. We will keep you updated as more information becomes available.
We are interested in hearing your views about the new changes. Please contact us via our members page through our website if you wish to voice your opinion. n
References 1 Cruess SR, Johnston S, Cruess RL. (2004) Profession: a working definition for medical educators. Teaching and learning in medicine: 16(1); 74-6. 2 http://www.rdhmag.com/articles/print/volume-32/issue-1/ features/start-up-company.html 3 Approved programs of study are programs accredited by the accreditation authority for the profession and approved by the National Board under the National Law. The approved programs are those which, upon successful completion, lead to registration or endorsement as a dental practitioner in the division or specialty in which study was completed or through other assessment, examination or qualification that qualifies a practitioner for general registration (section 53 of the National Law), specialist registration (section 57) limited registration with the Board (section 65) or endorsement (section 99).
