23 Apr 2020
In this fast-changing environment, where a day feels like a week and a week like a month, here is the latest information about the restrictions to dental practice, put in place to protect the public, and how Ahpra and the Dental Board of Australia (the Board) are responding to the challenges the COVID-19 pandemic brings.
The Board's last update on 2 April outlined the Australian Health Protection Principal Committee’s (AHPPC) advice to dental practitioners about practising within the context of the COVID-19 pandemic.
Today’s update highlights the AHPPC's latest advice, published on 23 April. What these latest changes mean is described below, together with information about the status of the advice in the current regulatory context.
The AHPPC has announced that it 'supports the current recommendation by the Australian Dental Association (ADA) that dentists [sic]* now move to level 2 restrictions, which will allow a broader range of interventions to be undertaken, including all dental treatments that are unlikely to generate aerosols or where aerosols generated have the presence of minimal saliva/blood due to the use of rubber dam. The ADA advises that dentists [sic]* can now procure their own supply of PPE to enable this expansion'.
*This applies to all dental practitioners.
The Board expects all dental practitioners to follow the AHPPC's advice. Remember that you must also check with your respective state or territory health department for directives that apply to dental practice.
According to the Prime Minister's statement, announced on 21 April, the level 2 restrictions are to come into effect from 27 April 2020.
Our profession has well-established behaviours and values which provide a framework for ethical decision-making in a wide range of situations. You should continue to apply such guidance as far as is practical, recognising these are unique and challenging circumstances.
Many practitioners are asking what they need to do and who they should listen to. Governments at all levels, Ahpra, the Board, professional associations and many others are working together to support the health workforce to practise in a safe way. Each of us plays a different, but essential role in protecting the public by controlling the spread of infection.
The spread of COVID-19 to Australia is seeing unprecedented restrictions applied nationwide as we attempt to contain infection rates. At present, the emergency powers that prescribe the restrictions take precedence over the health practitioner legislation (the Health Practitioner Regulation National Law).
While the emergency response to COVID-19 is a national issue, public health legislation is primarily a power of the states and territories. National Cabinet, put in place to manage the response to the pandemic, takes advice from the AHPPC and makes recommendations which are used to guide state and territory government decisions and their exercise of powers available under the state and territory public health Acts. These Acts allow for restrictions to control and prevent the spread of the virus, usually in the form of public health orders.
Our role and remit is to protect the public by regulating individual dental practitioners. The National Law does not give authority or power to the National Boards to issue public health orders. That is the responsibility of government. The role of a regulator is to ensure that only health practitioners who are suitably trained and qualified to practise in a competent and ethical manner are registered, with the aim of protecting the public.
The National Law allows Boards to help practitioners comply with their legal obligation to meet minimum regulatory standards to keep practising. The Board’s Code of conduct (the code) provides guidance in this respect. Underpinning the code is the assumption that practitioners will exercise their professional judgement to deliver the best possible outcome for their patients.
The Code of conduct also states that practitioners have a duty to make the care of patients or clients their first concern and to practise safely and effectively. You have a responsibility to protect and promote the health of individuals and the community and should be committed to safety and quality in healthcare.
The Code of conduct can be used as evidence of what constitutes appropriate professional conduct or practice of the profession in disciplinary (notifications) matters.
The Australian Health Protection Principal Committee (AHPPC) is the Australian Government’s key decision-making committee for health emergencies. It has an ongoing role to advise all governments on health protection matters and national priorities. It is tasked with mitigating emerging health threats related to infectious diseases and the environment, as well as natural and human-made disasters. National Cabinet takes advice from the AHPPC.
The Board expects all dental practitioners to follow the AHPPC’s advice
Risk is inherent in the provision of healthcare. Minimising risk to patients or clients is an important component of practice. The Board expects that dental practitioners have the requisite skill, training and experience to assess risk in their practice, including the risk of infection transmission.
The Board does not have the authority or power to issue public health orders. You are required to assess the relevant risks and make decisions about how to treat your patients safely, in the interests of your patient, yourself, the patients of the practice and the general public.
The Code of conduct provides general guidance under section 6 ‘Minimising risk’.
Professional bodies and associations, such as the Australian Dental Association (ADA), have a different but crucial role to play in supporting dental practitioners. The role of associations is to represent the profession by promoting it, developing good practice guidance and policy and advocating to government in support of their members. We would expect the associations to suggest practice guides for the AHPPC to adopt in a public health crisis.
While the Managing COVID-19 guidelines published by the ADA are not Board-approved guidelines, the Board expects all dental practitioners, including oral health therapists, dental therapists, dental hygienists, dental prosthetists and dentists, to follow the AHPPC’s recommendation and apply its advice in their practice setting.
The Board and Ahpra are adapting our regulatory requirements to respond to emergency health service needs and support health service delivery during the COVID-19 pandemic, while continuing to protect the public. This includes flexible approaches to support practitioners to meet their regulatory requirements, such as the continuing professional development standard, and to help mitigate disruption to clinical placements, exams and training programs. We’ve also developed guidance on using teledentistry and meeting professional indemnity insurance requirements.
You can read more on our website, including COVID-19 updates published on 2 April and 24 March 2020.
Dr Murray Thomas
Chair, Dental Board of Australia