Download Opening Statement by Dr. Eamon Croke, President, Dental Council

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Opening Statement to the
Joint Committee on Health and Children
Dr. Eamon Croke, President, Dental Council
Thursday 8th October 2015, Committee Room 2, LH2000, Leinster House
The Dental Council is grateful to the Chairman of the Joint Committee on Health and
Children, Mr. Jerry Buttimer, T.D. for his invitation to meet with the Committee. The Dental
Council have been in correspondence with the Committee following a letter from Mr. Paul
Kelly, Principal Clerk, of 16th October 2014. This letter resulted from the meeting of this
Committee with representatives of the Clinical Dental Technicians Association of Ireland
(CDTAI) on 1st October 2014 and I will return to the matter of that letter in the course of our
submission.
Firstly, I would like to outline the role of the Dental Council. The Council was established by
the Dentists Act, 1985. The primary function of the Dental Council is to protect the public. It
does so by promoting high standards of education and professional, ethical behaviour for all
its registrants. The Council is composed of 19 members.
There are three main Committees of the Council:
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Education and Training: this Committee oversees undergraduate training and
continuing professional development. It works in conjunction with the Irish
Committee for Specialist Training in Dentistry in establishing and evaluating
standards in postgraduate training. Continuing professional development is not
mandatory under the Act;
Fitness to Practice: this Committee assesses complaints in relation to the behaviour,
performance and physical and mental wellbeing of a dentist. In doing so, it may
establish grounds for an Inquiry, hold an Inquiry and report to Council on the
findings of an Inquiry;
Auxiliary Dental Workers: this Committee is responsible for establishing the classes
of auxiliary dental workers, their scope of practice, training and ethical conduct.
The Council’s term of office is 5 years.
There is mandatory registration for dentists and specialists, of which there are two
recognised specialties, orthodontics and oral surgery. Mandatory registration is in place also
for dental hygienists, clinical dental technicians and orthodontic therapists. The Council has
a voluntary register for dental nurses and is working very closely with dental technicians to
establish a voluntary register.
The Dental Council awaits a new Dental Act to allow it to fulfil its primary duty and meet the
demands of a world 30 years removed from the present Act. The Council have made
submissions on a range of functions it would envisage as appropriate to its ability to
regulate the dental team. The Council has been consistent in seeking new legislation that
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would permit effective, flexible regulation which is evidence-based, reasonable and
proportionate.
The Department of Health consulted widely on the legislation to replace the present Act and
published a report on its findings in June 2013 (Report of the Consultation Process on new
legislation to replace the Dentists Act, 1985). The Council met with the representatives of
the Professional Regulation Unit, Department of Health recently to discuss their ‘Summary
of Policy Issues for inclusion in the new Dental Bill’. (Appendix A)
The key policy issues we proposed to the Department of Health included:
 Fitness to Practise:
The Council would urge, in the strongest terms, that the wording in Part V of the
Dentists Act, 1985 in relation to Fitness to Practise be retained and amended rather than
introducing the very prescriptive provisions of both the Medical Practitioners Act and
Nurse and Midwives Bill. The Council’s experience of operating the provisions of Part V
of the current Dentists Act is that the procedures work well for managing fitness to
practise matters. The provisions in both the Medical Practitioners Act and Nurse and
Midwives Bill create a significant and unnecessary administrative burden and provide for
excessive opportunity for technical judicial review proceedings to be taken. It is the
Dental Council’s view that detailed procedural provisions do not need to be included in
the legislation as statutory bodies (and their committees) have a constitutional
obligation to observe fair procedures. In preparing this submission, the Dental Council
consulted with other regulatory bodies and was strongly persuaded that this is the
appropriate course of action, particularly in the light of the experience of the Medical
Council in implementing the provisions of the Medical Practitioners Act, 2007. The
Dental Council notes that the Fitness to Practise provisions of the Pharmacy Act, 2007
are less prescriptive than either the Medical Practitioners Act, 2007 or the Nurse and
Midwives Bill, 2010.
The Dental Council broadly supports the main provisions of both the Medical
Practitioners Act 2007 and the Nurse and Midwives Bill 2010 in providing for the
creation of a Preliminary Proceedings Committee (PPC), which is separate from the
Fitness to Practise Committee (FTP), the establishment of a Health Committee (HC) and
for a wider range of sanctions. The Council would welcome provisions allowing for
complaints to be referred by the PPC to mediation where the PPC establishes that there
is no prima facia evidence of a complaint on one of the grounds set out in the Act. The
Council also welcomes provisions allowing the PPC to refer matters concerning the
unfitness to practise of a practitioner to the Health Committee because issues
concerning the health of a practitioner often only come to light as a result of receiving a
complaint on other grounds.
The Dental Council notes that the Medical Practitioners Act, 2007 provides for a majority
of practitioners on all Committees, except the Fitness to Practise Committee, where the
majority must be non-registrants. The Dental Council is generally satisfied with the
provisions of the Medical Practitioners Act in this context and considers that this is a
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workable provision, on condition that the Dental Council may determine the
competencies required for appointments to both the PPC and FTP Committees and that
the Council makes the appointments to these Committees. In the Dental Council’s view,
the personal qualities and professional expertise of the members of both Committees is
of paramount importance.
While the provisions of Part V of the Dentists Act are generally adequate the addition of
the following provisions would greatly increase the effectiveness of the FTP Committee:
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provide for the appointment of registrants from the relevant class of auxiliary dental
worker when the case involves a member of that class.
allow for evidence to be heard by video link
allow a practitioner to consent to censure or remedial action (as per the Medical
Practitioners Act). This provision should also allow the practitioner to consent to the
attaching of conditions for the retention of his/her name in the register
allow for the Committee to consider matters summarily, following a
recommendation from the PPC (by way of statement or sworn affidavit), and
following such consideration, to recommend a sanction of advice, admonish, censure
or direct a practitioner to refund some or all of the cost of treatment fees
allow the Council to attach conditions to a registrants practise if there has been a
finding of fact at Inquiry, even though this may not constitute professional
misconduct. This provision is in the current Dentists Act but it is not in some of the
more recent regulatory legislation
allow for the FTP Committee to hear matters concerning unfitness to practise where
there are also other allegations (i.e. that the totality of the matter is dealt with by
one Committee), and that the Committee may hear such matters in private
provide for the publication of Fitness to Practise Committee reports where there is a
finding of fact or where an allegation has been proven, after the report has been
considered by the High Court and/or Council.
Having reviewed the legislation applicable to the other healthcare regulators, the Dental
Council is of the view that the provisions of Section 42 of the Pharmacy Act, 2007 are
preferable. This allows for Fitness to Practise Committee hearings to be held in public
but that the Committee may decide to hold a hearing in private after considering
submissions from either the complainant or registrant in this regard. The Council
believes that the registrant’s name should only be made public if there is a finding of
professional misconduct or if conditions restricting a professional’s practice are attached
to a registrant’s registration.
In the Dental Council’s view, the same range of sanctions that apply to practitioners
should apply to the entity registering dental premises, including the power to
temporarily close dental premises, to attach conditions to the ongoing registration of
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dental premises and the power to erase (permanently shut down) dental premises. The
Council would wish to have an additional provision giving the Council the right to apply a
significant and punitive fine on the entity registering a dental premises (e.g. in excess of
€100,000).
 Regulation of the allied dental health professions:
The Dental Council strongly disagrees with the provision in the ‘Summary of Policy Issues
for inclusion in the new Dental Bill’ (Appendix A) that only those auxiliary dental workers
who work independently will be registered. The Dental Council believes this proposal to
be regressive and potentially harmful to patient safety and the development of the
dental team.
The Dental Council believes that all members of the dental healthcare team should
undergo mandatory registration with the Dental Council. This regulatory system already
applies in the UK where all registrants are accountable to the General Dental Council
(GDC) and may be the subject of professional misconduct proceedings. In the Council’s
view the same procedures / range of sanctions as apply to dentists should be provided
for in relation to auxiliary dental professionals.
All dental healthcare professionals should be motivated by the three-fold aim of
safeguarding the health and safety of patients, promoting the welfare of the community
and maintaining appropriate standards in all aspects of his/her life, both personal and
professional, so the public have confidence in the dental profession. The sharing of
common ethical and professional behaviour by all dental healthcare professionals would
be reinforced by fitness to practise procedures for all registered members of the dental
healthcare team. This aim will be negated if the proposal is legislated for as it is
proposed.
At present there is no statutory provision for removing an auxiliary dental professional
from the register, other than if the registrant fails to pay his or her retention fee.
Auxiliary dental professionals do carry out treatments and it is appropriate that they are
accountable from both an ethical conduct and clinical perspective. Dental hygienists can
administer local anaesthetic, suitably qualified dental nurses can take radiographs, and
orthodontic therapists may fit and adjust removable orthodontic appliances. A proposal
to greatly expand the scope of practice of dental nurses to include additional intraoral
procedures has been with the Minister for approval for almost two years. It is important
that such workers are professionally accountable for their actions. Similarly, if a dentist
and an auxiliary worker were convicted of the same type of indictable offence (e.g.
sexual assault), the Council may decide to erase the dentist from the register but it could
take no action against the auxiliary dental professional.
The numerical size of the dental healthcare team in Ireland is small compared to that of
medical healthcare personnel so it is sensible to have all members of the dental
healthcare profession under the aegis of a single regulatory body. This will promote the
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continuing development of holistic, evidence-based and patient-centred regulation. In
keeping with this view the Dental Council proposes that all dental healthcare
professionals should have representation on the Dental Council under the new Dental
Act. The Dental Council believes that this is a cost-effective, efficient regulatory
proposal as it makes efficient use of resources and skills. The Dental Council also
believes such inclusion is consistent with best practice in the other dental regulatory
systems that the Dental Council has examined and will enhance patient safety and
confidence in the dental team.
The issue of illegal or ‘denturist’ practice highlights a quintessential issue to any
discussion on dental regulation; without registration is regulation effective, transparent,
consistent and how is accountability enforced? How does one know who is to be
regulated when one may not know who or where they are? Other concerns which arise
in the absence of registration include:
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Council has, heretofore, regarded that any intra-oral treatment poses a risk to
patients and should only be carried out by a registrant. Registrants such as dental
hygienists and orthodontic therapists have a real potential to damage or infect
patients if this work is not carried out by a suitably trained and accountable
professional
From a patient’s perspective, registration enshrines the fact that he/she is being
treated by a professional dental team
Registration means that registrants have to comply with ethical and practice
standards (CPD, infection prevention and control etc.)
Allows for autonomous practice and decision making
Having a registrant professionally accountable to the Council enhances an allied
dental health professional’s ability to deal with poor standards within the practice
Removing professional status will diminish the stature of dental nursing and dental
hygiene in the eyes of new entrants and may impact on the quality of future cohorts
of students
The status of auxiliary dental workers may be diminished in the eyes of the public
The programmes offered by educational institutions will be diminished.
The Council is very concerned with the proposal to reduce regulation where the risk is
perceived to be low. This trend carries advantages in other areas but in healthcare it
removes those not registered from the direct regulatory influence in the development
and maintenance of a safety culture. To ensure it has the capacity to fulfil valid
regulatory function, to enhance patient-centred safer, better healthcare, the Dental
Council requires the new Dental Act to provide mandatory registration for all members
of the dental team, including dental technicians, and not solely the registration of those
members of the team who can practice independently. It is the stated desire of all
organisations representing those who work legally within dentistry that mandatory
registration should be provided by the new Dental Act, for all dental healthcare
professionals, and appropriate regulation must follow.
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The issue of registration and regulation is at the core of illegal practice, which the
Clinical Dental Technicians Association of Ireland (CDTAI) brought to this Committee’s
attention on 1st October 2014. In that meeting the representatives alleged “that there
are significant numbers of people illegally practicing as Dental Technicians in Ireland and
further alleged that there has been a complete failure on the part of the Dental Council
to regulate the profession”.
The Registrar of the Dental Council repudiated the false allegations made by the CDTAI
delegation in his letter to Mr. Kelly of 23rd October 2014. The Dental Council, under the
Dentists Act, 1985 has no power to inspect or close illegal practice. The limitations
imposed on the Dental Council by the present Act to deal with alleged illegal practice are
widely recognised, and were highlighted in the Competition Authority’s Report
Competition in Professional Services: Dentists, 2007 (Executive Summary, 5). In addition,
the Registrar informed Mr. Kelly that while the Dental Council does not have a Register
of Dental Technicians, dental laboratories are regulated by the Health Products
Regulatory Authority (HPRA). The issue in question is the illegal, direct provision of
removable dental prostheses (dentures) to the public by unregistered and unqualified
‘denturists’ who may also, legitimately, provide dental technical support directly to the
dental profession.
The Dental Council has similar concerns to those expressed by the CDTAI and has done
so for many years, prior to the registration of the first Clinical Dental Technician (CDT).
The inability of the Dental Council to directly intervene in illegal practice is known to the
CDTAI, as Clinical Dental Technicians (CDT) have representation on the Council’s
Auxiliary Dental Workers Committee. Many hours have been given to the CDT
representatives, within Dental Council and in informal meetings, to explore their
concerns. They are fully aware of the limitations of the Dental Council’s power and the
CDTAI has misrepresented the Councils powers to you.
The Board:
The proposal that a new Dental Act would limit the Council size to a maximum of 12
members will irrefutably change the successful operational traits of the Dental Council.
While the Council appreciates that one of the main aims of having a non-dental majority
is to minimise the perception of professionals protecting professionals when considering
fitness to practise cases, it is important to realise that most of the work that Council
undertakes relates to dental education and general practice. To operate effectively, it is
vitally important that the voice of dental educators, specialists, as well as members of
the general practice dental team are represented at Council. The reduced Council
membership reflects the business model for a board overseeing the hiring of a CEO
(Registrar) and directing the overall strategy and output of the Council. This will require
a very significant increase in the number of staff.
One of the main strengths of the present membership is that the Dental Council has an
in-depth knowledge of the profession at all levels due to representation of general
practitioners, specialists and other members of the dental team. The proposed
reduction in number could challenge the Council’s effectiveness and consistency. There
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is no evidence to indicate a lack of transparency, objectivity and accountability in the
functions of the present Dental Council.
The Dental Council would advise that regulatory impact analysis specifically assess the
necessity and effectiveness of the proposed changes in light of the Council’s day-to-day
workload and international best practice.
 Regulation/Inspection of dental practices:
The Dental Council is strongly of the view that, in addition to the regulation of
practitioners, the places where dentistry is practiced should be subject to regulation.
Therefore, the Dental Council welcomes the provision made in ‘Summary of Policy Issues
for inclusion in the new Dental Bill’ that “the new legislation will provide for the
regulation and inspection of dental practices/premises. It will also provide that
regulation and inspection powers will be held by the Dental Council”.
The provisions concerning the registration and regulation of practitioners are well
established and the Dental Council’s proposals would strengthen the current
environment. The Council is seeking provisions that would allow it to establish and
maintain a register of dental premises (see “Corporate Dentistry” below). Having a
strong inspectorate is the cornerstone of the effective regulation of dental premises.
The Dental Council is mindful of the report of the Implementation Steering Group
(Commission on Safety and Quality Assurance) on Building a Culture of Patient Safety,
July 2008 and the recommendations therein. The Council is in agreement that the
licensing of public and private dental facilities should be mandatory and that the issuing
of licences should be based on ‘stated standards enforceable through inspection and the
imposition of sanctions if necessary’. Furthermore, the Dental Council believes that
these standards while being ‘transparent and fair’ must also be balanced and evidencebased to allow a level of engagement that will lead to improved patient safety and
quality of service.
The Dental Council believes it is best positioned to oversee the registration and
inspection process because of the expertise it has developed over years of regulating
dental practitioners. Legally and administratively it makes sense for one body to
regulate both dental practitioners and dental practices, and for that body to have an
inspectorate. The Dental Council has the ability to ensure effective, proportional and
transparent administration of a registration and inspection system for regulating dental
premises. It has the ability to assess new regulations and to advise and be accountable
to the Minister. Most importantly, it is probable that serious breaches of regulations
concerning dental premises will also uncover matters which may form the grounds of a
complaint against one or more dental healthcare professionals. In order to deal with
such matters expeditiously it is necessary to have both regulatory functions under the
direction of one organisation.
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An added benefit is that there is an opportunity to minimise the regulatory impact and
cost to dental practices (the costs of which would ultimately be passed on to patients)
by vesting responsibility for both regulatory functions in one entity. The new Dental Act
should provide for the Dental Council to carry out inspections with and/or on behalf of
other organisations and these could encompass inspections regarding radiology, clinical
waste management etc.
There are models in healthcare regulation already that could be adapted for inclusion in
the new Dental Act. The framework set out in the Pharmacy Act, 2007 allows the
Pharmaceutical Society of Ireland (PSI) to register and inspect pharmacies as well as to
statutorily regulate retail pharmacy businesses. The provisions set out in the Food
Safety Authority of Ireland Act, 1998 allow the Food Safety Authority (FSAI) to issue
improvement notices and orders, and in extreme cases, to close a premises down on the
authority of an individual nominated by the FSAI.
The Dental Council would wish to see the new Dental Act contain provisions giving it the
power to enter and inspect a dental practice (or a place where it is reasonably suspected
that dentistry is being practiced) similar to Sections 18 and 66-71 of the Pharmacy Act,
2007. The power to enter a place where it is reasonably suspected that dentistry is
being practiced is essential to the ability of an inspectorate to investigate reports of
illegal practice, including the illegal provision of dentures directly to the public. The
Council would seek these provisions to be supplemented with provisions similar to
Section 52 and 53 of the Food Safety Authority of Ireland Act, 1998 that will allow an
inspector to issue an improvement notice and/or order and, in the case of a serious
breach, for a premises to be closed on the authorisation of the Registrar or individual
nominated by the Dental Council. These powers are in addition to the provisions sought
under Fitness to Practise requirements regarding allegations against registered dental
premises.
Corporate Dentistry - limited companies and partnership:
The Dental Council is of the view that both the dental practitioner and the dental
premises should be registered with the Council, and that the entity registering a dental
premises must be accountable to the Dental Council for ensuring compliance with the
new Dental Act, both with statutory rules and compliance with statutory codes of
practices. The provisions sought are similar to the provisions governing the regulation of
retail pharmacies set out in the Pharmacy Act, 2007.
The business of dentistry has changed significantly over the last 30 years and has seen
the introduction of corporate chains of practices and the development of larger
practices with many practitioners. The Dental Council is of the view that registered
dental premises need not be owned or controlled by dentist(s), but they must be
regulated. The Dental Council has considered this matter from a public interest
perspective and considered the legislation and experience of regulating businesses in
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the Irish healthcare sector. It also had an overview of experiences in other jurisdictions
with dental bodies corporate.
Registration of Dental Premises:
It is the Dental Council’s view that the appropriate way to regulate is to provide for any
persons/partnerships/bodies corporate controlling a dental premises (this includes
clinical dental technicians premises and potentially independent dental hygienist
premises) to register the premises on a register maintained by the Dental Council. The
registering entity should be responsible for compliance with the legislative provisions of
the new Dental Act and any regulations made under this Act (including the improvement
notices/orders issued following an inspection). The Act should provide that the
controlling entity may be subject to either Fitness to Practise proceedings or prosecution
under the Act. This is similar to the provisions under the Pharmacy Act, 2007 governing
the regulation of retail pharmacy.
The Act should also provide that where a partnership/body corporate is convicted of an
offence under the new Dental Act or where there is a finding following a Fitness to
Practise inquiry in relation to the registered dental premises, every director and
manager of the body shall, unless he/she proves that the offence was committed
without his/her knowledge, be guilty of the offence.
Regulation of Registered Dental Premises:
The Council seeks a statutory provision to make codes of conduct and codes of practice
for registered practitioners and registered practices, as well as issuing guidance to the
public. These provisions should allow for the renewal of a registration of practices on a
periodic basis, inspections and to set out a procedure for the erasure and closure of the
practice for failure to pay the renewal fee or where a corporate entity is wound up.
The Council would envisage that the statutory code of practice for registered dental
premises would be based on stated standards centred on patient safety, a governance
framework which promotes accountability, clinical audit, risk management and adverse
event reporting. The Council would envisage that the statutory code could, inter alia,
include:
 an obligation to register the premises where any dental healthcare professionals
practise;
 a requirement to have a named, registered dentist nominated as principal dentist in
each registered dental premises;
 an equivalent requirement in each location where allied dental health professionals
practice independently (e.g. clinical dental technicians and possibly dental hygienists
in the future);
 an obligation on the named principal to ensure that Dental Council codes of conduct
and practice are implemented practice wide (e.g. cross infection control, maintaining
patient records, CPD etc.);
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display clearly the registration certification for all allied dental health professionals in
the practice, the registration certificate for the dental premises and the name of the
principal registrant;
an obligation to ensure that staff are properly registered;
an obligation to ensure that registrants have appropriate professional indemnity;
a requirement that where there are two or more premises controlled by an entity
(person/registered company/partnership) that the entity nominate a dental
superintendent who is a registered dentist with a minimum of 3 years, full time postregistration experience;
the business name of a registered dental premises or dental business shall not
violate any Dental Council code of practice.
 Principal Dentists and Registered Owner Representatives in dental
practices:
The Dental Council welcomes the provision made in ‘Summary of Policy Issues for
inclusion in the new Dental Bill’ that “the new legislation will provide for the
appointment of Principal Dentists and Registered Owner Representatives in dental
practices. This provision will also apply to any independent allied dental health practice
established”.
The Council seeks a provision to make it compulsory for the registering entity to appoint
a “principal dentist” to each registered dental premises and for the Council to make
rules concerning the experience and qualifications required to fill such a role. The
Council would envisage that a principal dentist would have a minimum of three years
post registration experience including a period of vocational training (see “Continuing
Education” section) or a minimum of 5 years’ experience if the dentist has not
undertaken a period of vocational training.
Chains of Registered Dental Premises:
The Council would seek to place an additional requirement on entities registering more
than one dental premises to nominate a “dental superintendent” (with a similar post
registration experience requirement to that of a principal dentist). It is envisage that
this registrant would be responsible for compliance with legislation / regulations across
all registered dental premises controlled by the registering entity. It is envisaged that
this would be done by way of regulation.
Prosecution of Offences:
The Council recommends that the proposed new Dental Act allow the Council to take
criminal prosecutions in a manner similar to the provisions under the Pharmacy Act,
2007 and the Food Safety Authority of Ireland Act, 1998.
This will permit the Dental Council to address rogue practices in a cost-effective manner.
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Competition Authority Report
The Competition Authority recommended in its report on dentistry that bodies
corporate should be “explicitly” allowed to engage in the practice of dentistry
(Recommendation 10, Dentists Executive Summary October 2007). The Dental Council is
strongly of the view that individual practitioners should continue to be accountable to
the Dental Council for their clinical practice and that corporate bodies should not be
allowed to “practise” dentistry. The inspectorate provisions (see “Inspection Powers of
the Dental Council” above) and the requested provisions to allow consideration of
complaints against the entity registering a dental premises (see “Fitness to Practise”
above) adequately balances the requirement to protect the public, a demand from some
practitioners to be able to incorporate their dental businesses and the weakness in the
current legislative framework.
The Dental Council also submits that the provisions sought adequately addresses the
concerns of the Competition Authority with the requirement to ensure patient safety.
 Staggered term of office (board appointments):
It is the strong view of the Dental Council that corporate memory primarily rests with
the staff of the Dental Council who have acquired an understanding of the day-to-day
functions of any Dental Council and the relevant legislation. The Dental Council does not
see any evidence to indicate that staggering the terms of the Council members will
improve the effectiveness or consistency of the Council’s functions. There is a steep
learning curve for all new Council members and the experience of this Dental Council is
that late appointees to the Council are disadvantaged by their late arrival as the other
Council members are familiar with their roles by that time. The work of Council has to
slow to accommodate the newcomers or they struggle to understand the nuances of
their new role, with a potential diminution of their contribution.
The Dental Council would encourage a debate on the ideal length of term for Council.
 Continuing Professional Development for dentists and allied dental
health professionals:
The Dental Council welcomes the provision in the ‘Summary of Policy Issues for inclusion
in the new Dental Bill’ that will require dentists and auxiliary dental workers to ‘maintain
their own professional competence’ and ‘that the Dental Council can require them to
demonstrate competence to its satisfaction in accordance with a professional
competence scheme’, but questions how it is possible to do this when the proposals will
effectively de-regulate most allied dental health professionals. Mandatory CPD only
works if ultimately there is some potential for impact on a professional’s registration for
non-compliance. If you have no register, how can you enforce a mandatory code of
continuing professional development?
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In 2008 the Dental Council endorsed the principle of Continuing Professional
Development (CPD) and advised all registered dentists of the Council’s desire to see
mandatory professional development for all registered allied dental health professionals
in a new Dental Act. On 1st July 2009 the Dental Council assumed responsibility for the
continuing professional development of dentists in Ireland, following the dissolution of
the Postgraduate Medical and Dental Board. The Council’s commitment to continuing
education is underpinned by its Professional Behaviour and Ethical Conduct Code of
Practice (2012) as well as and its Scope of Practice guideline (2014).
In April 2015, The Dental Council updated and published a voluntary scheme for
dentists, which set out CPD targets that should be achieved over a 5-year period with
designated core competencies (http://www.dentalcouncil.ie/competence-cpd.php). In
establishing this scheme, the Council’s aim is to encourage each member of the
profession to consider the development of their own skills and knowledge and to
encourage them into a formal recording process, in preparation for the introduction of
mandatory CPD. The core competencies acknowledge the primacy of patient safety.
It is the Council’s intention that all registered allied dental health professionals will be
accountable to the Council with regard to continuing competence. The Act should allow
the Council or the delegated competence scheme to refer issues concerning noncompliance to the Preliminary Proceedings Committee under the Fitness to Practise
provisions of the new Act.
Foundation (Vocational) Training:
The Dental Council is very disappointed that Foundation (Vocational) Training is absent from
the ‘Summary of Policy Issues for inclusion in the new Dental Bill’. The Dental Council would
aspire to the introduction of a mandatory Foundation Training scheme as it considers it not
only an elemental part of continuing professional development but also an essential part of
the development of any young dental professional, from a novice to a competent
professional in the mentored environment of independent practice. Foundation Training is
a period of training following initial qualification and registration that builds on the
achievements in the undergraduate curriculum and aims to produce a competent, caring,
reflective practitioner. It should enable the practitioner to demonstrate a level of
competence necessary for independent practice. This is generally achieved through treating
patients under supervision and taking part in structured and unstructured clinical review
and learning.
A voluntary Foundation Training scheme was established in Ireland in 1999 under the aegis
of the Postgraduate Medical and Dental Board. The scheme was initially a 5-year pilot
scheme when launched and it flourished until, regrettably, it was wound down in 2011. The
Foundation Training scheme in the UK is now mandatory for those working for the NHS,
although there are regional variations in how it is run. In Scotland, for example, there is
provision for the trainees to fail the programme and be obliged to undertake further
retraining.
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The Dental Council acknowledges that the current economic climate would make the
introduction of a scheme challenging in the short term. The Council would wish to have a
provision in the new Dental Act that would allow for the introduction of such a scheme by
way of statutory rule. Full consideration may be given at the point as to how the scheme
would fit in with the statutory CPD scheme. The Council would envisage that Foundation
Training would be:
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post registration in the register of dentists
of 12-24 months duration
take place in both private and public dental environment
under the aegis of the Dental Council
The Scottish model should be examined as a possible template for a new scheme.
Indemnity:
Additionally, The Dental Council is concerned that professional indemnity is not addressed
in the ‘Summary of Policy Issues for inclusion in the new Dental Bill’; professional indemnity
is an indispensable element of patient protection. The current Professional Behaviour and
Ethical Conduct Code of Practice states unequivocally that “a dentist shall hold appropriate
professional indemnity cover.” The Dental Council is of the view that any registered
member of the allied dental health professionals team who can perform intra-oral
procedures for his/her patients must have appropriate professional indemnity cover. The
Council is of the view the new Act should allow the Council make regulations in relation to
indemnity which would include, at a minimum, a stipulation that practitioners are required
to confirm on an annual basis (as part of the annual retention fee process) that they have
appropriate indemnity.