Fit for purpose

The Dental Council of Ireland is engaged in a process of updating its code of practice. Council has also made a submission to Government on the proposed amendments to the Dentists Act 1985.

Why were new codes needed?
Our previous Council formed an opinion that all of the Dental Council’s guidance publications should be reviewed. The replaced code on professional behaviour and ethical conduct was issued in 2012 and it was timely to review it.
The Dental Council has an obligation to ensure that our materials are fit for purpose, contemporary and, importantly, reflect current practice. The Council felt that new codes were required to try and ensure clarity and enhance patient safety. The most significant changes affecting the entire profession are the professional behaviour and ethics code and the medical emergency guidance, particularly the emergency drugs a practice should have available. The emergency drugs guidance is perhaps the code that will require the most attention from each of us, given specific requirements concerning patient safety. The code around public relations and advertising was particularly dated and needed significant attention. Indeed, we are revoking it entirely. New codes for registrants providing sedation were considered important and the code for non-surgical cosmetic procedures has also been changed. Changes in other pieces of legislation also needed to be reflected in our codes, for example legislative changes concerning adverse events with a requirement to disclose an adverse outcome to a patient, and changes concerning the protection of children, assisted decision-making and data protection.

A detailed process
This has been a considerable body of work, which has taken about three years to complete and has carried over from the previous Council, who completed most of the project. The initial work was completed by a subcommittee of Council, working with the Dental Council secretariat, who reviewed the codes on ethics, non-surgical cosmetic procedures and public relations. A separate group, initially under the direction of Prof. Leo Stassen and later Paul Brady, prepared the sedation guidelines, and a group chaired by Dr Brett Duane prepared the emergency drugs guidance, with the help of specially formed and broadly representative expert subcommittees. The IDA participated in these expert sub-committees. The recommendations of both groups were reviewed by the Dental Council and some amendments made.

Evolution of the ethical code
There followed a wide stakeholder consultation process with professional organisations, education institutions, the IDA, representative organisations and indemnity providers. Indeed, most of the responses received concerned a proposal, not acted on, to ensure that practitioners held a non-discretionary form of indemnity insurance to ensure that any patient was fully protected in an adverse outcome. After reviewing the feedback from the stakeholders, a final version of each code was agreed by the Dental Council. The finalised codes were submitted to the National Adult Literacy Agency to ensure clarity and that the information contained is accessible to and understandable by patients. This involved considerable work and was a more protracted process than previously. As a result of this process, the codes may read and appear somewhat differently to previous editions.

Changes to specific codes
Ethics
The code of ethics has a number of very important amendments to reflect changes in the nature of the practice of dentistry since the last code was published, changes identified in our fitness to practise processes, information received from patients, and other information identified from other third parties in the course of our work. The code is intended to serve a dual purpose: to guide the profession on ethical decision-making and practice; and, to inform the public on what to expect from the dental team when they attend for an appointment.

Non-surgical cosmetic procedures
The Council was of the view that stating that non-surgical cosmetic procedures were not the practice of dentistry did not adequately protect the public, as it undermined the Council’s ability to hold dentists to account who fall seriously below the standards of acceptable care. It also failed to recognise that there are a significant number of dentists providing these treatments. The view of the Dental Council is that each registrant is expected to be competent, and able to demonstrate competency, in any area in which they choose to practise, but particularly those not covered during the undergraduate curriculum.

Advertising and public relations
The Dental Council is withdrawing its Code of Conduct pertaining to Public Relations and Communications and the associated guidance. This code was largely ineffectual and failed to reflect the rapidly changing communications landscape. The guidance on advertising is now contained in the code of ethics and places the focus on the content of communications rather than on the method of communications. While advertising can be a contentious issue with members of the profession, registrants can also refer matters to the Dental Council for review. The Dental Council allows you to promote your practice as a dentist, but advises that any information you publish must be truthful, decent, factual and accurate, and must not be misleading, create unreasonable expectations or bring the profession into disrepute.

Remote consultations and treatment
The recent pandemic resulted in many dentists opting to provide remote consultations for their patients. Even before the pandemic, this was becoming a feature in dentistry and for these reasons the Dental Council felt that it is opportune to provide ethical guidance to dentists who, in certain circumstances, may have to provide remote consultations.

Increased obligations with regard to record keeping
The revised code includes enhanced obligations on dentists with regard to their record keeping and reaffirms the obligation that all dentists must comply with the European Union’s General Data Protection Regulation (GDPR).

Referrals
The roles of general dental practitioners and specialists in referrals are defined to ensure that the continuing dental care of the patient is maintained.

Medicines
Clarification on prescribing, controlling and storage of drugs is provided.

Conflict of interest and mentorship
New sections on conflicts of interest, and on supporting colleagues, teaching and research are included. These sections will become increasingly important as the concept of mentorship develops.

Council submission on the Dentists Act, 1985
The Dental Council was invited to prepare a submission on aspects of the Dentists Act 1985, and we considered this a unique and unprecedented opportunity to put forward the advantages, disadvantages and limitations of the current Act. We accepted willingly the challenge to prepare a wide-ranging and considered document, which we hope will be seen as useful and meaningful. It is a synthesis and the considered opinions of the last three Councils, reflecting the Dental Council’s views on the current status of the dental profession in Ireland.
The bulk of the project was conducted by the Registrar in conjunction with the finance and general purposes committee of the Council. We consulted widely with previous office holders and members of Council, and a draft document was considered in great detail during a full Dental Council workshop. The work involved a tight timeline over the summer of 2021, and a body of work was completed, which the Dental Council believes to be meaningful and significant. The final submission was sent to the Minister for Health, Stephen Donnelly TD, in mid-October 2021.
Five broad themes were identified to address omissions and weaknesses in the 1985 Act:

  1. Education, training and continuing competence.
  2. Dental practice regulation and other public safety measures.
  3. Independent practice for allied dental healthcare professionals.
  4. Consistent registration systems.
  5. Enhanced fitness to practice provisions.

Each policy proposal related to the themes is defined and explained. This is followed by a detailed explanation and, more importantly, a proposed solution, which already exists in other current regulatory legislation. Where applicable, each proposal in referenced to the action points and proposals in the National Oral Health Policy.

How does the current Act impact on the work of the Dental Council?
On the first page of the current Act, the Dental Council is tasked with the following directions:

  • it is obliged “to provide for the registration and control of persons engaged in the practice of dentistry”; and,
  • its “general concern is to promote high standards of professional education and professional conduct among dentists”.

We are concerned that gaps in the 1985 Act put patients at risk, and these gaps hinder our ability to satisfy our requirement to control persons engaged in the practice of dentistry, and that we cannot attest to high standards of professional education or professional conduct.
The main impediment is that the Dental Council has no means of knowing the competence of the profession or any individual practitioner without a member of the public, or another registrant, who feels sufficiently aggrieved, undertaking the very difficult process of making a formal complaint. Then, only if the Dental Council believes there is a prima facie case to answer, where there might be a serious falling short of the expected standards or significant breaches of our codes, can we start to inquire into the competence of the dentist.
Council would like to implement procedures to ensure that our profession is up to date, and assure the general public that we regulate a modern and current profession at all levels. Council is aware that many practitioners invest considerable time and effort in professional improvement and in ensuring that their practices are current in all aspects of best practice. However, as much as we might be aware of this, we have no way of knowing if the previous statement is true for any registrant. In my own dental career, which I started just before the current act became law, there have been five major advancements, which have completely changed the practice of dentistry. At no stage have I ever had to demonstrate competence in any of these areas to retain my registration. It is unacceptable in this day and age that the Dental Council cannot overtly provide assurance to the public, when admitting me to the Register each year, that I as an individual registrant, or any other registrant, or the profession, is fit for purpose.
The submission addresses this in considerable detail and our reasons are clearly laid out. To allow us to assure the public that we are a modern and competent profession, you will see that we believe a mandatory continuing professional development (CPD) scheme, practice inspections, and some changes to fitness to practice processes, are urgently required. The Dental Council also believes these should be enacted through new primary legislation. Certain sections of the current Act have proven themselves over time and we would like to retain those parts, while amending the Act with primary legislation to correct the gaps and omissions outlined in our submission. Significant amendments were made by primary legislation to the Medical Practitioners Act 2007 in 2013 to ensure that it remained fit for purpose.
We are the only profession in Ireland where CPD is not compulsory, and indeed we are not aware of any other EU or first world country where CPD is not compulsory for dentistry. This is an untenable situation in 2022 and puts patients at unnecessary risk. What might have been fit for purpose 37 years ago is not appropriate for a modern profession striving to be the best it can be. We need mandatory CPD now and the other proposed changes to follow swiftly. I encourage you to read the submission and to engage with the process. It can be found on dentalcouncil.ie under the publication tab.

Registration issues
Registration of dentists not trained in Ireland has become increasingly complex and time consuming. We are obliged to ensure the integrity of our Register, and the qualifications and good standing of people who request admission to it. The Dental Council is also required to resolve an application process within three months. We would like to assure the profession that all completed applications are dealt with within that time frame. Any omissions or gaps on an application form have to be completed and it is only at that stage that it can be considered. Under the GDPR, the Dental Council can only communicate with the applicant and all queries are dealt with in a timely fashion with most queries addressed within a week of receiving them. Any potential registrant will be aware of any omissions on the application form. For the most timely response, a complete application is the best way to proceed.

Dr Gerry Cleary
President,
Dental Council of Ireland