The evolution of the Division of Dental Therapists, Dental Hygienists and Oral Health Therapists in Australia is an interesting and winding path, which has evolved over time. Significant changes seem to have intensified over the last decade, and we have now entered the era of Independent Practice. 

What does this newfound ‘freedom’ mean for individual practitioners? And is it the same for everyone? I outline this in the context of patient care, and ask “who is driving the bus?”

History

As is often the case, to understand one’s current situation, it can first be helpful to understand how we got here. This is no less applicable when we consider the current era of independent practice, and some of the challenges and pitfalls that require navigation. The concept and creation of Auxiliaries in the Dental Profession in Australia is relatively new, in comparison to other Divisions. The first dental therapy schools were established in Australia and Tasmania and South Australia in 1966 and 1967, respectively,1 to assist in the treatment of children in the public sector. It was a requirement of this model of care, that dental therapists provided their treatment under the general supervision and/or prescription of a dentist.

This model of care continued relatively unchanged for a significant period of time, however there was some evolution with the introduction of Hygienists, who could operate in private practice, beginning in South Australia in 1979 though to Victoria in 19892. The ability for other auxiliaries being able to move into private practice occurred in 2000, though of note, Western Australia had permitted Dental Therapists to work in private practice since 1977, providing services under the prescription of a dentist to patients of all ages1. 

In 2014, significant changes swept through with the formation of the Australian Health Practitioner Regulation Agency, Ahpra. With this came the introduction of guidance from the Dental Board of Australia, including the Scope of Practice Registration Standard. This guidance outlined that a “team approach between dental practitioners was encouraged, so that patients are assured of receiving the most appropriate treatment from the dental practitioner who is most appropriate to provide it.” However, this iteration of the Registration Standard did not allow Dental Hygienists, Dental Therapists and Oral Health Therapists to practice as independent practitioners, rather that they were only able to work within a structured professional relationship with a dentist3.

Fast forward to 2017, and the first stirrings of further changes began with a consultation process involving the public, dental practitioners, and an independent review by the Australian Commission on Safety and Quality in Health Care (ACSQHC). The review regarded proposed changes to the Scope of Practice Registration Standard and Guidelines. This was completed, with the current Standard and Guidelines coming into effect on 1 July 2020, ushering in the new era of independent practice we are navigating today.

The current Guidelines for Scope of Practice builds on the Dental Boards Code of Conduct and still encourages practitioners to work together as a cohesive dental team to provide the highest standard of care, where each patient receives the most appropriate treatment from the most suitable practitioner4.

The Guideline recognises that to do this it is imperative that practitioners know their scope of practice and highlights that practitioners must only perform dental treatments in which they have been educated and trained, and are competent in referring where appropriate.

Where are we now 

So, what have these changes fundamentally meant for practitioners, practically, in their day-to-day working lives? Has the ability to work as an “independent practitioner” changed practice further to the previous structured professional relationship? 

Statistics show that the majority of both dentists and allied dental professionals are employed in metropolitan private practises5. When looking at that type of environment, it is not unrealistic to posture that these dental health professionals have continued to work in a collaborative team environment, as they previously had within a structed professional relationship, and the ability to work as an independent practitioner may have had minimal impact on their day-to-day lives.

A high priority raised with government and public health service providers was ensuring that any changes to scope would positively impact specific groups of patients, enabling better access and health outcomes for populations that carry a greater disease burden, such as rural and regional communities and aged healthcare5.

Regardless of whether the 2020 changes have affected you or your practice directly, one recurring issue we have assisted members with is the need for clarity when sharing patient care. Clinicians must ensure that everyone understands who is doing what and who holds responsibility at each stage, no matter the type or location of the practice. 

This is now where we must ask ourselves the question – Who is actually is driving this bus? This is critically important for all practitioners, teams, and patients, as no practitioner wants to experience a moment, where a patient’s treatment has not gone to plan, and it is determined that in fact no one, has been driving the bus. 

Dental Protection looks into this fundamental issue of shared patient care in the webinar, Sliding Doors – Who is driving the bus. Dental Protection utilises a number of cases from the vault, to consider instances where there has been confusion on who is ultimately at the wheel, and how this has adversely impacted patient care.

Members can watch an exclusive webinar on this subject here: https://prism.medicalprotection.org/enrol/index.php?id=1641

References 

1 Satur, Julie. (2007). The development of the dental therapy profession. Found at www.researchgate.net/publication/265446314_The_development_of_the_dental_therapy_profession 
2 Wexler G, The history of dental hygienists in Australia and their use in orthodontic practice. Aust Orthod J. 2017 Feb;Spec No:52-55. https://pubmed.ncbi.nlm.nih.gov/29709121/
3 Dental Board Guidelines Scope of practice registration standard June 2014 retired. Found at: https://www.dentalboard.gov.au/Codes-Guidelines/Policies-Codes-Guidelines.aspx
4 Dental Board Guidelines Scope of practice guidelines effective 1 July 2020 Found at: https://www.dentalboard.gov.au/Codes-Guidelines/Know-your-scope.aspx
5 ACSQCH – Review of the patient safety, patient quality and consumer benefit implications of the Dental Board of Australia’s proposed revised Scope of Practice Registration Standard – July 2019