When the Dental Council receives a notification about you, it decides which route under the Health Practitioners Competence Assurance Act 2003 (the HPCA Act) the concern belongs on: competence, health or conduct. It writes to you with the concern, asks for your written response by a date, and then decides whether to close the matter, order a competence review, refer it to its health process or appoint a Professional Conduct Committee. While a matter is open it can suspend your practising certificate or place conditions on it. Call your indemnity insurer the same day, secure the clinical notes, radiographs, treatment plans and estimates as they stand, do not contact the patient, and reply before the date with a response written against the record and the Standards Framework for Oral Health Practitioners.
Who the Dental Council regulates and where a notification comes from
The Dental Council registers dentists and dental specialists, dental hygienists, dental therapists, oral health therapists, orthodontic auxiliaries, clinical dental technicians and dental technicians. A notification can come from a patient or their whānau, a colleague, a practice owner, an employer, a hospital dental service, an auditor, the Health and Disability Commissioner or another agency. Two routes are mandatory under the HPCA Act. An employer must notify the Council when a practitioner resigns or is dismissed for reasons relating to competence (section 34), and a practitioner or employer who believes a practitioner may be unable to practise safely because of a mental or physical condition must notify the Registrar (section 45). The guide to a mandatory employer notification covers how the employment and Council processes run side by side.
Write the concern in the Council's letter out in one sentence of your own. That is the sentence your response has to answer.
The three routes
Competence. If the concern is that your practice may not meet the standard for your scope, the Council can order a competence review under section 36 of the HPCA Act. Reviewers look at your clinical records, radiographs and treatment planning, can interview you and observe you at work, and report to the Council. The guide to what happens in a competence review covers the review and the competence programme that can follow it.
Health. If the concern is that a mental or physical condition may affect your ability to practise, the Council's health process applies. The Council can require an examination, accept voluntary undertakings and set conditions. The guide to the health process under the HPCA Act explains it.
Conduct. If the concern is about behaviour, the Council can appoint a Professional Conduct Committee under Part 4 of the Act. The Committee investigates, hears from you, and recommends an outcome to the Council or lays a charge before the Health Practitioners Disciplinary Tribunal. The guide to how a Professional Conduct Committee process runs sets out each stage.
What the Council measures you against
The Standards Framework for Oral Health Practitioners sets the ethical principles and professional standards every registered oral health practitioner must meet, and the Council's practice standards beneath it deal with matters that include informed consent, infection prevention and control, patient records and advertising. Competence is measured against the competencies for your scope of practice. The Code of Health and Disability Services Consumers' Rights applies alongside the Framework, including the right to the information needed for an informed choice. The Council reads an allegation against the standard it engages, so find that standard before you write.
The concerns a dental practitioner can face
- Consent and cost. Treatment started without the options, the risks or the cost being explained, an estimate that changed without a fresh discussion, or a patient who says they did not agree to what was done. The Council reads the treatment plan, the written estimate and the note of the conversation.
- Overtreatment. Treatment the recorded findings do not support, or a plan more extensive than the clinical need. The Council can ask an independent practitioner to review your examination findings, radiographs and diagnosis against the treatment you provided.
- Infection prevention and control. Sterilisation, cleaning, single-use items, waterlines and the logs that show the practice meets the Council's standard. This concern can arise from an audit or a colleague without any patient being harmed.
- Records. Notes that are missing, written late, copied from another visit, or that do not match the claim made to a funder or insurer. The guide to a clinical records concern covers how a reviewer or Committee reads them, and the guide to an honesty or probity concern explains why a claim for treatment not provided is treated as serious.
- Advertising. Claims about results, comparisons, testimonials, offers and titles that the Council's advertising standard and the law on fair trading do not permit.
- Boundaries and privacy. A boundary with a patient or a colleague, including dual relationships with a patient who is a friend, a relative or an employee, and a patient's information shared without a reason. The guides to a professional boundaries concern and to a confidentiality or privacy concern cover both.
What happens, step by step
- The letter arrives. The Council sends you the concern, the material and a date. Call your indemnity insurer that day and gather the notes, radiographs, photographs, treatment plans, estimates, invoices and correspondence.
- You respond in writing. Facts from the record with references, your clinical reasoning at the time, what fell short, what you have done since with evidence, and what you have understood, in the terms of the Standards Framework. The guide to how to write a response to a Council notification gives the structure.
- The Council decides the route. On your response, the records and any further enquiries, it decides whether to close the matter, write to you with advice, order a competence review, refer the matter to its health process or appoint a Professional Conduct Committee.
- The review or investigation runs. Reviewers report to the Council on competence. A Professional Conduct Committee gathers documents, can obtain an independent clinical opinion, can interview you and witnesses, and puts its concerns to you before it decides.
- You are heard before any order. Before the Council sets a programme, imposes conditions or makes an interim order, it tells you what it proposes and gives you the chance to respond.
- The outcome is recorded. The Council tells you its decision, what it has told your employer and what appears on the register. A charge laid by a Committee goes to the Tribunal.
Interim suspension and conditions
While a Professional Conduct Committee investigation is open, section 69 of the HPCA Act lets the Council suspend your practising certificate or place conditions on it if it is satisfied that is needed to protect the public. You are entitled to be heard first. A practitioner who has stopped the type of treatment the concern relates to, arranged for a named colleague to review treatment plans, and set that out in writing gives the Council a reason to prefer conditions to suspension. The guide to interim suspension and conditions on practice covers the risk test.
What you can do now
- Get advice the same day. Your indemnity insurer, the New Zealand Dental Association or your own professional association if you are a member, or a lawyer, before you put anything in writing to the Council or your employer.
- Secure the records as they stand. Notes, radiographs, photographs, treatment plans, estimates, consent forms, invoices, sterilisation logs and messages.
- Write against the record and the Framework. Facts with references, reasoning at the time, what fell short, what you have done since, what you have understood.
- Start remediation before you reply. A revised consent and estimate process, a records audit with results, peer review of treatment plans, and courses completed with dated certificates. Completed steps are evidence; intended steps are promises.
The outcomes
After a competence review the Council can find the standard is met, set a competence programme or place conditions on your practising certificate, such as peer review of treatment plans or practice under supervision. On the health route it can accept undertakings or set conditions. A Professional Conduct Committee can recommend no further action, counselling, a competence review or conditions, or lay a charge before the Tribunal. The Tribunal can cancel or suspend registration (suspension for up to three years), impose conditions, censure, fine and award costs. The guide to a Health Practitioners Disciplinary Tribunal hearing describes what it weighs.
Where remediation fits
The part of a Council matter you control is what you have done since the concern was raised. Courses completed before your response goes, with dated certificates attached, are evidence that you have engaged with the Standards Framework. Ethics for Dentists and Professionalism for Dentists are written against the Dental Council's Standards Framework, so a certificate from either answers a concern framed in the Council's terms. Dealing with a Complaint or Investigation covers how to engage with the process, and Insight for Fitness to Practise covers how to show the Council you understand what went wrong and why.
Each course is NZ$200, takes 2 CPD hours, is self-paced with immediate access, and ends with a dated certificate issued by Healthcare Ethics Courses that you can submit to the Council or put in your remediation plan. The remediation courses for dentists facing a Dental Council investigation are listed on one page, and the Council and Board investigation process explained shows where each course sits. The guide to showing insight and building a remediation plan explains how to present the certificates with the rest of your evidence, and the guide to what happens after a notification to any Council or Board gives the whole HPCA Act process.
Sources and further reading
- Dental Council: the Standards Framework for Oral Health Practitioners, the practice standards, the scopes of practice, and the Council's pages on concerns, competence and health.
- Health Practitioners Competence Assurance Act 2003: sections 34, 36, 45 and 69 and Part 4 on Professional Conduct Committees and the Tribunal.
- Health Practitioners Disciplinary Tribunal: published decisions involving oral health practitioners, with the penalties imposed and the weight given to insight and remediation.
- Health and Disability Commissioner: the Code of Rights and how a complaint about dental treatment is assessed and reaches the Council.
Frequently asked questions
A patient says I did not tell them the cost. Is that a Dental Council matter?
It can be. Under the Code of Health and Disability Services Consumers' Rights a patient is entitled to the information a reasonable patient would expect before agreeing to treatment, and the Dental Council's standards treat the options, the risks and the cost as part of informed consent. The Council will read your treatment plan, the written estimate and the note of the discussion. If those records show what was explained and agreed, they are the centre of your response.
What does the Dental Council look at in an overtreatment concern?
It looks at whether the treatment was clinically indicated on the evidence you recorded at the time: the examination, the radiographs, the diagnosis, the options offered including no treatment, and the reason for the option chosen. It can ask an independent practitioner to review the records. Your response needs to show your reasoning from the record, not from memory, and what you have changed in how you plan and record treatment since.
Can the Dental Council act on an infection prevention and control concern without a patient complaint?
Yes. A concern can come from a colleague, an employer, an auditor or another agency, and the Council can act on it whether or not a patient has been harmed, because the question is risk to the public now. Expect to be asked for your sterilisation and cleaning logs, your procedures and evidence of how the practice meets the Council's standard. If something has fallen short, show what you have changed and how it is checked.
Does this guide apply to dental hygienists, dental therapists and dental technicians?
Yes. The Dental Council regulates dentists and dental specialists, dental hygienists, dental therapists, oral health therapists, orthodontic auxiliaries, clinical dental technicians and dental technicians under the HPCA Act, and the same three routes apply to each: competence, health and conduct. The Standards Framework applies to every oral health practitioner, with the competencies for your own scope of practice. Name your scope in your response and write against the competencies for it.
Who should I contact first after a Dental Council letter?
Your indemnity insurer, the day the letter arrives, and the New Zealand Dental Association if you are a member; hygienists, therapists and technicians can contact their own professional association. Either can tell you whether a lawyer should be instructed. Do this before you write anything to the Council or your employer. Where the concern alleges dishonesty, billing for treatment not provided, or conduct that could reach a Professional Conduct Committee, ask about a lawyer in the first call.