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Competence Review
 
The Dental Council is responsible under the Health Practitioners Competence Assurance (HPCA) Act 2003 for protecting the health and safety of the public by ensuring that oral health practitioners are competent and fit to practise.
 
The Dental Council is required to meet certain legal obligations under the Act, including overseeing a system to review the competence of oral health practitioners, and set in place educational programmes, if required, in a meaningful, fair and manageable way.
 
Under the HPCA Act oral health practitioners can have their competence reviewed at any time or in response to concerns about their practice. The Council has agreed that competency review procedures will only be instituted when public safety issues arise about a practitioner with identified or alleged competency deficiencies.
 
The Council considers that a competent practitioner is one who applies knowledge, skills, attitudes, communication and judgement to the delivery of appropriate oral health care in accordance with the scope of practice within which they are registered. Competency review assesses how well a practitioner is actually performing.
 

What does a competency review involve?

A competency review aims to ensure that the practitioner is practising at the required standard. Competency review is not a disciplinary process. It is designed to review and educate. Understandably a practitioner under review will still feel anxious about a competency review and the trained competency reviewers are aware of this and aim to be as supportive as possible.
 

Where do concerns about practitioners come from?

The Council may be notified of concerns about a practitioner's competence from any source including:
  • other health practitioners
  • the Health and Disability Commissioner (HDC)
  • employers
  • patients
  • a Professional Conduct Committee (PCC).

What happens when a concern is received?

The practitioner will be told about the concern and asked to comment. The matter will not be taken any further if the notification is considered to be frivolous or vexatious.
 
The Council considers the concern, the practitioner's comments and any other information it may have about the practitioner's performance against strict guidelines and decides whether a competence review is required.
 
The Council considers that the following factors increase the probability of underlying incompetence and are likely, in combination or on their own, to lead to a competence review:
  • A pattern of poor standards of care or competence - several instances, or one instance over a sustained period
     
  • The magnitude of the mistakes, including the size of the suspected deficit, and the possible degree of serious departure from normal safe and accepted standards of practice
     
  • The practitioner belongs to an 'at risk' group which includes practitioners working in a professionally isolated environment (eg working alone in private practice and/or not affiliated with any professional body) and those working at the outer boundaries of, or beyond, their scope of practise.
     

Who will review competence?

If the Council considers that a competence review is required it will appoint a Competence Review Committee (CRC) comprised of two (trained) peers and one (trained) lay person. The peers usually include a practitioner familiar with education, examinations or peer review and a true peer. In rare instances, a one-person review may take place. The reviewer in this instance will be a practitioner who practises in the same scope(s) of practice as the practitioner under review.
 
CRC members must sign a confidentiality agreement in which they undertake not to reveal or release any personal or health information obtained about the practitioner or his or her practice and patients except as legally required during the course of the review.
 
The practitioner being reviewed is informed of the names and qualifications of the CRC members. The practitioner may request a change if he or she perceives a conflict of interest or lack of expertise to review his or her specific practice.
 

Terms of reference for competence review

If a competence review is required the Council will develop terms of reference for the review, which provide a summary of why the competence review is being carried out, the scope of the review and the recommended assessment methods to be used. Most reviews will be focussed on particular areas of concern, but on occasions the terms of reference may be wider if there are indications of a more general competence problem.
 

Communicating with the Practitioner

If the Council decides a competence review is required it will advise the practitioner giving detail on:
  • The substance of the concerns, and the grounds on which the Council has decided to carry out a review
     
  • Information relevant to his/her competence that is in possession of the Council
     
  • The terms of reference and proposed committee membership for the competence review
     
The practitioner is given the opportunity to make written submissions and/or be heard on the nature of the planned review and the committee membership, either personally or through a representative. When a practitioner is heard personally he or she is entitled to have a support person present.
 
After considering any submissions by the practitioner and making any agreed changes to the format of the review or committee membership, the Council sends the CRC a copy of the terms of reference for the competency review so members can plan the review and tailor it accordingly.
 
The CRC chair will contact the practitioner concerned to fix a date for the review and to discuss how the review will be carried out.
 

The Competence Review Process

The CRC will visit the practitioner in his or her practice. The practitioner can expect the onsite part of the review to last one day and may have a support person present.
 
The review will be limited to particular areas of concern unless there are indicators of a general competence problem.
 
The competence review may review clinical management, practice systems, record keeping, prescribing, communication skills and may involve direct observation. Wherever possible the CRC will use carefully developed and standardised tools to assess performance.
 
Within one month of conducting the review, the CRC writes a report to the Council with a recommendation that the practitioner either does or does not meet the required standard of competence.
 
The Council sends the report to the practitioner for comment.
 
The Council then considers all the information before it and decides what, if anything, happens next.
 

Outcomes of competence review

If having considered all the information before it the Council considers that the practitioner's practice of the profession does not meet the required standard of competence it will require one or more of the following:
  • That the practitioner undertakes an educational programme
  • That one or more conditions be included on the practitioner's scope of practice
  • That the practitioner sits an examination or undergoes an assessment
  • That the practitioner is counselled or assisted by one or more nominated people
An educational programme may consist of one or more of the following:
  • A period of practical experience and/or training
  • The practitioner passing a further examination or assessment
  • Undertaking a course of instruction
  • The practitioner working under supervision
  • A review of the practitioner's clinical records
The Council will specify how soon the practitioner must comply with the requirements of an educational programme and will appoint educational and clinical supervisors if appropriate.
 
The aim of an educational programme is to produce the best possible outcome for the practitioner.
 

Confidentiality of information

The HPCA Act places important restrictions on the use of any information, statement or admission relating to a practitioner's conduct that is disclosed by that practitioner for the purpose of satisfying the requirements of any competence review or competence programme. In particular, no such information, statement or admission
  • may be used or disclosed for any purpose other than for that particular review or programme; or
  • is admissible against that practitioner, or any other person, in any proceedings in any court or before any person acting judicially.

Costs

The Council meets the costs of a competence review but the practitioner pays any educational programme costs.
 

Appeal Rights

The competence review process observes the statutory requirements of the HPCA Act and the principles of natural justice. The practitioner has the right of appeal when the Council imposes conditions on his or her scope of practice or suspends registration or the practising certificate.
 

Summary

Competence review is not a punitive or disciplinary process. Nor is it normally a re-examination of knowledge or skill. Rather it is an assessment of performance in actual practice.
 
Specific complaints are not investigated as part of the competence review process - although they may give an indication where the review should be focussed.
 
Competence review is an educative opportunity where the practitioner is assessed and where necessary assisted through a training programme to ensure they are practising to the required standard of competence.