Earlier updates on COVID-19

 21 May 2020: Dental Council update


Treatment for patients who turned 18 years old during lock down

We have received a number of queries from oral health and dental therapists about whether they can treat patients who turned 18 during the COVID-19 lockdown and whose treatment was delayed as a result of restrictions on dental practice during this time. 

We understand the GDB has been extended by the Ministry of Health for these patients. However, if you are an oral health or dental therapist, and treating patients over the age of 18 is outside your scope of practice, then you cannot treat these patients.

This means only dental therapists registered in the Adult Care in Dental Therapy Scope of Practice and oral health therapists who do not have the exclusion – Restorative treatment on patients 18 years and older – on their scope of practice, can provide restorative treatment to patients over the age of 18.

If restorative treatment has been delayed for patients during the COVID 19 lockdown who have since turned 18, then treatment must be provided by a practitioner whose scope of practice allows them to treat adult patients.

Allied health reporting

The Ministry of Health is requesting data from practitioners who provided emergency or urgent dental treatment during the lockdown. We will be in touch with practitioners in due course to collect the information the Ministry needs.

Ministry of Health consultation on core performance standards for responsible authorities

The Dental Council is one of 16 responsible authorities under the Health Practitioners Competence Assurance Act 2003 (the Act).

The Ministry of Health is currently seeking feedback on draft Terms of Reference and core standards for performance reviews of responsible authorities. (See the Ministry of Health website for more information about responsible authorities.)

When the Act was amended in 2019, one of the amendments introduced regular, independent performance reviews for responsible authorities (refer s 122A of the Act) including the Dental Council. This is in line with international trends in health occupational regulation, which include a strengthening of consumer protection, standardisation of legislation and institutional design, and improving the overall performance of regulators.

This consultation document outlines the rationale for performance reviews, issues to be addressed, and key points regarding development of the reviews.

The Ministry proposes (general) terms of reference and performance standards for the reviews and has invited feedback from our stakeholders on those proposals.

Submitting feedback

Please note this is not a Dental Council consultation process and feedback should be provided directly to the Ministry as follows:

The deadline for submissions to the Ministry is 26 June 2020.

Certifying role for registered dentists proposed under 111 contact code

The Commerce Commission is seeking feedback on their draft 111 contact code.

Under the code home phone customers on new technology who consider themselves as being at a greater risk of needing to call 111, may qualify for extra support at no cost.

The code proposes that certain professions and community leaders, including dentists, are deemed ‘person of standing’ and can certify applications from home phone customers to their providers for extra support.

The code also requires telecommunications providers regularly remind their customers that new technologies will not work in a power cut, how to protect themselves and what further support is available.

This short overview  of the proposed code also suggests ways consumers can protect themselves.

Feedback on the 111 Contact Code is due by 5pm, Wednesday 17 July 2020 and can be provided either by completing the online survey or by making a submission.

 

Andrew Gray & Marie Warner

Chair & Chief Executive

 

 14 May 2020: COVID-19 update: Gowns at alert level 2 and price setting


Level 2 guidelines – gowns clarification

We have received several queries about the requirements in the alert level 2 guidelines for outer protective clothing, such as gowns.

Long sleeved gowns are mandatory only under the alert level 2 guidelines when performing aerosol generating procedures for high risk patients (confirmed or suspected COVID-19).

When treating low risk patients (non COVID-19 positive or suspected patients) the normal infection prevention and control (IPC) practice standard PPE rules apply, regardless of whether aerosol is being generated or not.  

The IPC practice standard requirement for outer protective clothing is:

Wear outer protective clothing (for example, gowns, tunics) over your street clothing or uniform. Outer protective clothing is to be made from material that does not permit blood or other potentially infectious materials to reach clothes or skin underneath.

To meet this requirement practitioners typically wear:

  • First layer - street clothes or uniform.
  • Second layer - either a gown, or a tunic, or scrubs as the outer protective clothing. This provides additional protection to prevent contaminants from reaching the skin and is usually short sleeved to allow for appropriate hand hygiene up to the elbow. 

The outer protective clothing does not need to be impervious but should be water resistant at minimum.

The requirements for changing outer protective clothing, specified in the IPC practice standard are:

  • Change outer protective clothing - as soon as possible when visibly soiled or wet, when exposed to contaminated aerosols for prolonged periods of time, and at least daily.
  • Remove outer protective clothing before leaving the treatment area for - a break involving eating and/or drinking, a toilet break, and before leaving the practice premises.

In the event that a practitioner chooses to wear a long sleeved gown or arm sleeves (personal preference), then the long sleeved gown/arm sleeves must be changed at least between patients. This is because, unlike the situation when a short-sleeved gown is worn, the forearm cannot be ‘cleaned’ between patients.

Practitioners have also asked whether a plastic apron is appropriate outer protective clothing.  A plastic apron does not provide the same coverage as a gown or tunic. Specifically, the shoulders, upper arm and back will not be covered – and the neck area may gape dependent on the practitioner’s positioning during the procedure. For this reason, a plastic apron as the only outer protective clothing is not considered appropriate. You might want to consider wearing a plastic apron as an additional layer of outer protective clothing over your gown/tunic when cleaning or decontaminating instruments, or during procedures generating a lot of splatter. 

Price setting

Increased costs due to COVID-19 requirements

Precautions and protocols required to practise safely during the COVID-19 pandemic have added to the cost of providing dental services. Many practices are facing increased cost and lower revenue due to PPE costs, hygiene requirements and limits on patient numbers and proximity.

In the last weeks we have received inquiries about dentists charging their patients up to $110 to cover PPE or toilet cleaning required to meet alert level 4 and 3 guidelines.

This situation raises the question of how practitioners can increase their pricing so that is consistent with their legal and professional obligations. 

Consumer protection – Price Watch

Since the first cases of COVID-19 appeared in New Zealand, there have been reports of inflated prices for some essential or high-demand goods such as hand sanitiser and face masks. 

In response to these reports, the Government has set up Price Watch – a team within the Ministry of Business, Innovation and Employment that monitors and, if necessary, takes action against businesses involved in price gouging.  As part of this initiative, consumers are being actively encouraged to ask businesses questions about any price increases and to notify Price Watch of any suspected price gouging.

Price Watch has recently advised the Dental Council that it has received multiple reports relating to fees charged by oral health practitioners.  

Relevant considerations for practitioners

It is not illegal for businesses to increase their prices. Oral health practitioners, like any other business, are free to set their own prices.

However, engaging in misleading or deceptive conduct or making false representations is not legally permitted. If a practitioner tells a patient the reason for a price increase, then that reason must be genuine.  If the reason is misleading or not genuine, then the practitioner risks breaching the law. 

Some ethical and professional obligations are also relevant to price setting.  The Standards Framework for Oral Health Practitioners requires practitioners to:

  • Put patients’ interests first, including by putting the interests of patients ahead of personal, financial, or other gain. 
  • Maintain public trust and confidence, including by:
    • acting with honesty and integrity at all times with patients and the public
    • ensuring their professional and personal conduct justifies trust in them and the profession.

These principles and standards mean that oral health practitioners must always be clear and transparent with patients about their pricing and only give honest and genuine reasons for price increases.  If a practitioner fails to do so, they risk breaking the law and breaching their professional obligations.

Patients should be fully informed, not only on treatment options but for all possible costs. To reduce the likelihood of patients making complaints, practitioners should proactively advise patients of price increases (for example, by advising patients of an applicable price increase at the beginning of an appointment rather than at the end). 

Andrew Gray & Marie Warner

Chair & Chief Executive 

 11 May 2020: Alert level 2 guidelines issued


The joint Ministry of Health and Dental Council guidelines for oral health services at COVID-19 Alert Level 2 have now been approved and are available on our website.

Thank you to the associations and education providers who provided feedback to the draft guidelines that helped shape the final version. Copies of the feedback received and the Council’s responses are also available on our website.

Andrew Gray & Marie Warner

Chair & Chief Executive 

 11 May 2020: Progress update on alert level 2 guidelines


The government will make an announcement later today about when and if we will move to alert level 2.

We finalised the draft alert level 2 guidelines last week after considering the feedback received from associations and making some changes to address that feedback. Our report back to the associations on their feedback is being prepared and will be published on our website.

The updated guidelines are now with the Ministry of Health and infectious disease specialists for their review andsign off.

We are working to support you to plan your return to practice under alert level 2 as early as possible. We will immediately email the final alert level 2 guidelines to all practitioners and publish them on our website as soon as practically possible.

Andrew Gray & Marie Warner

Chair & Chief Executive  

 7 May 2020: Update on resuscitation training requirements and responses during COVID-19, and ACC claim code


Resuscitation training requirements

The Medical emergencies practice standard requires practitioners to complete resuscitation training every two years.

The Council's recent decision to waive recertification programme requirements for 12 months does not change this fundamental requirement.

We understand that many practitioners count resuscitation training as part of their CPD hours. Council wants to make it clear that although the recertification requirements have changed, the requirement for resuscitation training every two years has not.

Retaining resuscitation competence through regular training is important because this clinical skill is not used frequently by many practitioners, and is vital if and when required.  

The Council acknowledges that many resuscitation training courses have been deferred during the COVID-19 pandemic response. If your resuscitation training certificate expires, Council will allow a grace period but expects that you will complete your resuscitation training as soon as a suitable course becomes available.

In the meantime, we recommend you revisit your most recent training material to refresh your memory on the various protocols and algorithms. However, please ensure you complete the practical refresher training as soon as possible.

When you apply for your next annual practising certificate online, you can respond to the resuscitation training question in one of the following ways:

  • confirm that you have a valid resuscitation training certificate, or
  • have enrolled in an upcoming course, or
  • indicate that you have not yet been able to enrol in a course due to unavailability following the COVID-19 pandemic but will do so as soon as a suitable course becomes available.

Please note also that other training or refresher courses required by various practice standards have similarly not been waived. Examples of these include:

  • training to administer sedation or monitor sedated patients
  • infection prevention and control refresher training when required (can be done in-house), and re-familiarising yourself with the ‘practice specific IPC procedures’ of the practice in which you work, at least annually
  • review of medical emergency procedures at least six monthly with role play or ‘staging’ of a medical emergency in the review, to give staff members the opportunity to practise their respective roles.

Resuscitation during the COVID-19 pandemic

We have also received some queries about additional precautions or changes in protocols when performing resuscitation during the COVID-19 pandemic.

The Australian and New Zealand Committee on Resuscitation statement (3 April 2020) on resuscitation during the COVID-19 pandemic states: 

ANZCOR recognises that this a difficult time for the community and health care providers.

The underlying principles for CPR remain the same.

Any Attempt at Resuscitation is Better than No Attempt.

What has changed with this COVID-19 pandemic is the risk to rescuers.    

Healthcare workers should be provided with appropriate PPE to perform their roles.

Many sudden cardiac arrests occur in the presence of family members, and many will be unrelated to COVID-19.

For lay rescuers who are unable or unwilling to do rescue breathing, compression only CPR is acceptable.

After any attempts at resuscitation, please adhere to current advice about hand washing, cleaning and decontamination. 

The New Zealand Resuscitation Council website has helpful resources for practitioners to determine changes to resuscitation that may be required, and how to best protect yourself if required to perform resuscitation, during the COVID-19 pandemic.

Examples of these resources:

The NZ Resuscitation Council is happy for practitioners to approach them with specific resuscitation questions at info@nzrc.org.nz

(published with permission from NZ Resuscitation Council)

ACC claim code: Dental Consultation by Telehealth for COVID-19

Yesterday we advised dentists of the new claim code that ACC approved for dental consultations by telehealth, which will allow dentists to claim $46.59 for telehealth consultations from the start of COVID-19 Alert Level 4 (25 March 2020) until notified by ACC.

There appears to be some uncertainty whether the new ACC dental consultation telehealth claim code applies to all telehealth consultations; it does not. The claim code is only for dental consultations by ACC registered providers who provide telehealth for ACC clients.

Any specific queries related to this claim code can be addressed to ACC.

COVID-19 Level 2 guidelines

We hope to share the final COVID-19 Level 2 guidelines with you soon.

Until then, stay safe!

 

Andrew Gray & Marie Warner

Chair & Chief Executive

 6 May 2020:ACC claim code: Dental Consultation by Telehealth for COVID-19


ACC has approved the following claim code: DET - Dental Consultation by Telehealth for COVID-19.

Dentists can now claim $46.59 for telehealth consultations from the start of COVID-19 Alert Level 4 (25 March 2020) until notified by ACC. Guidelines for using telehealth in dentistry during the COVID-19 alert level response is available on the Council website.

Under Alert Level 3 dentists continue to serve their communities by providing urgent or emergency care when treatment cannot be deferred.

Marie Warner

Chief Executive

 5 May 2020: COVID-19, recertification, engagement update


The government’s call to unite against COVID-19 has presented us all with new challenges over the last six weeks. We have each made massive changes in our home, work, and social lives.

Thank you for the numerous messages of support we have received over the weekend for the work we are doing to support the government’s call. Understandably, many practitioners are expressing their frustration and concerns to us about the ongoing restrictions on their practice during this time.

New Zealand remains in alert level 3 and together with all oral health practitioners, we look forward to the PM’s briefing on Thursday 7 May and Cabinet’s decision to be announced on 11 May 2020 about the next move.

Alert level 2 guidelines

As advised, associations and educational institutions were invited to provide feedback on the draft level 2 guidelines last week. Their responses have now been received, and once collated and reviewed, and any resulting changes made, we will submit the finalised guidelines to the Ministry of Health for approval.

As indicated previously, our aim is to issue the guidelines to practitioners as soon as Ministry decisions on delivery of health services at alert level 2 are finalised.

Recertification requirements waived for 12 months due to COVID-19

In our 27 March update, we advised that the Council has suspended the current recertification programmes for the time being.

At its meeting yesterday (4 May 2020), the Council decided to waive recertification requirements for 12 months.

What this means for practitioners

  • This means that all practitioners will have until 31 December 2021 to meet CPD hours and peer contact requirements notified on 28 August 2019.
  • Practitioners will need to submit a self-declaration of their CPD activities and peer contacts after 31 December 2021.
  • The start of the new recertification programme programme has also been deferred by 12 months, so will start from:
    • 1 October 2021 for dentists and dental specialists
    • 1 April 2022 for all other oral health practitioners.

Why has Council made these decisions about recertification?

Practitioners are currently and will likely continue to face severe impacts on their businesses, livelihoods, and personal wellbeing due to the COVID-19 response.

Recertification programmes are one of the key tools that the Council has for ensuring ongoing competence. The Council needs to balance the current situation with our statutory duty to protect public health and safety, by ensuring practitioners are competent to practise.

We encourage all practitioners to complete any professional development that is possible to keep your professional knowledge and skills up to date while the recertification programme requirements are waived.

We are pleased to note there has been a significant increase in the online CPD activities available. The Council would like to thank the professional associations, organisations and other providers who have made this possible.

Communications

The Council Chair and CE attended a ZOOM call with the NZDHA members last week to respond to queries about their return to work, the alert level guidelines, sourcing PPE and other concerns. Over 300 members came into the call. We would like to thank NZDHA for their support, engaging with us constructively and giving us the opportunity to take part in this collegial forum.

The Council continues to work closely with professional associations. Over the coming week we will meet with the executives of NZIDT, NZDHA, NZDOHTA, NZDA and Te Ao Mārama. Last week we met with the NZDA President and CEO and will meet with NZDA Branch Presidents tonight.

Our team is working remotely as it deals with the increased demands of the pandemic situation and are aware that we currently have an email backlog. We have contracted additional resources to assist with the COVID-19 response and endeavour to respond as quickly as possible to the significant volume of practitioner queries during this this uncertain time for many.

Please look after yourself

Being an oral health practitioner can be challenging and stressful at the best of times and even more so now, as we face the uncertainty of a global pandemic. This is a difficult time for everyone.

Once again, thank you for your contribution to supporting the national COVID-19 response. Please look after yourselves and your whānau in this difficult time.

Andrew Gray & Marie Warner
Chair & Chief Executive

 30 April 2020: Guidelines for COVID-19 alert level 2 - PROVISIONAL high-level principles


As you will be aware New Zealand is currently at alert level 3 lockdown with a review by Cabinet due on 11 May 2020.

Understandably, practitioners are seeking urgent information about the guidelines that will apply under alert level 2 as soon as possible.

At alert level 2 – Reduce, the disease is contained, but the risk of community transmission remains.

At this stage, the Ministry has indicated that “community health services will mainly operate as normal” under level 2 (refer to the Ministry website). Although the Ministry indicates that there will be further changes to New Zealanders’ access to health and disability services under level 2, specific details are not yet available.

Progress to date with alert level 2 guidelines

We have shared the alert level 2 draft guidelines with key associations and educational institutions for their feedback by Monday, 4th May 9am.

We are unable to consult with every practitioner in the time available so if you have any particular concerns with the principles outlined below, please raise these directly with your professional association for them to consider in the feedback they provide on the draft guidelines. 

IMPORTANT: Please keep in mind that the draft guidelines have not been finalised and may change. This includes the PPE and room requirements at level 2. A finalised Level 2 guidelines will require Ministry and Council approval.

Council has consulted the Ministry on these draft guidelines for oral health services under alert level 2. These draft guidelines contain the following PROVISIONAL high-level principles:

  • At alert level 2 routine care can be provided for patients who are not confirmed or suspected to have COVID-19.
  • When delivering care to patients who are not confirmed or suspected to have COVID-19, normal PPE and room requirements, same as before COVID-19, apply as described in the Council‘s Infection Prevention and Control practice standard.
  • The PPE and room requirements that apply for confirmed or suspected COVID-19 patients are similar to those outlined in the guidelines for alert level 3.
  • Stronger staff and patient management provisions will be required under alert level 2. Some of these include:
    • If you or your team member is unwell, stay at home.
    • Ongoing screening of patient health when making appointments to appropriately treat COVID-19 suspected or positive patients in the correct environments
    • Scheduling and managing patients to limit the time they will spend in a common area and unnecessary contact with others - particularly vulnerable groups such as patients over 70 years of age and those considered high risk for severe COVID-19 infection because of a pre-existing health condition.
    • When performing aerosol generating procedures for all patients:
      • Use measures aimed at reducing the extent and contamination of aerosol and splatter wherever possible. For example, high volume evacuation systems, use of rubber dam, and pre-procedural mouth rinses.
      • If the room has a door, close it.
    • Record contact information for everyone entering your practice for easy contact tracing, if required.

Process for finalising guidelines

After feedback has been received from the associations and educational institutions:

  • Council will consider consultation feedback received and revise the draft guidelines, and seek Ministry approval of these as interim guidelines.
  • The interim guidelines will then be published on our website for all practitioners to access.
  • Once the Ministry has finalised its parameters for health services under level 2, any refinements can be made and the guidelines submitted for final sign-off; and the final guidelines published once approved by Council and the Ministry.

Understandably, the multiple processes take time, and final approval after the Cabinet’s decision on alert level 2 can take a few days. We aim to share the final guidelines with you as soon as practically possible. 

We are working to support you all in planning for a return to practice. In the interim, it is hoped that the preliminary information shared with you will signal what the practising environment for oral health services could look like under alert level 2, but please remember these decisions have not been finalised and the draft guidelines are still subject to change.

Look after yourself

We are aware that many practitioners are currently facing severe impacts on your businesses, livelihoods and personal wellbeing. We encourage you to seek help and support from those close to you, your own doctor, and other organisations able to assist.

Andrew Gray & Marie Warner

Chair & Chief Executive 

28 April 2020: Update on COVID-19 pandemic response


The Council fully understands the hardship and anxiety many oral health practitioners have experienced as a result of necessary restrictions on your practice due to COVID-19.

A national emergency and response to a global pandemic creates extraordinary and challenging circumstances. In response to the COVID-19 crisis, the New Zealand government has put in place unprecedented public health and social measures that have significantly impacted on individuals, their health, and the economic future of our country. The Prime Minister has indicated a move slowly and cautiously to safely return New Zealanders to work.

We have now moved to alert level 3 and we know that practitioners are urgently seeking clarity about the extent of any restrictions and guidelines that will apply under alert levels 2 and 1 so you can plan for future care.

Many practitioners have questioned the Dental Council’s role and the actions of Council during the COVID-19 crisis. To assist and answer your questions, this update provides the following information:

  • the roles of key parties
  • what the Council has done so far
  • what the Council is doing now and will be doing next
  • how the Council has and will continue to involve professional associations
  • responses to some specific practitioner concerns.

The roles of key parties during the pandemic response

In a public health crisis, the government is responsible for putting in place public health and social measures to respond to the threat of community infection. Our government has developed an alert system setting out restrictions, including restrictions on the delivery of oral health services, that apply under each alert level.

The relevant government departments provide their sector with further detail about what can and cannot be done at each level. We have seen this with the Ministry of Health’s active role in determining ‘essential’ health services at level 4 and ‘safe’ health services at level 3.

The regulatory authorities, which includes the Dental Council, can then provide further, more tailored direction or guidance to their professions, as necessary.

During the COVID-19 response, the Council’s authority to regulate key aspects of professional practice continues to operate within the provisions of the Health Practitioners Competence Assurance Act (the Act). Our key responsibility is to protect the public by ensuring practitioners deliver safe oral health care within the COVID-19 restrictions that apply.

The role of individual health providers including employers, professional associations, educational institutions and, ultimately, individual oral health practitioners, is to operationalise the guidelines issued by the Ministry and the regulator, and support each other to institute practices that fall within this framework and suit their work environment based on their clinical judgement.

What the Council has done so far

To meet our key responsibility to ensure public safety, Council has taken a lead role liaising closely with the Ministry of Health (the Ministry) to prepare and provide guidance to ensure practitioners deliver safe oral health treatment to their patients. The guidelines we have developed to date have stood up well and have been recognised internationally.

Immediately after the government announced alert levels and initial measures, the Council reached out to key associations and we were able to issue early communications to practitioners with the support of these groups. Professional associations including NZDA joined with the Council and the Ministry in issuing a joint statement on 23 March 2020 requiring all non-essential and elective dental services to be suspended.

The guidelines for the move to level 4 were developed under extreme time pressure that limited the opportunity to seek wider feedback. We worked directly with the Ministry and our professional advisors to issue these guidelines within 20 minutes of level 4 coming into effect.

For the most recent alert level 3 guidelines the Council formed a clinical advisory group to provide advice and to develop draft guidelines for oral health practitioners during the COVID-19 response. These guidelines were developed based on the assumptions about the possible restrictions the Government and Ministry would put in place for alert level 3.

Professional associations and the two educational institutions were given an opportunity to provide feedback on the draft guidelines. Following feedback, the Council and Ministry finalised the guidelines prior to approval by the National Health Coordination Centre (NHCC) which includes infectious diseases specialists. This takes considerable time but once approved, the guidelines were issued to practitioners on the same day.

What the Council is doing now

We have begun developing the level 2 guidelines and will follow a similar process as we did for level 3. Our objective is to work as quickly as possible to complete drafting the guidelines, gather feedback, finalise and obtain sign off before issuing these to practitioners.

Last week, comparisons were made to Australia and some practitioners asked why the same level 2 treatment guidelines that have been announced there cannot apply in New Zealand also.

The primary reason we have not followed the Australian guidelines is that our two governments are making different decisions and we are required to follow the decisions of the New Zealand government for the New Zealand situation.

As you will be aware, the New Zealand government has decided we will be at alert level 3 for at least two weeks before it reviews the next steps on 11 May 2020. We are developing the guidelines for level 2 according to our government’s requirements for health service delivery at this level.

Working with professional associations

At all times, the Council aims to work positively and constructively in the best interests of not only the public but practitioners and sector groups as well. Our preference is always to work with associations and we fully support them in their role.

As a regulatory authority, the Dental Council’s role is quite different and distinct from the roles of associations who represent the interests of their members and take actions on their behalf.

We have proactively tried to engage with associations throughout the COVID-19 response and have sought their feedback and contribution wherever possible.

Although the constantly evolving and developing nature of the COVID-19 response has meant our usual wider consultation processes are not possible, the Council has invited key associations to communicate jointly and contribute to the process of developing guidelines.

We have continued to engage with key associations, gain input to guidelines and seek feedback within very short timeframes. This has been difficult and we have and will continue to endeavour to issue guidelines to you all as soon as possible in what is a complex New Zealand health system over this time.

The most significant government decision made during the COVID-19 response for dental services has been the requirement to suspend non-essential and elective dental treatment. Recognising the huge impact this decision would have on each oral health practitioner, the Council issued a joint statement with the Ministry and associations on 23 March 2020 to this effect.

Other practitioner concerns

PPE

We know that many practitioners have found it difficult to source PPE supplies and these concerns have been relayed to the Ministry through many channels. As we have previously noted, sourcing PPE is not the role of the regulator.

We encourage and support practitioners to continue working together within their personal and professional networks, with their associations, dental suppliers and local DHBs to source necessary PPE supplies.

Fees

Many comments have been made about annual practising certificate (APC) fees during this crisis. The Council does understand the financial strain many are under and has worked within its constraints to relieve such pressure where possible with the removal of late penalties for APC applications.

Some practitioners have asked for APC fees to be refunded or waived this year.

The Dental Council is a regulatory body and is in a different position to voluntary membership associations who do have the ability to waive membership fees which some have done. The Council does not receive “membership” fees. After consultation with practitioners and associations, annual fees payable are gazetted through a parliamentary process.

We understand that many practitioners are currently unable to work. But, holding a current APC is a legal requirement under the Health Practitioners Competence Assurance Act for all practitioners to practise, and we are unable to change this.

Communications

Understandably, practitioners have many concerns and questions during this difficult time.

The Council takes on board the criticism and dissatisfaction with communication from us over this crisis. The Council has had a significant increase in direct inquiries from practitioners and we are attempting to respond individually as quickly as possible. This is proving difficult due the sheer number of inquiries and the detailed and specific questions in each one.

We will aim to provide more frequent general updates to all practitioners on progress over this difficult time for you all.

Communications with associations from the guideline development process for the de-escalation to level 3 are also available on our website including feedback received and our replies which include Council’s consideration. We will also publish this information when guidelines are developed for levels 2 and 1.

Look after yourself

We are aware that many practitioners are currently facing severe impacts on your businesses, livelihoods and personal wellbeing. We encourage you to seek help and support from those close to you, your own doctor, and other organisations able to assist.

Thank you

To everyone who has supported the Ministry, the Council members and staff, as well as all those of you who have continued to make significant sacrifices and support the nation through this crisis, we would like to personally say thank you.

This is a difficult time for everyone as we each face personal challenges of our own. Throughout these challenges, we will continue to try to work with you all in a professional, constructive, timely way to achieve the government’s objectives and support the national COVID-19 response.

We will continue to provide advice and issue joint Ministry and Council guidelines with input from associations and key sector groups as quickly as we possibly can in these unprecedented times.

Andrew Gray & Marie Warner

Chair & Chief Executive

22 April 2020: Alert level 3 guidelines for oral health practitioners 


Thank you to the oral health team

The Dental Council would like to thank oral health practitioners for the essential services you are providing to help New Zealanders through the current COVID-19 pandemic. This is a difficult time for all during what are uncertain changing times. You have sacrificed a lot and are making a positive difference to the containment of COVID-19 in our country at a time where you yourselves face personal and financial pressures of your own. Every health professional is being asked to play an important front-line role to stop the spread of the virus while simultaneously continuing to provide essential health services to New Zealanders. Your efforts together with those of the nation are making a positive difference to the containment of COVID-19 in our country.

Move to Alert Level 3

The Prime Minister has  announced that New Zealand will move to COVID19 Alert Level 3 from 11.59pm on Monday 27 April. This will be reviewed following two weeks at Alert Level 3 to assess success of virus elimination.

The government has indicated that primary healthcare and services are “open” but restricted under Alert Level 3. For dental care to be provided safely, restrictions on providing urgent and emergency dental care only continue to apply.

Together with the oral health team at the Ministry and with input from providers across the sector* and associations, the Council has developed guidelines for oral health services at COVID-19 Alert Level 3 to allow you to continue to support your patients under the new Alert Level 3 restrictions.

Possible moves to Alert Level 2 and 1 in the future

The Council is similarly working on guidelines for when alert levels are possibly de-escalated further to levels 2 and 1.

The public health and social measures which apply at these levels have yet to be defined in detail by the government and we will release level 2 and 1 guidelines for you as soon as these details have been finalised by the Ministry of Health.

The Dental Council’s role

Over the last weeks, the COVID-19 response has been evolving and changing and will likely continue to do so. Gathering information and applying in the context of oral health care has been extremely challenging. We have been liaising closely with the Ministry of Health and other regulators, taking lessons learnt from international partners and consulting with providers and professional associations to help determine standards, guidance and the level of information we provide.

Specialised advice on the clinical aspects of COVID-19 and the impacts on delivering health services comes from the Ministry of Health, subject matter experts and other government authorities.

Our role is limited to providing guidance based on direction from government and other relevant higher authorities to ensure you provide care that is safe for your patients and for you during the pandemic response.

We understand the greatest challenge with providing care safely for many practitioners has been access to adequate supplies of PPE. This concern has been relayed to the relevant people in the Ministry and we are aware many DHBs have been working with private practices to make supplies available where possible. Further, we understand that PPE supply is now accessible through some sources, and we urge practitioners to continue to work together, and with your local DHB, dental suppliers and associations, to overcome ongoing issues.

Again, thank you

Being an oral health professional is challenging and stressful at the best of times, and even more so now as we face the uncertainty of a global pandemic. All New Zealanders can be proud of the way we have managed lockdown and cared for ourselves, families and each other.

We are aware that many practitioners are currently facing severe impacts on your businesses, livelihoods and personal wellbeing. We encourage you to seek help and support from those close to you, your own doctor, and other organisations able to assist.

From all of us at the Council, we thank you for the support many have provided and expressed over the last weeks. To all oral health providers, thank you for your continuing hard work, care and commitment to supporting New Zealanders and keeping us all safe.

Andrew Gray and Marie Warner

Chair and Chief Executive

21 April 2020: Update on Alert level 3 guidelines for oral health practitioners 


Update on COVID-19 Alert level 3 guidelines for oral health practitioners

Dear practitioners,

We know that the uncertainty around dental practice due to the ongoing COVID-19 restrictions is causing you much concern.

The Dental Council is working with the Ministry of Health to determine the dental services that can occur when we move into Alert level 3 at 11.59pm on Monday 27 April as announced by the Prime Minister yesterday.

Once the dental services that can occur under Alert level 3 are confirmed by the Ministry, the guidelines we have developed and shared with key associations will be finalised. We will advise practitioners as soon as possible of the outcome. 

The decision making process is complex in this dynamic and unprecedented environment. We are balancing the need to ensure the guidance we provide is accurate and aligned with the government’s intent, while we strive to provide you as much time and information as possible to allow you to prepare.

Thank you for your patience.

 17 April 2020: Telehealth guidelines in dentistry  


Guideline for using telehealth in dentistry during the COVID-19 alert level response

The Dental Council has developed a document to provide guidance to registered oral health practitioners when using telehealth during the period when the COVID-19 alert levels (1-4) apply.

We encourage practitioners who are triaging patients by phone or other digital means to decide whether they require urgent or emergency care, to familiarise themselves with the telehealth guidelines.

 16 April 2020: Update on guidelines


Update on guidelines for COVID-19 alert levels

Providing healthcare during a global pandemic is complex and challenging. The New Zealand government has introduced an alert level system to respond to the COVID-19 outbreak. For the past three weeks, extreme restrictions have been in place to stop the spread of COVID-19 including substantially reduced oral healthcare services.

Due to the high risk of transmitting COVID-19 during aerosol-generating procedures common in dental procedures, dental treatment has been limited to emergencies only with specific PPE requirements under alert level 4.

The restrictions on dental practices have been challenging for all our oral health practitioners. As well as concerns for the safety and ongoing oral health of their patients, practitioners are dealing with personal safety concerns and the potential impacts on them as business owners, employers or employees.

We recognise that the prospect of moving to a new alert level is creating more uncertainty and practitioners are seeking further guidance as early as possible. We are receiving an increasing number of inquiries from practitioners about providing dental treatment in alert levels 3, 2, and 1.

The Council has formed a Clinical Advisory Group including a range of practitioners from district health boards, private general practice, dental specialist practice and oral health community services. This group is developing guidelines for oral health care treatment under each alert level based on the same template and risk assessment used in the joint MOH/Council guidelines for alert level 4.

We will seek feedback from key professional associations before finalising the guidelines for each alert level. However, we will be unable to finalise and issue these guidelines until the government decides which alert level will apply next and clarifies how (and which) businesses can operate as the country de-escalates levels. We are working to publish the guidelines as close as possible to the relevant government announcements.

As soon as guidelines for each level have been finalised and approved by the Ministry of Health, we will advise practitioners and make them available on our website.

Stay well.

 2 April 2020: New rules for electronic prescriptions to support virtual care in the community during COVID-19


The Ministry of Health have introduced the following new rules to make it easier for you to provide electronic prescriptions to support virtual care.

This is especially important during this Covid-19 epidemic when exchanging paper prescriptions between prescriber, patient and pharmacy is burdensome, challenging and unsafe.

Some of the rules apply to systems that are integrated to the New Zealand Electronic Prescription Service (NZePS). Others are temporary and will expire when the Covid-19 alert levels are lowered.

 27 March 2020: COVID-19, APC fees, recertification etc


Every health professional is being asked to play an important front-line role to contain the spread of the COVID-19 virus and provide essential health services. We know this is a stressful time for all our oral health practitioners, especially as you are being asked to make unprecedented changes to the way you run your practice.

Over the last weeks, the COVID-19 response has been constantly evolving and changing. During this challenging time, we have been liaising with the Ministry of Health, professional associations and other regulators to provide practitioners with certainty and guidance wherever possible.

Gathering and understanding new information has been challenging for us all as the COVID-19 situation is constantly developing and raising new issues to consider. We are working with our international partners and looking at what advice we can provide to all.

We are working differently

We are all adjusting the way we work and live in this unfamiliar situation. Being at COVID-19 Alert level 4 is a new experience for everyone. As a Council we understand this is not a time where business operates as usual.

Dental practices should now be operating in a very different way. This means you should not be providing any non-essential and elective dental treatment. However, practitioners should still provide care to their patients by providing a telephone contact service and triaging patient needs. Practitioners will only need to open their practice when required to provide emergency treatment or urgent care. This service could be done locally or regionally amongst practices or services.

Our Secretariat team is now working remotely from their homes. Please be patient if you experience delays to our usual services during this time - we are doing our very best to support you.

We will be updating our information and responding to your queries as best we can. We also urge you to regularly review our website and also the government and Ministry of Health websites for the latest updates.

Guidelines for emergency dental treatment during COVID-19 alert Level 4

We are now at COVID-19 alert Level 4. The purpose of escalation to Level 4 is to stop the spread of the COVID-19 virus throughout New Zealand. Only businesses that provide essential services are permitted to remain open during this time.

The Ministry updated its list of essential services on 25 March to include emergency dental care. We have received clear advice from the Ministry of Health that dental treatment for urgent care or emergencies which cannot be deferred may continue to be provided during the Level 4 alert period, subject to availability of specified PPE and facilities.

The Ministry and Council issued joint guidelines on providing urgent and emergency care on 25 March 2020.

These guidelines have been updated and may be updated further in the coming weeks. The most recent version is on our website and is clearly dated 26 March 2020.You should access the guidelines by clicking the link in the Updates section located in the top right corner of our home page. This will provide you with the latest version.

Please access the guidelines from our website each time you need them from the Updates page to ensure you have the latest version.

Please access the guidelines from our website each time you need them from the Updates page to ensure you have the latest version.

Please note the key changes that have been made to the guidelines since they were issued on 25 March 2020:

  • Patients that have recovered from COVID-19 have been removed from the medium and high-risk groups.
  • Long sleeve gowns for low risk care is not necessary if not available. Long sleeve, impervious gowns are still required for medium and high-risk care.
  • The diagram on page 5 for medium risk care has been updated so the patient criteria match the management processes.

Can you help?

The Ministry of Health is looking for health professionals who are able and willing to work for a limited amount of time as part of the national strategic approach to managing COVID-19. If you think you may be able to help, you can register your interest with the Ministry of Health here

Annual practising certificates (APCs)

Many oral health practitioners are currently applying for APCs required to practise between 1 April 2020 and 31 March 2021.

Some practitioners have contacted us as they are unsure whether they should be renewing their APC at a time when their practice is closed.

Although times are uncertain, a current APC will still be a legal requirement to the profession in respect of which you are registered. If you are intending to provide oral health services, then you will need to hold a current APC.

We understand that deciding whether to renew your APC may be stressful for some practitioners at this time. Council will waive the additional processing/late fee which applies after 1 April 2020 if you decide to defer applying or completing your 2020/21 APC application immediately.

You should talk to your employer and refer to the COVID-19 website for information about support if you are experiencing financial difficulty at this time.

Recertification

Recognising that meeting CPD requirements over the next few months will be difficult for many practitioners, the Council has decided to suspend the current recertification programme that ends on 31 December 2020. This means practitioners are not required to complete CPD and contact peer activities for the time being.

Given the importance of maintaining your competence when normal business resumes, we encourage all practitioners to complete any professional development that is possible for you during this lock down period, such as online reading and learning, journals etc.

Working together

We all have a role to play and we are all in this together. Along with the rest of New Zealand, we are adjusting and learning as we do our best to meet the government's directions and work together to stop the spread of COVID-19. 

 26 March 2020: Information for all health workers


Ministry of Health - Information for all health workers

The Ministry of Health is moving to increase the capacity of the health workforce to deliver essential health services.

We are seeking expressions of interest from health and care professionals who are able and willing to work for a limited amount of time as part of the national strategic approach to managing COVID-19.

We have already been asking retired health professionals to express their interest in working within the health and disability system, and now we would also like to hear from current health workers who may be available as non-essential services are paused.

We are seeking people to work in both general and clinically specialised roles as we scale up the health and care workforce. People will be matched to roles based on their competencies, and appropriate training and oversight will be provided (where required) to ensure safe practice.

The Ministry of Health has put in place a system to nationally coordinate the matching of supply and demand. This means understanding who is available to work, and matching them to roles that need to be filled in the sector. Some of these will be contact roles, while others will be supporting services such as Healthline and contact tracing, which can be done remotely.

The Ministry of Health is partnering with Accent Health to manage this process on our behalf. For health workers, they will be collecting information about their availability, coordinating re-registration with the relevant regulatory board or council where required, and then supporting the process to get into employment quickly.

Employers will be able to log their workforce requests, and then people will be matched to positions. We are aware that demand may exceed supply, and we are developing a prioritisation process to manage this. This will be communicated once finalised.

If you are a health or care worker who is able to assist with the COVID-19 response please register your interest here https://tinyurl.com/covid19nz.

If you are an employer, further information will be available in the next 24 hours on how to log requests.

 25 March 2020: MOH and Dental Council joint guidance


Ministry of Health and Dental Council joint guidance for urgent and emergency oral health treatment: COVID-19 update

New Zealand will move to COVID-19 Alert Level 4 at 23:59 on Wednesday 25 March 2020.

This will place extreme restrictions on all our lives to stop COVID-19 spreading through our communities. Oral health will be significantly affected with a substantial reduction in the delivery of oral health care to New Zealanders during this time.

The Dental Council and the Ministry of Health have worked hard with Ministry experts to provide clear direction to oral health practitioners on treatment that can be provided to your patients. We have prepared Guidelines for Oral Health Services at Alert Level 4 that outline how you can provide urgent and emergency care safely for you, your staff and your patients.

While we are in COVID-19 Alert Level 4, providing urgent and emergency oral health treatment to New Zealanders is an essential service and a priority for the Minister and the government. COVID-19 is the biggest crisis we have faced as a nation, and a crisis we must all work through responsibly together for the good of all New Zealanders.

 23 March 2020: Ministry of Health, Dental Council and Professional Associations' joint statement: COVID-19 update


As you will be aware the Prime Minister has announced New Zealand is now at Level 3 for COVID-19 alert, Restrict - Heightened risk that disease is not contained. This includes probable community transmission occurring and possible multiple clusters break out. Measures needed locally and nationally include:

  • Alternative ways of working required
  • Some non-essential businesses closures
  • Non face-to-face primary care consultations, and
  • Non acute (elective) services and procedures in hospitals deferred and healthcare staff reprioritised.

The Prime Minister has also announced New Zealand's COVID-19 alert will increase to Level 4 by 1pm Wednesday 25 March, Eliminate - Likely that disease is not contained. Measures needed locally and nationally include:

  • People instructed to stay home
  • Educational facilities closed
  • Businesses closed except for essential services
  • Rationing of supplies and requisitioning of facilities
  • Travel severely limited
  • Major reprioritisation of healthcare services.

Therefore the Ministry of Health, Dental Council and the New Zealand Dental Association require all non-essential and elective dental services be suspended immediately to reduce community spread, including to yourself, your staff and your patients. All emergency treatment** and relief of pain which cannot be managed by medications, should continue with appropriate precautions taken.

The Ministry of Health, Dental Council and the New Zealand Dental Association will require all oral health practitioners to transition fully to all applicable Level 4 measures by 1pm Wednesday 25 March.

*This message is supported by:

  • New Zealand Dental Association
  • New Zealand Dental & Oral Health Therapists Association
  • New Zealand Dental Hygienist's Association
  • New Zealand Institute of Dental Technologists
  • New Zealand Association of Orthodontists

**Emergency treatment includes oral-facial trauma, significant infection, prolonged bleeding or pain which cannot be managed by medications.

 22 March 2020: MOH and Dental Council joint statement


Ministry of Health and Dental Council joint statement: COVID-19 update to oral health practitioners

New Zealand oral health practitioners,

As you will be aware the Prime Minister has announced New Zealand COVID-19 alert levels. These new alert levels specify the public health and social measures to be taken. Nationwide, New Zealand is currently at Level 2 - Reduce. This means disease is contained but the risk of community transmission is growing because we have more cases. Amongst the recommendations at Level 2 are:

  • New Zealanders over 70 and those with certain medical conditions told to stay at home as much as they can to reduce risk of contact with the virus, and
  • Workplaces to implement plans to reduce person-to-person contact, including work from home where possible.

At Level 3 we will see alternative ways of working required and some non-essential businesses closed.

We recognise this is a difficult time for all practitioners and at this time it remains the decision of individual practitioners, whilst abiding to mandatory practice standards, to decide what services they continue to provide within their respective scopes of practice.

However, in the national interest the Dental Council and the Ministry of Health together strongly recommend that all non-essential and elective dental services, particularly those generating aerosol, should be suspended immediately to reduce the risk of community spread, including to yourself, your staff and your patients. All emergency treatment* and relief of pain should continue with appropriate precautions taken.

Together as an oral health community we can all play our part, by working through these challenges and uniting against COVID-19.

*Emergency treatment includes oral-facial trauma, significant infection, prolonged bleeding or pain which cannot be managed by medications.

New Zealand Dental Association COVID-19 Response: Interim Advice for Oral Health Practitioners (20 March 2020)

 

 30 January 2020: Update on novel coronavirus


The Ministry of Health has announced that the novel coronavirus (2019-nCoV) is publicly notifiable from today (30 January 2020). Oral health practitioners are legally required under the Health Act 1956 to notify their local medical officer of health if they suspect or diagnose 2019-nCoV.

Practitioners should continue to check the Ministry website for information for the public, travellers and health professionals.  The situation continues to evolve, and the Ministry is actively reviewing its advice daily. Please ensure you check the Ministry’s website regularly for the most recent information.

As always, practitioners should ensure they meet the infection prevention and control (IPC) practice standard and in particular, the provisions relating to "Transmission-based precautions" that you will find on page 21 of the standard. We draw your attention also to our recent newsletter article about infection control.

Please direct any queries about 2019-nCoV to ncovresponse@health.govt.nz.

Marie Warner

Chief Executive