Shared Care in Dental Treatment

The Australian health system is renowned for its high standards and commitment to patient care. Central to this system is the Ahpra and the National Boards shared Code of Conduct, which provides a framework for the ethical and professional behaviour for dental professionals. Many dentists work alongside and share care of their patients with dental therapists, dental hygienists, and oral health therapists. Dentists also refer patients within a practice and externally to colleagues and specialists, for a multitude of reasons. This article discusses two important aspects of dental care mentioned in the Code of Conduct – scope
of practice and shared care.

Professional relationships and scope of practice

Previously, dental therapists, dental hygienists, and oral health therapists were required to practice in a structured professional relationship with a dentist. However, changes in July 2020 granted practitioners greater autonomy, no longer mandating a direct supervisory relationship but encouraging collaborative professional relationships for patient care.

Despite this autonomy, confusion still persists regarding the varying scopes of practice that exist within each division of practice, and this is an issue we regularly receive questions about from our members.  

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This is largely dictated by the individuals’/practitioners’ education, training and competence. The scope of practice guidelines mandate that practitioners only provide treatment within this framework and refer patients to more qualified practitioners when necessary¹. This ensures adherence to legal and ethical standards while acknowledging professional capabilities and limitations of the individual practitioner. When treatment requirements fall outside a practitioner's scope of practice,
it is crucial that referral to a more qualified dental practitioner/specialist is facilitated1. This ensures that patients receive the best possible care from those who are most capable of providing it.

Shared care

Fundamentally, comprehensive dental care requires an organised/planned approach to patient treatment and care. Dentists, therapists and hygienists are expected to collaborate with each other in the best interests of their patients and, if needed, other healthcare providers. Respecting each other's roles and expertise, under the premise that ‘teamwork or collaborative care’ enhances the quality of treatment, is crucial to providing the best care to the patient.

The concept of shared care is a pivotal consideration in comprehensive dental treatment involving multiple registered practitioners. The Code of Conduct outlines principles essential for effective shared care:

Communication:
Timely and accurate sharing of information.

Teamwork:
Collaboration across different dental specialties and healthcare fields.

Patient-Centred Care:
Involving patients in decision-making processes.

Continuity of Care:
Seamless transitions between different levels of care.

Professional Respect and Trust: Valuing contributions from all team members.

Documentation:
Comprehensive records to support continuity of care.

However, the code states that working collaboratively does not alter a practitioner’s personal accountability for their professional conduct and/or the care they provide². The Code states that a practitioner should:

Understand your role and the role of other team members and address the responsibilities associated with that role.

Advocate for a clear delineation of roles and responsibilities. There should be a recognised team leader or coordinator even though care within the team may be provided by different practitioners from different health professions within different models of care.

Communicate effectively with other team members or practitioners, including to support continuity of care.

Inform patients about the roles of team members or other practitioners and be clear who has ultimate responsibility for coordinating the patient’s care².

Similarly, it stipulates the importance of delegation, referral and handover, meaning that practitioners are expected to:

Take reasonable steps to ensure that any person to whom you delegate, refer or hand over to has the qualifications and/or experience and/or knowledge and/or skills to provide the care needed.

Understand that, although as delegating practitioner you will not be accountable for the decisions and actions of those to whom you delegate, you remain responsible for the overall management of the patient and for the decision to delegate, and

Always communicate sufficient, timely information about the patient and the treatment needed to enable the continuing safe care of the patient².

In summary, the Code of Conduct and the scope of practice guidelines set out clear expectations for all dental practitioners involved in the care of a patient. Providing comprehensive dental care in a shared model of care can be extremely rewarding. However, consideration must be given toward the issues that can arise if a clear/ concise coordinated plan is not established from the outset, along with appreciating the importance of timely and appropriate communication with the patient at all stages of the journey of their care.

In this year’s webinar edition of Sliding Doors, titled ‘Who is driving the bus?’ we discuss the challenges that can occur when failure to delineate clear roles and practitioner responsibilities occurs. We will review cases from the Dental Protection vault that beg the question – Who is driving this bus anyway: is it you, your colleague, or your patient? We hope you can join us on October 2.

Book now prism.medicalprotection.org/course/view.php?id=1641

¹Dental Board of Australia, July 2020, Scope of Practice Registration Standard.

²Ahpra & National Boards, June 2022,
Code of Conduct.

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