RESPECT PUBLIC DENTISTRY SO EVERYONE CAN SMILE AN ISSUES PAPER ABOUT VICTORIA S PUBLIC DENTAL SECTOR

Transcription

1 RESPECT PUBLIC DENTISTRY SO EVERYONE CAN SMILE AN ISSUES PAPER ABOUT VICTORIA S PUBLIC DENTAL SECTOR

2 RESPECT PUBLIC DENTISTRY SO EVERYONE CAN SMILE AN ISSUES PAPER ABOUT VICTORIA S PUBLIC DENTAL SECTOR All Victorians deserve to smile. Good oral health is critical to avoiding pain, to employment and to social inclusion. This can only be achieved by the government ensuring adequate and predictable funding, and recognition for our highly trained and committed public dental practitioners. Public dentists salaries are on average 40% behind their interstate colleagues, and public dental specialists are also well behind. Unless urgent action is taken to address these issues, community health centres and public hospitals will struggle to deliver public dental care to our most vulnerable and marginalised Victorians (Figure 1). This Issues Paper was developed by the Australian Dental Association Victorian Branch, in partnership with Professionals Australia. It describes the Victorian public dental sector landscape, and the issues that the sector is facing. This work is the culmination of research, consultation, and a survey of public dentists, public dental specialists, and dental specialists in training (registrars), who are members of the Australian Dental Association Victorian Branch. PUBLIC DENTAL FUNDING UNCERTAIN AND INSUFFICIENT SERVICE PROVIDERS UNABLE TO PLAN IN ADVANCE UNSUSTAINABLE PUBLIC DENTAL SECTOR FIGURE 1 THE PROCESS OF DECAY IN VICTORIA S PUBLIC DENTAL SECTOR LACK OF COORDINATION ACROSS THE SECTOR, WAITING LISTS INCREASE, INEQUITABLE AND UNCERTAIN EMPLOYMENT CONDITIONS COST OF DELIVERING CARE INCREASES HIGH PROPORTION OF EMERGENCY TREATMENT, RATHER THAN PREVENTING DENTAL PROBLEMS. EMPLOYEES WORK IN A HIGH STRESS ENVIRONMENT LACK OF ACCESS TO TIMELY DENTAL CARE IMPACTS COMMUNITY ORAL HEALTH, AND RESULTS IN INCREASED HOSPITAL EMERGENCY DEPARTMENT PRESENTATIONS. EXPERIENCED PUBLIC DENTAL PRACTITIONERS LEAVE THE SECTOR 2 RESPECT PUBLIC DENTISTRY SO EVERYONE CAN SMILE

3 TABLE OF CONTENTS 1. OBJECTIVES OF THIS ISSUES PAPER 4 2. EXECUTIVE SUMMARY 4 3. LIST OF KEY RECOMMENDATIONS 5 4. INTRODUCTION EVERYONE DESERVES TO BE ABLE TO EAT, SPEAK AND SMILE WITHOUT PAIN OR EMBARRASSMENT 4.2 UNCERTAIN AND INSUFFICIENT PUBLIC DENTAL FUNDING IMPACTS OUR COMMUNITY, PUBLIC DENTAL AGENCIES, AND THEIR EMPLOYEES THE VICTORIAN PUBLIC DENTAL CARE LANDSCAPE HISTORY OF PUBLIC DENTAL FUNDING ARRANGEMENTS SEPARATE ENTITIES PROVIDE PUBLIC DENTAL SERVICES IN VICTORIA, WITH LITTLE CAPACITY FOR CENTRAL COORDINATION CURRENT PUBLIC DENTAL WORKFORCE DESCRIPTION 8 6. THE ISSUES INSUFFICIENT AND UNPREDICTABLE FUNDING INEQUITABLE ACCESS TO CARE, FUNDED BY AN ACTIVITY DRIVEN SYSTEM 6.3 INEQUITABLE EMPLOYMENT CONDITIONS FOR PUBLIC DENTISTS AND PUBLIC DENTAL SPECIALISTS (SPECIALISTS) WORKFORCE SUBSTITUTION REFERENCES 11 Publication Date: 27 June 2017, Australian Dental Association Victorian Branch & Professionals Australia, Version: 1.0 RESPECT PUBLIC DENTISTRY SO EVERYONE CAN SMILE 3

4 1 OBJECTIVES OF THIS ISSUES PAPER This issues paper seeks to explain the problems faced by Victoria s public dental system, and to describe a range of measures by which to address these at all levels of government, and in individual public dental agencies. 2 EXECUTIVE SUMMARY The call to action: we call on the Victorian and Federal Governments to ensure a strong and sustainable public dental sector, which can respond to the community s needs, through adequate and predictable funding. Everyone deserves to be able to eat, speak and socialise without pain or embarrassment 1. Good oral health is an essential component of good general health. Poor oral health can lead to pain, and inability to eat hard foods, embarrassment, missing school or work, missing the chance of employment, and can make other health problems, such as diabetes and heart disease worse 2. With the exception of dental care for some eligible children, dentistry sits outside of the Medicare system. In Victoria, public dental care is available to children, homeless people, asylum seekers, Aboriginal & Torres Strait Islanders, people with mental health conditions, and adults who hold concession cards. This constitutes around 41% of Victorians, or 2.5 million people 3. The funding for public dental care is unpredictable, insufficient, and lacks a long term coordinated strategy. The unpredictability of public dental funding significantly impacts on the ability of service providers to deliver timely care to those who need it. This results in long waiting times for dental care, and a focus on providing emergency restorative care, rather than prevention, and desired health outcomes. Consequently, the mental and physical health of patients on the waiting list can suffer 4. There are also significant implications for the public dental workforce. With 53 separate entities funded to provide public dental care in Victoria, a lack of an overarching workforce recruitment, retention, and development strategy is already having significant impacts. The ability to recruit and retain experienced clinicians and foster leadership is hampered by extremely low wages compared to other jurisdictions, with Victorian public sector dental practitioners earning up to 40% less than their colleagues interstate. There is also insufficient focus on supporting employee professional development and providing opportunities for professional progression. The public dental workforce is very committed to providing high quality dental care to their patients, but their ability to do so is challenged by a system that fosters a focus on repairing dental problems, rather than preventing them, and employment circumstances that encourage promising young health professionals to seek employment opportunities elsewhere. Governments needs to take urgent action to secure the future of Victoria s public dental system, through providing increased and predictable funding, shifting the system from a treatment to a prevention focus, providing equitable and timely access to care, and ensuring a strong and supported public dental workforce. In essence, we urge the government to respect public dentistry, so everyone can smile. 4 RESPECT PUBLIC DENTISTRY SO EVERYONE CAN SMILE

5 3 LIST OF KEY RECOMMENDATIONS 1. Provide sufficient and predictable funding to support Victoria s public dental sector. This is essential to support Victoria s most vulnerable and disadvantaged people, and to ensure that poor oral health does not create further disadvantage. 2. Create a funding, performance reporting, and reward system that focusses on patient needs, outcomes and prevention, not activity. The funding and performance measurement model needs to support equitable access to public dental care, and performance measures that focus on health outcomes. 3. Remunerate public dentists and public dental specialists to attract and retain the best and brightest. The salaries for these clinicians are up to 40% lower than their interstate colleagues. This is unsustainable, and must be addressed. 4. Provide a system for strategic and coordinated public dental workforce planning and management across all publicly funded agencies. This is essential to the sustainability of the sector. 5. All public dentists should be on the same pay scale, regardless of where they work. It is inequitable to provide higher salaries to people who work in some clinics, and lower salaries to others, even though they all provide similar care to the same population. 6. Fund dentists and dental specialists to participate in essential continuing professional development training activities. Victoria s public dental patients deserve the highest quality dental care, and the continuing enhancement of clinicians professional skills directly benefits patients. 7. To maintain a high standard of care, the important role of the dentist as the team leader must continue to be recognised. Appropriate methods for respecting, recognising and rewarding this role must be put in place, including performance measures that recognise the dentist s leadership responsibilities, and the complexity of the care provided to patients. 8. Review and update the public dentist and public dental specialist classification systems to better align with their modern roles and responsibilities. RESPECT PUBLIC DENTISTRY SO EVERYONE CAN SMILE 5

6 4 INTRODUCTION 4.1 EVERYONE DESERVES TO BE ABLE TO EAT, SPEAK AND SMILE WITHOUT PAIN OR EMBARRASSMENT Good oral health is an important component of good general health. It helps people to eat, speak and socialise without pain or embarrassment 1. Poor oral health can lead to pain, an inability to eat and speak, and missing school or work. It can impact the chance of getting a job. It can also impact on other serious medical conditions, for example, poor oral health can make diabetes or heart disease worse 2. Around 41% of Victorians are eligible for public dental care, but only one in four access treatment in the public sector over a two-year period 3. Some of these people are among the most vulnerable and disadvantaged in our community. They include young children, children in outof-home care, pregnant women, adults who hold concession cards, people with chronic and complex health conditions, people in nursing homes, Aboriginal and Torres Strait Islanders, and refugees and asylum seekers. People in lower socio-economic groups have a greater risk of poor oral health. In a recent report on the availability of public dental services in NSW, the CEO of the National Council of Social Service, Tracy Howe, said There are so many judgements made against people with bad teeth. It s like wearing a badge of poverty and that is a huge issue 5. This is as true in Victoria as in NSW, and many of these people have no alternative to public dental care, and we cannot afford to let them down. Unlike many medical services, basic dentistry sits outside the federally-funded public health system. Although some Medicare-funded basic dental care is available to eligible children, dental care for adults is not available free of charge through Medicare. This means that access to public dental care mostly relies on unpredictable funding in small amounts from the State and Federal Governments. This lack of coordination of public dental care, and the absence of a consistent longterm plan, significantly impact the ability of service providers to deliver timely care to those who need it. There are so many judgements made against people with bad teeth. It s like wearing a badge of poverty and that is a huge issue 5 In 2009, the National Health and Hospitals Reform Commission (NHHRC) said: We want to state loudly and clearly that it is inexcusable in a relatively wealthy country such as Australia that we do not ensure universal access to effective, basic dental health services. 6 The NHHRC proposed a national dental care scheme to improve equity of access to care. However, more than seven years later, Australians are still waiting for our governments to act on this recommendation. A long-term plan is therefore needed, which allows for forward planning of service delivery and infrastructure management, provided by a strong and supported public dental workforce. 4.2 UNCERTAIN AND INSUFFICIENT PUBLIC DENTAL FUNDING IMPACTS OUR COMMUNITY, PUBLIC DENTAL AGENCIES, AND THEIR EMPLOYEES Victoria s public dental system is under extreme strain. Chronic underfunding for service delivery and infrastructure, funding uncertainty, and a lack of investment in the dental workforce has resulted in a poorly coordinated and transient service model, with a high reliance on emergency dental care. This is unsustainable. Although the state-wide average waiting time for public general dental care is 16.5 months 7, there is great variation across Victoria, with some clinics reporting waiting times of almost 2.5 years 3. This is too long to wait for dental treatment. It means that dental problems, which if treated early, could have been prevented or needed only minimal intervention, become serious, causing pain and requiring emergency dental surgery or avoidable hospital admissions. There is also a personal cost to patients, whose oral health deteriorates while waiting to access dental care. This situation forces clinicians to focus on expensive emergency restorative care, which accounts for around 40% of the public dental care provided in Victoria 8. This limits the capacity of public agencies to provide the preventive care that the community needs in a timely manner. Instead of helping these clients to keep their teeth for life, public dentists are required to perform many more extractions, which is morale-sapping and contrary to their professional ethics. Dentists want to do the best for patients so they can keep their teeth for life. Switching to a prevention-focussed public dental system will require increased funding, forward planning, coordination, and engagement of the workforce. 6 RESPECT PUBLIC DENTISTRY SO EVERYONE CAN SMILE

7 5 THE VICTORIAN PUBLIC DENTAL CARE LANDSCAPE 5.1 HISTORY OF PUBLIC DENTAL FUNDING ARRANGEMENTS Both at a state and federal level, funding is attached to a limited number of performance indicators, which measure activity, rather than health outcomes. The current system for performance measurement therefore favours procedures, rather than prevention. This issue was recently highlighted in the Victorian Auditor General s Report on Access to Public Dental Services 3, and Dental Health Services Victoria is developing a new, outcomes-based method for measuring the performance of our public dental system. This is encouraging, and we urge the government to appropriately fund this process. Public dentists and public dental specialists have expressed support for a move towards a more prevention-focussed system, rather than one that mostly measures the number of procedures performed. However, to achieve this goal will require employers to first address systemic workforce issues. With some exceptions, dental care sits outside the Medicare system. Most public dental funding is provided by the State Government. This is supplemented by a limited amount of Commonwealth funding, and the amounts available have been unpredictable and time-limited. The most recent funding announcement from the Commonwealth Minister for Health provided more certainty in principle, however the Commonwealth funding amounts for public dental care will be significantly reduced. Another Commonwealth scheme, the Child Dental Benefits Schedule, provides for eligible children to access dental care from any provider. While the eligible Victorian population continues to climb, the level of public dental funding provided by the Victorian Government still lags behind, with around $ M p.a. of funding provided from , and $226.1 M committed for Given that around 41% of Victorians, or approximately 2.5 million people 9 are eligible for public dental care, the funding commitment equates to just $91 per person, which is manifestly inadequate to treat the advanced oral diseases that so many public dental patients suffer from. With the available funding, public dental services treated 351,756 people in Given current resources, it would take almost eight years to treat each eligible Victorian once. To simply account for inflation, and population increases, a funding increase of at least 3.4% would be needed each year. This level of funding would prevent waiting times for public dental care from further increasing. Funding additional increases will be needed to account for the reduced Federal public dental funding, address the need to offer care to more eligible people, to move from a treatment to a preventionfocussed service, and to remedy systemic workforce issues SEPARATE ENTITIES PROVIDE PUBLIC DENTAL SERVICES IN VICTORIA, WITH LITTLE CAPACITY FOR CENTRAL COORDINATION Public dental care in Victoria is delivered by Dental Health Services Victoria (DHSV), and 52 separate contracted health agencies, which operate under three distinct legal and governance arrangements 3 : DHSV and 30 of the agencies are public health services, under the Health Services Act 1988 (Vic) A further 21 agencies are independent companies limited by guarantee, and established under the Corporations Act 2001 (Cth) One is an incorporated association established under the Associations Incorporation Reform Act 2012 (Vic) There are 81 separate public dental clinic sites. There are also numerous outreach clinics, which provide care to people in remote locations, aged care facilities, and to those who need in-home care. With so many public dental agencies involved, central coordination and long-term strategic planning are essential to ensuring the best outcomes for the community. However, the uncertain funding environment has meant that the ability to do so is limited. There is also little coordination of the engagement and training of the public dental workforce, with employment conditions increasingly varying from one employer to the next, creating inequitable outcomes and dissatisfied employees. Employee relativities are much worse however between Victorian public dental services and interstate agencies. Further, because the wage rates in other states are significantly higher, there is now evidence that Victorian public dentists are moving interstate to take up better remunerated public-sector roles. It is expected this trend will only grow given the massive pay differentials. RESPECT PUBLIC DENTISTRY SO EVERYONE CAN SMILE 7

8 5.3 CURRENT PUBLIC DENTAL WORKFORCE DESCRIPTION Public dentists lead the dental team, and they are ultimately responsible for their patients well-being. They also perform the most complex dental surgery procedures, and the majority of emergency dental care dentists account for around 61% of the public dental workforce 3. The dental team also includes dental therapists, oral health therapists, dental hygienists, dental assistants, dental prosthetists, administrative staff, and managers, many of whom are also treated less favourably than their counterparts interstate. There is also a team of public dental specialists, who provide care to patients with very complex needs. Victorian public dentists are employed under at least eight different enterprise agreements, with some on separate individual contracts. Dental specialists and dental specialists in training are covered under a ninth agreement, and other types of dental practitioners are covered under still more agreements. The result is that public dental clinicians, even though they all provide care to the same population, experience different employment conditions depending on where they work. We have also received reports that some dentists, who work part time at two different clinics, receive different payment levels for similar work at each location. As is recognised with other health professions, such as nurses, this move to disparate conditions is likely to cause perverse behaviour that will ultimately weaken the overall system and quality of care^. What may appear to be a logical move for an individual community health centre, to reach a unique outcome for dentists at their workplace, will create a poor outcome for public dental services in the state, and limit the mobility of qualified and experienced public dental sector staff within the sector. Public dentists and public dental specialists are saying that, due to the lack of central control over employment conditions, recruitment and retention of experienced dentists is a problem, and this is worse in regional areas. The workforce is not being strategically planned or managed, resulting in an insecure and inconsistent employment environment, and impediments to the development of clinical leadership capacity. Further, because the wage rates in other states are significantly higher, there is now evidence that Victorian public dentists are moving interstate to take up better remunerated public-sector roles. It is expected this trend will only grow given the massive pay differentials. ^Note that nurses, who work in public hospitals or community health centres, remain employed under a single, State-wide enterprise agreement. 8 RESPECT PUBLIC DENTISTRY SO EVERYONE CAN SMILE

9 6 THE ISSUES 6.1 INSUFFICIENT AND UNPREDICTABLE FUNDING Public dental clinics need to create supportive environments that enable dental practitioners to provide effective dental care to their patients. The system has experienced successive years, where public funding levels and availability have been very uncertain. This uncertainty has caused an inability for public clinics to plan in advance. It also causes a lack of coordination, and there is little room for long-term public dental infrastructure or workforce planning. Public dental clinic employers are therefore reluctant to make any commitments to their dental employees on future salary increases or employment continuity, and longer-term efforts to improve the quality and efficiency of services are thwarted. Recommendation: 1. Provide sufficient and predictable funding to support Victoria s public dental sector. This is essential to support Victoria s most vulnerable and disadvantaged people, and to ensure that poor oral health does not create further disadvantage. 6.2 INEQUITABLE ACCESS TO CARE, FUNDED BY AN ACTIVITY DRIVEN SYSTEM Around 2.5 million Victorians are currently eligible for public dental care 3. The state-wide waiting time for public dental care is reported to be 16.5 months 7, however there is wide variation in the actual waiting time from one clinic to the next, with some people waiting for almost 2.5 years to access care 3. A previous study of people who spent an extended time on a public dental waiting list found that People who spend long periods of time on the waiting list can face deterioration in their general and social health 4 A lack of investment in oral health is a false economy. In addition to the significant personal cost, including pain and embarrassment due to unsightly and decayed teeth, there is a significant economic impact. This includes avoidable hospital admissions, more complex restorative care rather than prevention, impacts on broader health, and impacts on the ability to obtain work. People who access public dental care are among our most vulnerable and disadvantaged, and poor oral health creates further disadvantage. We urge the government to break this cycle by providing sufficient funding to allow timely and equitable access to dental care for all eligible Victorians. In addition, the current public dental care funding and performance measurement model focusses on activity, and therefore favours procedures over prevention. There are currently few performance measures that reflect patient outcomes, rather than patients treated. We understand that Dental Health Services Victoria (DHSV) is developing a plan to move away from the activity driven system, in favour of prevention and outcomes, and we urge extensive consultation with the affected workforce and consumers in the development of this plan. The government must also effectively fund and support this work. Recommendation: 2. Create a funding, performance reporting and reward system that focusses on patient needs, outcomes and prevention, not activity. The funding and performance measurement model needs to support equitable access to public dental care, and performance measures that focus on health outcomes. 6.3 INEQUITABLE EMPLOYMENT CONDITIONS FOR PUBLIC DENTISTS AND PUBLIC DENTAL SPECIALISTS (SPECIALISTS) Public dentists and specialists are essential to providing dental care to the most vulnerable people in our community. They choose to work with the most vulnerable Victorians, and they need to be respected and supported to do this critical work. The care provided extends far beyond simple procedures, such as cleaning teeth and the provision of fillings. Our public-sector dentists and specialists say that the professional roles and expectations they fulfil continue to grow. They are treating more asylum seekers, migrants, homeless people, people with substance addictions, mental health and chronic disease patients, dementia patients and mixes of all of these. They also need to work with interpreters and case workers. This requires dentists and specialists to have advanced knowledge across many clinical areas, experience in treating patients with behavioural problems, and a high-level of empathy. It requires both clinical excellence and broader leadership skills to effectively care for often highly complex patients. As professionals, they are motivated to provide this care in the most efficient way, so more Victorians can access quality care. Current measures of productivity, both of public dental clinics, and individual clinicians must recognise the complex environment in which they work. At present, productivity measures are unable to do this, and instead measure the numbers of patients treated, and procedures performed. As the leaders of their dental teams, dentists and specialists have responsibility for leading and mentoring junior staff, and hold ultimate responsibility for the welfare of the patients in their care. This requires clinicians with a broad range of skills and experience. Expectations are very high, and resources to support this are limited. RESPECT PUBLIC DENTISTRY SO EVERYONE CAN SMILE 9

10 This requires dentists and specialists to have advanced knowledge across many clinical areas, experience in treating patients with behavioural problems, and a high-level of empathy. It requires both clinical excellence and broader leadership skills to effectively care for often highly complex patients. Dentists and specialists must also undertake mandatory Continuing Professional Development (CPD) training, in which a minimum of 60 hours over 3 years through lectures, courses and reading, must be achieved. The public and employers expect dentists and specialists to keep acquiring new skills and knowledge to enhance their expertise, and to provide certification for each extension of scope. Most public dental employers also offer limited or no support for dentists to undertake this mandatory training: public dentists are only offered limited paid CPD leave, and they often need to pay registration fees to attend these programmes. It is important that vulnerable Victorians who are eligible for public dental care get first-class treatment. Dentists and specialists must therefore be supported by their employers to continue to maintain and further develop their clinical and professional expertise. Public dentists and specialists say that the challenges they face in the constrained funding environment can often lead to highlevels of stress and disillusionment. This is not being recognised by employers or the government. Therefore, to secure the sustainability of the public dental workforce, it will be essential to develop strong employee retention strategies. Clinicians have also expressed frustration about their interactions with non-clinical managers, who struggle to balance funding limitations with the needs of patients and employees in the clinic, and this impacts patients and staff. Victoria s public dental system has a good safety and quality record, but this may not be sustainable if the workforce is not nurtured and valued. Given the massive wage differentials with other states and the private sector, there will be growing problems in attracting and retaining a quality workforce. There are also concerns that moves by employers to create separate enterprise agreements for dentists depending on where they work is creating inequitable employment conditions, and restricting the mobility of the public dental workforce between clinics. This results in a fragmented and dissatisfied workforce. Recent graduate dentists say that they are looking to move interstate to obtain work at substantially higher salaries. Dentists in regional areas in Victoria are reporting that their clinics are having increasing difficulty recruiting and retaining dentists with three or more years experience. New graduates, once recruited, leave the sector after gaining sufficient experience to work elsewhere, and there are few incentives to encourage them to stay. Because Victorian public dentists with 2-3 years experience have the option of either moving to public sector employment in another state, where they will be paid around 40% more (Figure 2), or moving to the private sector, the ability to retain experienced clinicians and develop leaders is under threat. Given that dentistry is an essential service, the government must act as it has done with other professionals providing essential services, where there was clear evidence of significant pay differentials with other states. FIGURE 2: PUBLIC DENTISTS IN VICTORIA WITH THREE YEARS EXPERIENCE EARN LESS THAN NEW GRADUATES IN SOME OTHER STATES * ANNUAL BASE SALARY VIC $65,094 NSW $85,009 SA $101,745 QLD WA VIC $96,123 $99,845 $85,389 NSW SA QLD $110,877 $119,465 $106,614 WA $121,528 *Public dentists in VIC with three years experience earn less than new graduate public dentists in SA, QLD, and WA, and up to $36,139 p.a. less that colleagues in other states with a similar level of experience. 0 NEW GRADUATE 3 YEARS EXPERIENCE *This is an example. Actual salaries may vary according to individual circumstances. 10 RESPECT PUBLIC DENTISTRY SO EVERYONE CAN SMILE

11 Recommendations: 3. Remunerate public dentists and public dental specialists to attract and retain the best and brightest. The salaries for these clinicians are up to 40% lower than their interstate colleagues. This is unsustainable, and must be addressed. 4. Provide a system for strategic and coordinated public dental workforce planning and management. This is essential to the sustainability of the sector. 5. All public dentists should be on the same pay scale, regardless of where they work. It is inequitable to provide higher salaries to people who work in some clinics, and lower salaries to others, even though they all provide similar care to the same population. 6. Fund dentists and dental specialists to participate in essential continuing professional development training activities. Victoria s public dental patients deserve the highest quality dental care, and the continuing enhancement of clinicians professional skills directly benefits patients. Given that dentistry is an essential service, the government must act as it has done with other professionals providing essential services, where there was clear evidence of significant pay differentials to other states. 6.4 WORKFORCE SUBSTITUTION Public dental agencies will seek to use the lowest unit labour cost to deliver dental services. Some have assumed that only Dental Therapists (DTs) and Oral Health Therapists (OHTs) are required to treat public patients, ignoring the complex health conditions many eligible patients experience, which require the more extensive training of a dentist. Many patients have such complex care needs that dentists also need to be able to refer them to dental specialists. The DTs and OHTs can do preventive work and simple fillings, however, around 40% of attendances are emergencies 3, and these must usually be performed by dentists. Proposed measures to reduce costs by utilising DTs and OHTs are only appropriate in some circumstances. Where the needs of the patient are complex, or emergency dental surgery is required, this care should be provided by a dentist. Dentists and specialists are essential components to the dental health team, and they have a critical role in providing the leadership required for the team to function well and to ensure the right clinical care decisions are made. These responsibilities should be recognised, respected and rewarded. Recommendations: 7. To maintain a high standard of care, the important role of the dentist as the team leader must continue to be recognised. Appropriate methods for respecting, recognising and rewarding this role must be put in place, including performance measures that recognise the dentist s leadership responsibilities, and the complexity of the care provided to patients. 8. Review and update the public dentist and public dental specialist classification systems to better align with their modern roles and responsibilities. 7 REFERENCES 1 Oral Health Monitoring Group. Healthy Mouths, Healthy Lives: Australia s National Oral Health Plan (2015). 2 Dental Health Services Victoria. Links between oral health and general health - the case for action. (2011). 3 Victorian Auditor General. Access to Public Dental Services in Victoria. (2016). 4 Health Issues Centre. Was I still on the waiting list? - A study about people waiting for public dental care. (2009). 5 Browne, R. Dental visits beyond reach for many in NSW: NCOSS report, in The Sydney Morning Herald ( ). 6 Australian Government. A Healthier Future For All Australians Final Report of the National Health and Hospitals Reform Commission (2009). 7 State Government of Victoria. Victorian Health Services Performance - Statewide - Average time to treatment for general dental care - Quarterly Data, (2017). 8 Dental Health Services Victoria Annual Report Australian Bureau of Statistics. Australian Demographic Statistics - September Quarter 2016, cat. no (2016). RESPECT PUBLIC DENTISTRY SO EVERYONE CAN SMILE 11

12 RESPECT PUBLIC DENTISTRY SO EVERYONE CAN SMILE AN ISSUES PAPER ABOUT VICTORIA S PUBLIC DENTAL SECTOR Australian Dental Association Victorian Branch Inc PO Box Box 9015, South Yarra, VIC 3141 Tel: ask@adavb.org Professionals Australia Level 1, 163 Eastern Road South Melbourne, VIC info@professionalsaustralia.org.au Tel: