Continuing education is mandatory. A credit system has been introduced and administered by BgDA
The NHIF monitors the quality of dental care in the system of mandatory insurance. The quality of dental care in private practice is not actively monitored. Some control is achieved by BgDA on the basis of the Ethical Code and the Rules of Good Medical Practice in Dentistry.
Patient complaints are generally managed by the Ministry of Health, and the regional and national Ethical Committees of BgDA.
The penalties for infringement of the Ethical Code vary in severity, from censure, financial penalty to erasure from the register (for a term of from three months to two years).
Key Points to Consider When Inducting or supporting a Dentist Qualified in Bulgaria
Dentists qualified in Bulgaria :
Have limited experience of a publicly funded health service if they qualified after 1990;
Have limited experience of UK monitoring procedures (e.g. NHS dental services) or UK requirements for clinical governance (e.g. clinical audit);
May not appreciate that amalgam separators are mandatory in the UK;
Unless qualified before 2003, will not have undertaken vocational or foundation training in Bulgaria, just a 6 month mandatory pre-graduate practical training in the dental schools;
May have no knowledge of registration for dental care professionals other than dentists.
Country : Czech Republic
Population: 10,532,800 (2011)
Number of registered dentists: 9,158 (2011)
Number of active dentists: 7,007 (2011)
Qualified overseas : 317 (2011)
Number of dentists registered in the UK in 2007: 48 in 2008: 62 in 2009: 84 in 2010: 90 in 2011: 104
The country is administered as 13 regions and Prague has regional status (5).
In the Czech Republic, about 90 per cent of the dental care is delivered by private dentists and the remaining 10 per cent is provided by university dental clinics, municipal health centres, the armed forced and hospitals. According to the Czech Dental Chamber (CSK), the active dental workforce started to decrease after 2008. About 63 per cent of active dentists are older than 50 years. It is presumed that in the next few years the number of dentists, leaving their dental practices due to reaching retirement age, will be higher than the number of newly graduated dentists. There is no significant movement of dentists from the Czech Republic to neighbouring countries. The number of emigrating dentists is similar to that for immigrating dentists (5).
Dentists must register with the Ministry of Health, the CSK and their Regional Authority. The CSK maintains a register containing the dentists´ details, including qualifications and professional performance information. There is a statutory requirement for all dentists to undertake continuing professional education in order to maintain their registration (5).
Oral healthcare is co-ordinated by the CSK. It is compulsory for all Czech citizens to be a member of the health insurance system. Up to 80 per cent of dental care is paid for by the health insurance system and the balance is covered by the patients. The health insurance scheme (HIS) cover the costs of "standard" dental care for children up to 18 years of age in full, with the exception of some prosthodontics and fixed orthodontics for which special rules apply. The HIS also covers the basic dental care of adults. The costs of tooth-coloured fillings and more complex prosthodontic treatments are covered partly by the HIS (up about 30 per cent of the costs) and the remainder by patients themselves. Dental care of children and adolescents is provided predominantly by private dental practitioners (5).
The undergraduate dental course lasts five years. Prior to 2009, there was a 36 months programme of vocational training for all new Czech dental graduates. It stopped in 2009, after changes to the clinical content of the undergraduate dental course, which is now comparable to that in other EEA countries. Czech dentists, who qualified prior to 2009 were not allowed to work in other EU countries immediately upon qualification. After completing courses it is possible to obtain certificates of proficiency in periodontology, oral surgery, paediatric dentistry and general dentistry comparable in the UK to dentists with special interest (5).
There is no obligatory registration for dental hygienists, dental technicians and dental assistants in Czech Republic.
Education of dental hygienists started in 1999. The number of hygienists was 307 in 2010.
To work in the Czech Republic, a dentist must be registered with the Czech Dental Chamber (CSK) which defines requirements on operating a dental practice and confirms compliance with the dentists´ professional performance needs. It also maintains a register containing the dentists´ details, including qualifications and professional performance data and administrates the ethical code
To establish a new practice dentists have to register with the local state health authorities and fulfill all the necessary conditions (qualification, lack of disciplinary convictions, and equipment of the practice). There is a one-off registration fee payable to the Regional Authority and in 2008 it was 1,000 CZK (40 Euros) (5)
There are no regulations to control the location or size of dental practices. The law does not allow the selling of lists of patients. The state doesn’t offer assistance for establishing a new dental practice
The dental workforce has to be vaccinated against Hepatitis B and has to be checked regularly for sero-conversion. The employer usually pays for vaccination of the dental staff
Professional liability insurance is compulsory for all dentists. For work abroad it is necessary to make a special supplement to the insurance contract
Training in ionising radiation is mandatory for undergraduate students as part of the curriculum. Dentists have to pass an examination on ionising radiation every ten years
Ionising radiation equipment is registered by the State Office for Nuclear Security it must be checked annually by an accredited company
Amalgam separators are obligatory. The disposal of clinical hazardous waste and amalgam must be carried out by an accredited company
Anyone can own a dental practice but they need a dentist present on the premises at all times
Since 2004, dental studies have taken place under a new a curriculum, according to the standards of the EU. The dental course lasts for five years
For dentists graduating before 2009, there was a programme of vocational postgraduate training for 36 months, under supervision. It was certificated by the Dental Department of the State Institute of Postgraduate Education in Medicine
Since 2009, dental graduates no longer undertake vocational training and are able to be fully licensed immediately upon qualification. However, in practice if a new graduate wishes to open a new practice and to contract with the health insurance scheme, they are expected to have worked under supervision for a period of time after they have graduated. Non-EEA graduates who wish to work in the Czech Republic must work for one year under supervision before they can practice independently
Czech vocational training is not compulsory for graduates of other EEA countries’ dental schools
There is specialist training in three specialties: orthodontics, clinical dental medicine and oral-maxillo-facial surgery
To enter specialist training a dentist must have completed 36 months in general dental practice (for oral-maxillo-facial surgery, medical practice is an acceptable alternative). Specialist training in orthodontics takes three years, for clinical oral medicine it takes four years and oral maxillo-facial surgery takes six years
3. Support Systems
The CSK protects the interests of dentists and patients and maintains professional standards and ethics of dentists
To obtain registration, a dentist coming from another EEA state must have a recognised qualification, permission for permanent residence in the Czech Republic, a work permit, and pass an examination in spoken Czech. Dentists from non-EEA countries must pass the full recognition process as required by Directive 2005/36/EEC
4. The Dental Team
There is no obligatory registration for dental hygienists, dental technicians and dental assistants
Dental hygienists are permitted to work after completion of three years training in a special higher school specifically for dental hygienists. Dental hygienists can only work under the supervision of a dentist and their duties include scaling, cleaning and polishing, removal of excess filling material, local application of fluoride agents, the application of preventive sealants and oral health education
Dental technicians can train in a variety of ways. Four years in a high school for dental technicians, after which they can only work as assistant dental technicians is the usual pattern. Some will study for a further three years and can then work independently and employ other technicians. They normally work in private laboratories, only a few are employed by dentists or dental practices
Dental nurses must undertaken three years at the school for dental nurses or can be general nurses trained by dentists. They are permitted to undertake oral health education
5. Dental care Delivery
Oral healthcare is coordinated by the CSK.
Most children (97 per cent) and adolescent up to 18 years age, pensioners and 67 per cent of adults are covered by an obligatory tax-financed public health insurance run by the nine state-approved health insurance companies. The rest of the population is insured by health insurance schemes and employees by sick funds.
The insurance fund is part of the compulsory public health insurance system. Up to 75 per cent of dental care is paid from the health insurance system. The Sick Funds are self-regulating under the national legislation.
The dental service is delivered through a system of university clinics, or by private dentists. In 2007, about 90 per cent of dental care was delivered by private dentists.
The insurance system provides cover for all standard conservative treatment such as amalgam fillings, basic endodontic treatment, surgical and periodontal items and for a few basic prosthodontic items.
Cosmetic fillings and non-basic endodontic treatment, implants and fixed orthodontic appliances in adults have to be paid for completely by patients. Crowns and bridges, partial dentures and removable orthodontic appliances are paid partly from sick funds and partly by the patient.
For dentists working within the health insurance system, it is mandatory that they complete a price list of items partially covered by the insurance system, or items which are fully covered by the patient. Control of the price-lists is maintained by the financial authority and is checked routinely, by audit of bills and documentation or as a result of a complaint by a patient.
The contracted dentist sends a monthly invoice with the list of patients and the treatment provided to the health insurance company. The payment from the insurance company follows in 30 days
The dental services provided in hospitals by dentists usually cover all aspects of oral health care and in- patient oral surgery. Hospital dentists also assist in the education and training of dental undergraduates. About half of the dentists working in hospitals are specialists, the others are in training. They can be either fully or partially employed and they can also work in private practice
Less than 1 per cent of dentists (mainly in Prague and in other larger cities) work completely outside the system of health insurance. Their fees are totally unregulated
6. Quality assurance mechanisms
Participation in continuing education has been obligatory since 2004
The outcome of the CSK continuing postgraduate education cycle is a Certificate of Proficiency in general dentistry, periodontology, oral surgery, paediatric dentistry and orthodontics.