Number of dentists registered in the UK in 2007: 419 in 2008: 449 in 2009: 466 in 2010: 509 in 2011: 579
There are thirteen regions but no regional governments, and many services were provided locally through fifty four prefectures, each managed by a public health department (5). In January 2011, the prefectures were abolished and reformed into 76 peripheral units (27)
In 2012, 48 per cent of Greek dentists were aged over 50 years and only 1 per cent were under the age of 30 years. 47 per cent of dentists were female. The workforce grew until 2008, when there were 14,260 dentists but has declined slightly to 13,919 in December 2011 (27) and to 12,574 in March 2012, approximately 6 per cent of dentists were unemployed (5).
Oral healthcare in Greece is almost entirely delivered by private practitioners, with patients paying the full cost of treatment themselves. Those who are not self-employed private practitioners work in hospitals (as NHS employees), in NHS rural health centres, or are employed part-time by the Social Security Organisation which manage outpatient departments in many urban areas, providing dental care to insured people of all ages (5) .
National Health Service (NHS) health centres mainly provide annual consultations, preventive and other simple restorative treatment to children under the age of 18. The Social Security pays 75 per cent of the dental care for children up to 16 years of age – the parents are required to pay the balance (5).
The Government is responsible for the payment of fees, the quantity and quality of work and, in association with the Hellenic Dental Association, (HDA) ethical behaviour. The quality of work carried out within the Social Security Schemes, is monitored by dentists employed part-time by the Schemes (5).
Professional liability insurance is not compulsory for dentists. Apart from requiring the standard “CE” tag, radiological equipment does not require any other specific notification (5).
For dentists practicing within the National Health Service, continuing education is mandatory. However, since there is no structured continuing education programme available, there are no sanctions connected with non-compliance (5). The HAD proposed a compulsory CPE scheme for all dentists. This was implemented in February 2012. All dentists (both those working in the public and the private sectors now have to provide evidence of 150 hours CPE in a five year cycle to renew their practicing licence.
There are two dental schools, both publicly funded and part of the main University. There is no regulated post-qualification vocational training, nor a foundation training programme in Greece.
All regional Societies are automatically members of the Hellenic Dental Association (HDA). Dentists pay an annual fee, in order to be registered with the competent Regional Societies (5).
Until March 2012, in order to practice in Greece, a dentist required a recognised diploma, and a licence to practice from the Competent Authority (the Prefecture). Since April 2012, the licence is issued by the Regional Dental Society and dentists must be registered with one of the 52 competent Regional Dental Societies.
Dentists in Greece must work within an ethical code which defines the relationships and behaviour between dentists, and also advertising. The ethical code is implemented by the Regional Dental Associations and the HDA.
Vaccination against hepatitis B is not compulsory for dental workers. However, since 1995, all faculty members and all undergraduate level students at the University of Athens, School of Dentistry have been vaccinated against hepatitis B.
Liability insurance is not compulsory for dentists. However, professional indemnity insurance is available from private general insurance companies.
Both the EU and the National Radiological Protection Board Guideline Notes for Dental Practitioners have been adopted.
Amalgam separators are a mandatory requirement.
Dentists are allowed to form corporate bodies (companies) under a Presidential Decree of 2001.
2. Education and Training
There are two dental schools, both publicly funded and part of the two main Universities.
In 2011 - 2012, their intake was 236 students.
For those graduates who apply for enrolment in a postgraduate programme, in a clinical dental specialty, a two year period of clinical experience after graduation is required for acceptance into the programme. There is no Foundation Training programme.
There are two recognised specialties (orthodontics and oral and maxillo facial surgery).
In addition to the recognised specialists, there are a considerable number of specialists who are working in private practice, or at a University in the common specialisations in dentistry (5)
The only dental care professionals are dental technicians and a limited number of chair-side assistants
Training as a dental technician involves a three year programme in a Technical Professional Institute or Lyceum, followed by a placement in a dental laboratory. Registration is with the Ministry of Health and Welfare. Dental technicians are allowed to work independently in a private clinic or laboratory, under the prescription of the dentist - but they are not permitted to work in the mouth of a patient (5).
Dental chair-side assistants cannot work independently, without the supervision or prescription of a dentist. They are required to hold a diploma, certificate or other evidence of formal qualification, after a two year course at a Private Technical College (including six months in a dental practice) then at least six months post qualification in a practice. They must be registered with the Ministry of Health and Welfare. The majority of dentists work without assistants (dental nurses).
The NHS provides free healthcare to all. NHS health centres mainly deliver preventive and other simple restorative treatment to children under the age of 18. The Social Security funds 75 per cent of the dental care for children up to 16 years of age – the parents are required to pay the balance.
Oral healthcare in Greece is almost entirely delivered by private practitioners, with patients paying the full cost of treatment themselves. Those who are not self-employed private practitioners work in hospitals (as NHS employees), in NHS rural health centres, or are employed part-time by the Social Security Organisation (IKA), which has its own outpatient departments in many urban areas, providing dental care to insured people of all ages. NHS dentists are not allowed to practice privately, whilst IKA-employed dentists may do so.
Approximately 80 per cent of dentists work in private practice (4). Dentists in private practice are self-employed, and earn their living through charging fees per item of service. Approximately 10 per cent of dentists in private practice are also part-time salaried employees of the IKA, of other social security funds or are part-time academics or military dentists.
Just over half the dentists employed in the NHS work in health centres, providing services to children under the age of 18. They are full-time salaried employees in ‘exclusive occupation’ - without other part-time work commitments. These centres also provide emergency services to adults and the elderly. Treatment is free at the point of delivery (5).
Within NHS hospitals, dentists provide preventive care and emergency or full treatment, as required, to all hospitalised patients, free of charge. Adults over the age of 67 also receive social security subsidies if they are on low incomes, as well as those who have been handicapped due to accidents or birth defects (5).
The social security organisation delivers primary dental care via its Dental Clinics, or its dentists working within the System directly to insured or retired adult patients, plus full and/or partial dentures. Crowns, bridges and inlays are not available (5).
6. Quality assurance mechanisms
Continuing education is a mandatory requirement, but in reality is not actively monitored. NHS staff members are self-regulated for CPD and attend various seminars either at their hospital or from other seminar providers. CPD activities are organised by the HAD, universities, hospitals and dental societies in various fields and specialties.
Since February 2012, there has been a requirement for 100 hours of CPD in a four year cycle in order to retain a licence to practice.
However, since there is no structured continuing education programme available, there are no sanctions connected with non-compliance.
The National Government has ultimate responsibility for the payment of fees, the quantity and quality of work and, in association with the HDA, ethical behaviour.
For work carried out on behalf of the Social Security Schemes, standards of dental care are monitored by dentists employed part-time by the Schemes.
Serious complaints by patients are referred to the Central Disciplinary Council of the Ministry of Health and Welfare. Within the NHS there are also disciplinary councils in hospitals, and in local health centres. In addition, the disciplinary boards of each local dental association will also deal with complaints. Where complaints are not due to misunderstandings, a patient may be examined by a specialist dentist from the University.
The ultimate sanction for either a private practitioner or an NHS-employed dentist is the forfeiture of the right to practice. However the sanctions which are typically applied are usually restricted to warnings and financial penalties. Within this process, dentists have a right of appeal, to the disciplinary board of the HDA. Ultimately patients also have the right to appeal to Greek civil and criminal law (5).
Key Points to Consider When Inducting or Supporting a Dentist Qualified in Greece
Dentists qualified in Greece :
Have limited experience of a publicly funded health service;
Have limited experience of UK clinical governance requirements (e.g. clinical audit);
Will not have undertaken vocational or foundation training in Greece;