Post on 27-Jun-2020
Opening and management
of dental practice.
Labor and legal
relationships
Prof. Dr.Krassimira Yaneva, PhD
Plan of the lecture:
1. Requirements for opening of
dental practice
2. Requirements for signing
contract with NHIF
3. Labor and legal relationships
4. Postgraduate education
Options for newly graduated
dentist to work as:
1. Free, private practitioner
2. An employee on a contract – in public
health services, (In Bg there are such
services with Council of Ministers and
Ministry of Defense), hospitals for
treatment of dental diseases, academic
teachers in universities.
Options for private
practitioner to work:
1. In dental surgery, legalized and registered
as a medical treatment facility (own property
or owned by another person).
2. In a surgery, forthcoming for legalization
and registration (building new surgery, or
transforming premises that have a different
status - suit, studio, office).
The opening of a dental office must
comply with the following legal
documents:
1. Medical Treatment Facilities Act
2. Territory Planning Act – 2001
3. Order RD № 09-325 / 04.04.2000 of the Ministry of Health “Hygiene requirements for premises of medical, dental, medical-dental diagnostic and counseling centers, medical diagnostic laboratory and medical technical laboratory, as well as providing anti-epidemic control in them”.
4. Guidline №1 / 21.04.2003г. of the Regional Health Inspection for separate collection, storage and disposal of waste from medical treatment facilities.
5. Act for Health and Safety at Work– 1997.
Sanitary requirements for
dental surgery:
1. Area
2. Walls
3. Floor
4. Exposure
5. Light
6. Fire safety
7. Water supply and sanitation
8. Electrical installation requirements
9. Disinfection and sterilization requirements
10. Requirements for separate waste disposal
11. Requirements for furniture and equipment
Sanitary requirements for
dental surgery:
1. Area for: dental office – 12m2; waiting room – 9m2;
rest room – 3m2; dental office with 2 working places -
10m2 each; dental technician workplace – 5m2 etc.
2. Walls – 2.50m height; with X-ray equipment – 3m.
3. Floor – made of material, resistant to moisture and
disinfectants.
4. Exposure – N, N-W, N-E
5. Light – Local/General = 5-10/1
Sanitary requirements for
dental surgery:
6. Fire safety - Presence in the office of fire
extinguisher 6 kg; All electrical contacts in the office
to be zeroed; The fridge in the office to be
connected with a separate installation; Presence of
main switch on/off at the exit of the office.
7. Disinfection and sterilization requirements -
presence of autoclave, disinfectants in shelf life.
8. Electrical installation requirements - Economic
use of electricity; Safety and reliability in operation
with electrical appliances; Effectiveness and
durability of use of electrical appliances.
Sanitary requirements for
dental surgery:
9. Water supply and sanitation- Presence of sink with
hot and cold water; Water installation of dental unit is
built from PVC pipes with diameter of 15 mm, which
must be placed into the canal under the floor to a
depth of at least 10 cm and secured with PVC pipe;
Under the spittoon there is separator, which retains
the silver amalgam in order not to pollute the soil.
10. Requirements for separate waste disposal – 3
containers for: Hazardous waste (organic waste);
Non-hazardous waste (household waste); Sharp
instruments
Sequence of the procedures for
legalization of premises in a medical
treatment facility:
1. Required documents:
- Notarial deed of the premises,
which will be transformed into a
dentist's office;
- Permission N16 (permission for
use the building);
- A notarized consent of
neighbours.
Sequence in the procedures for
legalization of premises in a medical
treatment facility:
2. Preparing of projects by authorized
architectural company:
- General architectural project design
- Project for heating and ventilation
- Project for water supply and sanitation
- Project for electrical installation
Sequence in the procedures for
legalization of premises in the medical
treatment facility:
3. Approval of the projects by the Regional Health Inspection for compliance with sanitary and hygiene requirements.
4. Presentation of all documents in the
Municipality to issue of "Permission
for building“.
Sequence in the procedures for
legalization of premises in the medical
treatment facility:
5. After completion of building works -
application to Regional Health Inspection
(RHI) for approval the implementation of
the project, i.e. comparison of project to
execution.
Sequence in the procedures for
legalization of premises in the medical
treatment facility:
6. Two expert committees from RHI check the working conditions in the new cabinet:
6.1. Directorate “Laboratory Control”:
- Protocol for lighting
- Protocol for physical parameters of the
environment – t°, humidity etc.
- Protocol for noise
6.2. Directorate “Epidemic Control”:
- Disinfection
- Sterilization
- Separate elimination of the waste
Sequence in the procedures for
legalization of premises in the medical
treatment facility:
7. Positive opinions from the Expert
Committees, together with a report by an
authorized company for building supervision
are given to the municipality with a request for
registration of the premises in the
cadastre of the settlement as a medical
treatment facility. The deadline for a
response from the municipality (Chief
Architect) is 1 week.
Sequence in the procedures for
legalization of premises in the medical
treatment facility:
The municipality permit, together with the
positive certificates of expert committees of
RHI are submitted in RHI where is issued
THE SANITARY PERMIT OF THE
MEDICAL TREATMENT FACILITY
The Sanitary Permit certifies that treatment
and diagnostic procedures can be
performed in this room.
The dentist could be registered in
Regional Health Inspection (RHI):
1. As a freelancer – individual practices
for primary and specialized dental care.
2. As a sole trader (ST) or a limited
liability company (Ltd) – (registered under
the Commercial Law) –group practices,
practices for outpatient specialized care,
hospices.
Required documents when
registering a dentist as a freelancer:
1. Diploma for completed education in Dental Medicine
2. Diploma for acquired dental specialty (if any)
3. Criminal Records Certificate
4. Certificate of membership in the BgDA
5. Sanitary Permit of the surgery
Required documents when registering the
dentist as a ST or Ltd:
1. Court decision for registration.
2 . Tax registration certificate.
3 . Unique identification code.
4 . Rules for the structure, activity and internal order of the medical
facility.
5 . Copies of diplomas of the dentists who will work in medical
facility- for higher education and specialty.
6 . Certificates from BgDA for membership of persons who will
work in medical facility .
7 . Criminal record certificates of employees.
8 . Hygienic conclusion of the dental office from RHI .
9. Permit from the competent authorities for the use of X-ray
equipment.
After the registration in RHI,
within 1-week should be done:
1. Registration in the National Insurance
Institute – Bulstat number
2. Registration in Tax Administration:
- Tax number for registered under the
commercial law;
- Identification number (EGN – Public
Registry Number) - for working as
a freelancer.
Work in contract with National
Health Insurance Fund (NHIF):
1. Who is entitled to contract with the
NHIF?
2. What documents are required?
3. What is the contract period?
4. Contract signing procedures
5. Obligations of the parties in the
contract - the doctor and NHIF.
Who is entitled to contract
with NHIF:
1. Individual practices for primary care;
2. Group practices for primary care;
3. Individual and group practices of specialists in “Oral Surgery";
4. Individual and group practices of specialists in "Pediatric Dentistry";
5. Dental centers, offering primary care;
6. Medical-dental centers, which employ specialists in “Oral Surgery" and / or "Pediatric Dentistry".
Required documents for signing the
contract with Regional Health
Insurance Fund:
1. Application form
2. Certificate of current membership in BgDA
3. Certificate of registration in RHI
4. Declaration that there is the required technical
and dental equipment
5. Bulstat Registration
6. Bank account for the remuneration from the
fund.
The contract with RHIF:
1. Shall be signed within 1 month after
submission of required documents.
2. Is active 1 year (until the signing a new
Framework Agreement or change of the
currant);
National Framework Agreement
1. National Framework Agreement (NFA) is
a contract between the NHIF and
professional organizations of doctors and
dentists.
2. It describes medical activities that are
paid in whole or in part by the fund.
3. Outpatient dental activities are organized
in a packages of services for primary and
specialized dental care for persons up to the
age of 18 and over 18.
Control over contractors:
The Regional Health Insurance Funds exercise control over contractors:
1. Medical control on: observing the rules of good medical practice, the type and amount of services, the type and quantity of prescribed drugs, documents of temporary disability etc.
2. Financial control on: a financial performance of the contract and record keeping.
Termination of the
contract with the NHIF:
1. Upon expiration of the contract, modification or adoption of new NFA.
2. Upon deletion of office registration in the
Regional Health Inspection.
3. By mutual agreement of the parties with notice:
- 3 months in advance for the primary
health care;
- 1 month - for specialized health care.
Hiring and dismissal of supporting staff:
1. Hiring under a contract of employment: The employment contract contains: hours of work, duration
of working day and working week, amount of paid annual
leave. Employees employed under a contract of employment
are compulsorily insured for all social risks.
2. Hiring under a civil contract: In the civil contract,
the contractor himself determines his working time and
place, as well as the length of the working day. Persons who
have a civil contract do not have paid annual leave and are
not entitled to temporary disability benefits by the National
Social Security Institute, since no deductions are made for
the sickness and maternity fund.
3. Dismissal with a prior notice: The notice period
for termination of employment is between 30 days and 3
months
Postgraduate education:
1. Continuous education (development,
qualification)
2. Specialization: The training for
acquiring a specialty in the healthcare
system is carried out in accordance with
the terms and conditions of Ordinance
No. 1 / January 22, 2015. of the Ministry
of Health.
Continuing education:
1. BgDA program for PGE. Since 2005 the
BgDA has introduced a program of PGE
with free of charge lectures, performed by
leading Bulgarian and foreign lecturers.
2. Lectures and courses led by local and
foreign specialists.
3. Congresses, symposia, conferences.
4. Monographs, textbooks, articles,
newspapers, magazines etc. The purpose of continuing education is to maintain the knowledge and
skills of dental practitioners at advanced level!
Specialization in dental
medicine
The specialization in dental medicine is
carried out through 3-4 year programs
with theoretical and practical training in a
particular field of dental science.
Theoretical training is provided by the
dental faculties, and the practical training
is carried out in medical facilities
accredited for training in a specialty.
Dental specialities in Bg:
I. Clinical specialities:
- Dental Implantology
- Dental Clinical Alergology
- Pediatric Dentistry
- General Dentistry
- Conservative dentistry
- Oral Surgery
- Orthodontics
- Periodontology
- Prosthetic Dentistry
- Dental Radiology
Dental specialities in Bg:
II. Non-clinical specialities:
- Biochemistry
- Social Medicine and Dental Public Health
III. Specialities for persons with
degrees “Master in Medicine” and
“Master in Dental Medicine”
- Maxillo-Facial Surgery
Procedure to determine the type
and number of specializations:
(according to Ordinance N 1/22.01.2015)
1. Until 15 June – RHI give their proposals about
the need of specialists to the Minister of Health.
2. By September 1st the dental faculties send to the
Minister of Health information about the graduates
with the “Golden Hippocrates”, “Golden Hermes
with caduceus” and “Golden Galen” awards who
have the right to choose a specialization at will.
3. Until 30 October – the Minister of Health
determines the specializations, that the state will
fund.
Procedure to determine the type
and number of specializations:
4. From 1st to 31 of November - the candidates submit
their applications in the universities.
5. Until 31 of December - the selected candidates are
ranked and published on the website.
6. In 7 days the school sends the data of the selected
candidates to the Ministry of Health.
7. Specialization and its financing start from January 1st
next year.
8. After expiry of specialization and fulfilling the
necessary requirements a trainee takes a state exam in
the specialty. After successful taking the examination the
trainee receives a certificate of specialty.
.
Procedure to determine the type
and number of specializations:
8. When ranking for specialization, funded by
the state, the contract between a successful
candidate, University and the Ministry of
Health is signed.
9. When ranking for specialization for fee the contract between a successful candidate
and University is signed.
I wish you a green light in
your future profession!!!