The General Dental Council is to remove its barrier to Direct Access for some dental care professionals after considering the impact on patient safety. In the past every member of the dental team had to work on the prescription of a dentist. This meant that patients had to be seen by a dentist before being treated by any other member of the dental team.
Following a detailed review of evidence and a full discussion at a Council meeting on 28 March 2013, it was agreed this should change as outlined below. Full guidance for registrants will be published before these changes come into effect on 1 May 2013.
Chair of the GDC Kevin O’Brien said:
“This decision has been made with patient safety as an upmost priority. Registrants treating patients direct must only do so if appropriately trained, competent and indemnified. They should also ensure that there are adequate onward referral arrangements in place and they must make clear to the patient the extent of their scope of practice and not work beyond it.”
It should be remembered that:
• All registrants must be trained, competent and indemnified for any tasks they undertake.
• All registrants must continue to work within their scope of practice regardless of these changes.
• All registrants must continue to follow the GDC’s ‘Standards for Dental Professionals’.
• Dental care professionals do not have to offer direct access and should not be made to offer it.
Dental hygienists and dental therapists
Dental hygienists and dental therapists can carry out their full scope of practice without prescription and without the patient having to see a dentist first.
Dental hygienists and dental therapists must be confident that they have the skills and competences required to treat patients direct before doing so. A period of practice working to a dentist’s prescription is a good way for registrants to assess this.
Registrants who qualified since 2002 covered the full scope of practice in their training, while those who trained before 2002 may not have covered everything. However, many of these registrants will have addressed this via top-up training, CPD and experience. Those who qualified before 2002, or those who have not applied their skills recently, must review their training and experience to ensure they are competent to undertake all the duties within their scope of practice.
Dental nurses can participate in preventative programmes without the patient having to see a dentist first.
Orthodontic therapists should continue to carry out the majority of their work under the prescription of a dentist.
Orthodontic therapists can carry out Index of Orthodontic Treatment Need (IOTN) screening without the patient having to see a dentist first.
Clinical dental technicians
Clinical dental technicians should continue to see patients direct for the provision and maintenance of full dentures only and should otherwise carry out their other work on the prescription of a dentist.
However the Council stated that with the potential for further training for CDTs this decision could be reviewed.
The work of a dental technician (other than repairs) should continue to be carried out on the prescription of a dentist.
Dental professionals are encouraged to get in touch with the GDC if they have any questions.
The move was welcomed by the Office of Fair Trading:
“The OFT welcomes the General Dental Council’s measures to make important dental services more accessible for patients.
In its report, published in May 2012, the OFT found that while the majority of patients are satisfied with their dentists, the GDC’s measures were restrictive. Now, patients will be able to get direct access to dental care professionals, such as dental hygienists, without a referral from a dentist. The OFT is pleased that the GDC will remove these restrictions.
By giving patients direct access to dental therapists and hygienists, the GDC’s move will help patients get access to the services they need to maintain their oral health.”
However, the British Dental Association, which represents UK dentists, called the decision “misguided” and said it “undermines best practice in patient care”. In a BDA statement, released immediately following the GDC decision, Dr Judith Husband, Chair of the BDA’s Education, Ethics and the Dental Team Committee, said:
“This is a misguided decision that fails to consider best practice in essential continuity of care, patient choice and cost-effectiveness, and weakens teamworking in dentistry which is demonstrated to be in patients’ best interests. Dental hygienists and therapists are highly-valued and competent members of the dental team, but they do not undertake the full training that dentists do and on their own are not able to provide the holistic, comprehensive care that patients need and expect. Our fear is that this could lead to health problems being missed in patients who choose to access hygiene and therapy appointments directly.
“The decision also ignores the stated limitations of the literature review on which the decision has been based and goes against the findings of the GDC’s own patient survey last year, which found that just three in ten people favoured a move to allow direct access.
“The undue haste with which the decision is to be implemented does nothing to alleviate the impression that this is an inadequately-considered decision that is being pushed through without proper reference to the risks it creates.”
The BDA has campaigned against such a change, stressing the importance of coordination of patient care in a dentist-led team and the need for patients to see a dentist first.