Tariq Drabu Dentist Affairs Around Direct Access

Should the public be able to access dental care directly without having to see a dentist first? The General Dental Council (GDC) are consulting about this on their website and this consultation closes on 31.12.12.

Up until a few years ago the practice of dentistry was restricted to a small group, namely those doctors and dentists that were registered with the relevant regulatory bodies. Therefore it was limited and restricted as to who could practice dentistry; this was backed up by legal sanction if a non-registrant was found to be practising. In 2006 registration became compulsory for a further group of practising colleagues namelydental nurses, dental technicians, orthodontic therapists and clinical dental technicians – known as dental care professionals (DCPs). Therefore since 2006 the practice of dentistry has been redefined as being performed by these particular groups. However each group has its own parameters as to what it can and cannot do in terms of the practice of dentistry and that is known as the ‘scope of practice.’ It is also a requirement in almost every case for a patient to see a dentist in the first instance and for the dental care professional to be working under the prescription of a dentist. So for example a dental hygienist will administer gum treatment to a patient on the prescription of a dentist as part of an overall treatment plan. Pretty much the only exception to this protocol is for the construction of complete dentures by a clinical dental technician.

Direct Access means that any member of the general public will have access to any member of the dental team without first referring to a dentist. This was one of the recommendations of a report to dentistry by the Office of Fair Trading. Although I support quite a lot of what was written in that report it was noted by many in the dental profession that the report was very one sided and made very far reaching conclusions on the basis of some very flimsy statistical evidence particularly by extrapolating data. These far-reaching conclusions were then pounced upon by the media as the headlines and much of what is positive in the report about dentists and dentistry was overlooked. However whether we like it or not the OFT report is supported by the government and therefore it is very likely that direct access will become the norm in future. Therefore I guess the question that we all have to ask ourselves will be ‘does seeing a dentist in the first instance increase the protection of the public or is it actually a restriction of practice?’ If you read the dental press you will see that the GDC is seen in a very poor light by the majority of dentists who are at best suspicious of its motives and actions. It has also been recently criticised by  the healthcare watchdog the CHRE.

Notwithstanding the shortcomings at the GDC, I support and would urge every member of the dental community to step forward and contribute their opinions regarding direct access. These potential changes will be the biggest shakeup to dentistry that I have ever known in my professional life time. There would be some parallels with the American model of service delivery where dental nurses are given extended roles and duties in support of the dentist. Here at Langley Dental Practice many of our dental nurses already have extended duties qualifications, in that they can take impressions on patients, they can apply fluoride and they can take x-rays. I am a passionate believer in the dental profession having a voice in its own future affairs and will be contributing to the consultation and would encourage all dental professionals to do the same.

I believe in developing every member of the dental team to their full potential and for career development in dentistry to be seen in the context of a process of lifelong learning and improvement. Affairs and concerns around direct access represent the most important changes to dentistry since 1948 and the founding of the NHS. Apathy and disinterest are not options. The consultation closes on 31 December 2012 and I would encourage every interested member of the dental community to contribute their opinions and take our profession forward into the 21st century.

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