Scope of practice

John Chope explains why the GDC decided to return to its old policy of prescribing the lists of duties for its registrants…

Part of the GDC’s project to egister the whole dental team included ditching the statutory prescribed lists of duties for DCPs. These were very rigid lists locked up by cumbersome primary legislation. Instead, the Council reckoned that by determining the curriculum for qualification and also by approving post-qualification courses, it could regulate the tasks for each group by insisting registrants only performed the tasks they had trained for and were competent at.

Whilst it seemed a good idea at the time, this plan met with opposition from both registrants and patients who told the GDC they wanted more guidance and more certainty on what the different dental professional groups were permitted to do. In other words, they wanted to know the boundaries of each
professional group.

So the GDC Scope of Practice working group was set up last year with members from all the professional groups. The working group was asked to come up with lists of permitted duties for dental nurses, orthodontic therapists, dental hygienists, dental therapists, dental technicians, clinical dental technicians and dentists.

The task consisted of determining for each group the list of duties that derive from the basic qualification and a further list of additional skills that could be developed throughout the career without becoming the means of sneaking into another professional group by avoiding the full professional training programme.

For example, it should not be possible for a nurse to become a hygienist simply by extending the skills with a load of post-qualification modules. he Scope of Practice Group’s report was published as a consultation exercise and earlier this month it was debated by the GDC and lists of duties were approved.

The professional group with the longest list of potential additional skills was dental nursing. Here, 24 additional skills were whittled down to 18. After a strongly argued debate, nurses were approved to place rubber dams but not record occlusion and not tooth whitening. Tooth whitening under the prescription of a dentist was, however, approved for dental hygienists and therapists and suture removal after the wound has been checked by a dentist was approved for all groups except technicians. Taking impressions was approved for dental nurses and technicians. The only additional skill listed for dentists was the provision of implants.

Although the profession may appear to have stepped back towards the old regime of prescribed lists – the majority if not all registrants’ duties are likely to be regulated in the first instance by the GDC’s approval of their training which is expected to be a more responsive process than previously. No professional group will be able to claim a right to practise a particular skill or carry out an exclusive
task. Because the regulations governing this measure are no longer bound by legislation but by the GDC’s own rules, as training opportunities develop, registrants’ skills expand and the policy is seen to be successful, the GDC will have the freedom to re-visit the scope of practice of its registrants with a view to both adding and removing tasks from a much more flexible and dynamic prescribed list than in the past.

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