Trying to second guess what direct access means? Head of standards at the GDC, Janet Collins, gives us the lowdown
As I’m sure most of you are now aware, the GDC has announced it is removing barriers to direct access for some DCPs. This is a significant change, not only for how some members of the dental team can work, but also for how patients and members of the public access dentistry in the UK. The decision was made at a Council Meeting on 28 March 2013 and I would like to take this opportunity to explain, in more detail, what it means.
Reaching the decision
In December 2011, Council set up a Task and Finish Group to consider the issue of direct access.
Part of their remit was to recommend a policy position to the Council, taking into account the Council’s primary purpose of protecting patients. The subsequent review involved a wide-ranging series of activities, including:
• A literature review
• Patient and public research carried out by Ipsos Mori
• A call for ideas
• Stakeholder feedback
• Online consultation.
The literature review, for example, identified more than 100 research papers that were relevant to the review of direct access. The quality of the evidence regarding dental access issues to dental care practitioners was varied but, as a whole, of moderately good quality.
The review was completed in June 2012, and the findings of this study concluded that:
a) There was no evidence of significant issues of patient safety resulting from the clinical activity of DCPs
b) There was evidence that access to dental care improved as a result of direct access arrangements, of cost benefits to patients and of high levels of patient satisfaction
c) There was some evidence that DCPs may over-refer patients to dentists, which may ensure patient safety but lead to wasteful use of resources and a high level of ‘no shows’ on referral
Guidance for registrants will be published before these changes come into effect on 1 May 2013. More details about all of these activities can be found on the GDC website at www.gdc-uk.org
In addition, the online consultation ran from 1 October 2012 to 31 December 2012 and it received more than 1,420 responses. A summary of the consultation responses is included in the Task and Finish Group’s proposal to Council and can be found on our website.
The GDC wasn’t the only body interested in the issue of direct access. The Office of Fair Trading’s report, Dentistry: An OFT market study, was published in May 2012 and discusses the benefits to patients of introducing direct access. The OFT has since welcomed the GDC’s ‘measures to make important dental services more accessible for patients’.
It’s not mandatory!
First of all, it’s worth remembering this decision does not make direct access mandatory. No dental care professional has to offer it. Registrants treating patients direct must only do so if they are appropriately trained, competent and indemnified. They should also ensure 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
• 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
• Registrants must make clear information available to patients on the treatment available and the role of the team members
• 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.
What DH&Ts cannot do under direct access
• Tooth whitening – The first application of tooth whitening treatment must be done by a dentist; any subsequent application can be done by a DH&T on prescription from the dentist
• Prescribe radiographs – The dentist remains the only member of the dental team who can prescribe radiographs
• Prescribe local anaesthesia – As a prescription-only medicine it can only be prescribed by a suitably qualified prescriber, usually a dentist or doctor
• Botox – As a prescription-only medicine, it can only be prescribed by a registered doctor or dentist who has completed a full assessment of the patient.
Most of the work of an orthodontic therapist will continue to be carried out on prescription. However, orthodontic therapists can now carry out Index of Orthodontic Treatment Need (IOTN) screening without the patient having to see a dentist first.
Who can do what?
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. DH&Ts must be confident 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.
Janet has been head of standards at the GDC since 2006. Prior to taking up that role, her experience at the Council included handling patient complaints, the launch of the Council’s continuing professional development requirements, leading its work with dental hygienists and therapists and most recently managing the introduction of registration for the other DCP groups.