Are nurse-led clinics the future?
Due to scope of practice, dental nurses can now become providers in their own right – resulting in dental nurses running their own in-practice clinics working under the prescription of a dentist. Many nurses are invoicing up to £1,000 per day.
This isn’t a new concept. I had my own clinic in 2005 at a time when the scope of practice was not as broad as it is now.
I saw patients for radiographs, photographs and oral-hygiene instruction, all of which I was either qualified or trained to do. This resulted in the dentist saving 15-30 minutes per new patient. I would see the patient at the end of their assessment and take records, the dentist would then treatment plan before seeing the patient to present their options.
In 2015 I have dental nurses who are using scope of practice to take impressions, shades, make trays and much more. For a dental nurse to be able to do this they need to have certificates of competency in each area and have a signed off completed record of experience. To take radiographs nurses need to be qualified in this area. They also have to be competent in patient management, note taking and be adequately insured.
Once all of these boxes have been ticked and systems implemented your dental nurse is ready to run their own clinic. For dentists wishing to work fewer hours, this could provide them with a day working on their business without the treatment room sitting empty.
There are thousands of dentists in the UK offering GDP orthodontics. This has been a huge growth area in dentistry and with the right marketing practices have found treatment uptake to be very successful. The most common problem I come across in dental practices is profitability. Many practices start off on the wrong foot by entering a price war or by running offers with huge discounts. The fee should be set based on a dentist’s hourly rate. It should not to be set just to be cheaper than a local practice. When auditing the profitability of these systems one thing is always evident, the fee needs to go up!
Another way to increase profitability is to have in place a weekly or bi-monthly nurse-led records clinic. Your up-skilled dental nurse can take photographs and impressions for you. These appointments are often valued at £100-£150 depending on the dentist’s hourly rate. Yes, the dental nurse will take longer to do this but you are saving yourself a great deal of time to schedule higher value treatments.
Providing a comprehensive new patient assessment can take anything from 45 minutes to 90 minutes. Referring to your up-skilled dental nurse immediately after an examination would shorten the dentist’s appointment time drastically. Under your prescription the nurse can take any photographs and radiographs you need and take impressions for study models. If you do not need this to be articulated you can have your nurse pour up and trim the models in the practice too.
There are further appointments the up-skilled dental nurse can hold for you:
• Implant records appointment
• Whitening impressions and tray fabrication
• Impressions for mouth guards and splints
• First-stage denture impression.
We find that when seeing patients it is best for the up-skilled dental nurse to describe themselves as a ‘clinical treatment coordinator – an up-skilled dental nurse who is highly trained to work under the prescription of a dentist. If your practice already has a treatment coordinator the patient will be familiar with the TCO name and by adding ‘clinical’ to the front of the title it builds value.
Rachel Hughes is a clinical treatment coordinator (CTCO) for JM Dental Care in the midlands. Once a week Rachel has her own clinic and is responsible for all of the clinical coordinator duties in her practice. Rachel is paid an hourly rate (the same as a highly skilled nurse in any practice) yet she has a unique role that provides her with a different aspect to being a dental nurse. This gives her motivation and passion for her role. Rachel can easily invoice £1,000 a day as she has so much experience as a CTCO. Depending on the patient, a records appointment for a GDP orthodontic system takes Rachel around 30 minutes. A nervous patient would be allocated more time for patient management and reassurance.
Rachel also has the OHE (oral health education) qualification so often nervous patients will come and see her first to help gain confidence. This happens a day or two before a treatment appointment with the hygienist or dentist. Her role plays a big part in building confidence in patients and preparing them for the treatment they have delayed for so many years.
Implementing the CTCO role
First and foremost the dental nurses have to be GDC registered. They then have to be trained to take alginate and silicone impressions, and take a full series of dental photographs. You may also wish to enrol your nurses onto the Radiography and OHE qualification.
With scope of practice for impression taking and photography the nurses must have a signed off record of experience. This means they have been able to grade their impressions to the correct standard and have proven they know when an impression does not fit the required standard. They will then be awarded a certificate of competency enabling the nurse to treat patients. They will also need a training programme for patient management and clinical requirements such as understanding the prescription and note taking. There needs to be strong systems in the practice for these areas.
The next stage is to business plan how the role works for the practice and how often clinics need to be run. In my opinion the clinics need to be run at least every other week.
Clinical treatment coordination is a fantastic role for dental nurses leading to increased motivation within the team, high practice profit and a greater patient experience. If you would like to discuss implementing this role into your practice please do not hesitate to contact me.
Laura Horton has an outstanding knowledge of dentistry. Having joined the dental profession in 1996, she has experienced many different environments and is a registered DCP and dental radiographer. She has also studied business and sales management and marketing, and has management experience in dentistry. Laura’s passion lies within the training and implementation of the treatment coordinator role.